The malar region has been a crucial target in many facial rejuvenation techniques because the beauty and youthful contour of a convex midface and a smooth eyelid-cheek sulcus are key features of a pleasing face-lift result. The full midface subperiosteal lift has helped to address these issues. However, the desire of patients currently for a rapid recovery and return to work with a natural-looking result has influenced procedural selection. Another concern is for safer procedures with reduced potential risk. Progressively fewer invasive techniques, such as the minimal access cranial suspension (MACS) lift, have been a response to these core concerns.
After 3 years of performing the conventional three purse-string suture MACS lift, the author developed a practical procedural modification. For a total of 17 patients, the author combined limited regional subperiosteal lift and periosteal fixation with a simple sling approach to the more fully released malar tissue mass to make a single-point suspension just above the lateral orbital rim.
The percutaneous sling lift appears to offer a degree and naturalness of rejuvenation of the malar region similar to those of the MACS lift and the full subperiosteal midface lift, but with fewer suspension points and less undermining. Also, the author observed less ecchymosis and edema than with the full midface subperiosteal lift, as would be expected. In all 17 cases, the need for the second and third purse-string sutures was eliminated.
The early results for the percutaneous sling lift indicate that it offers promising results, rapid recovery, and reduced risk of serious complications.