Aesthetic blepharoplasty has undergone a transformative shift from subtractive techniques to those emphasizing tissue preservation and augmentation. This article gives an overview on modern techniques on upper and lower eyelid blepharoplasty.

Lower blepharoplasty is among the most performed facial procedures. It is performed by either a transcutaneous or a transconjunctival approach. The transconjunctival approach offers several advantages compared to the transcutaneous approach. Most important among these advantages is the potential preservation of the support function of the orbicularis muscle. This preservation potentially lessens the risk of complications such as lower eyelid retraction and ectropion. The approach can be used in a wide spectrum of cosmetic and functional indications.

Aesthetically attractive eyelids typically exhibit a combination of features, including ideal eyebrow height, volume, and contour; appropriate eyelid height and shape; harmonious upper eyelid fullness; and a balanced amount of visible tarsal platform or eyelid crease show. Patients may exhibit a dysmorphic appearance or asymmetry of the upper eyelid for various reasons, either congenital or acquired. Bony and soft tissue asymmetries, variation in globe position, and innervational or mechanical defects may lead to issues warranting correction with blepharoplasty, brow surgery, and/or ptosis repair.

Esthetic blepharoplasty is a commonly performed facial cosmetic surgery aimed at enhancing the periocular region by reducing excess skin, fat, or muscle in the eyelids. However, this procedure carries the risk of altering the canthal position and several other complications. The lateral canthus position significantly influences a patient's esthetic outcome. A balanced canthal position is vital for maintaining natural eyelid contour and preventing issues such as ectropion or scleral show. This article outlines management of the lateral canthus during blepharoplasty, covering relevant anatomy, surgical planning, and techniques to address laxity or malposition.

Understanding surgical anatomy is crucial for facial plastic surgeons performing blepharoplasty. This article highlights the senior author's 41-year experience with transcutaneous lower eyelid blepharoplasty, emphasizing techniques for optimal results and minimal complications. Key elements include meticulous incisions, hemostasis, fat management, and orbicularis muscle suspension. Postoperative care focuses on preventing complications and expediting healing. Comparative studies indicate both approaches yield good results but with some limitations to the best cosmetic outcomes with the transconjunctival approach in many patients. Proper techniques in both approaches are essential for optimal eyelid positioning.

Recent focus on aging face surgery has seen a paradigm shift in approach and related outcomes. This article describes the author's experience with extending prezygomatic dissection in deep plane facelift surgery to the suborbicularis space, release of the orbicularis retaining ligament and revectoring the orbicularis oculi as part of a truly composite deep plane flap to achieve lasting improvement in lower eyelid position, fat pad herniation, and midface lift obviating the need in many for lower blepharoplasty or canthal surgery.

This article reviews the buccal fat pad's anatomy, its role in facial aging and aesthetics, as well as a variety of techniques published that involve buccal fat modification including excision, repositioning, and grafting.

The deep plane lip lift is designed to rejuvenate the lips by enhancing both incisive display and vermillion show. This study aims to quantify the effect of orbicularis oris muscle plication on these 2 features during a deep plane lip lift. Findings revealed a consistent inverse 1:1 relationship between vermillion show and incisive display following plication-each 1 mm increase in incisive display corresponded to a 1 mm decrease in vermillion show. These results suggest that orbicularis oris muscle plication can be strategically employed during a lip lift to precisely refine lip aesthetics.

Aesthetic surgical management of the inferior periorbital region should include an approach to volume augmentation of the midface and infraorbital hollow, reduction of fat pseudoherniation in the lower eyelids, and treatment of the overlying skin. A combined approach using volume augmentation with fat grafting, a transconjunctival approach to the lower eyelid fat pads, and conservative management can produce optimal aesthetic results while minimizing complications. The treatment paradigm is to restore volume optimally while minimizing fat resection in the lower eyelids. Volume augmentation is used to restore youthful contours, and to counter deflation and laxity in the periorbital and midfacial regions.

Autologous fat grafting to the midface and periorbital regions offers a powerful solution for addressing age-related facial volume descent and depletion, contributing to a rejuvenated appearance. Herein, we explore the biological principles of fat grafting, the methodology for harvesting, processing, and injecting fat, and its application in facial aesthetics. We describe the role of different types of autologous fat in restoring volume and improving skin texture and quality. Finally, we discuss the evolving techniques aimed at enhancing graft retention and aesthetic outcomes with a focus on the midface and periorbital regions.

The endoscopic brow lift delicately alters the balance between the elevator and depressor musculature of the brow-forehead complex to elevate the position of the brow, reduce rhytids, and achieve improved symmetry of the brows. Wide subperiosteal dissection to the level of the zygomatic arch and orbit is critical to the successful endoscopic brow lift. Myotomies are performed in order to weaken the depressor musculature so that the natural function of the frontalis can predominate to lift the brow. Lateral suture fixation is sufficient to obtain long-term, stable rejuvenation of the brow-forehead complex when complete dissection is achieved.

Correction of the aged forehead must address the soft tissue redundancy while minimizing the issues of incisions, paresthesia, and hair loss. In 2006, the senior author (N.A.G.) devised the Endo-Coronal Forehead Lift. A calculated, limited coronal strip is resected based on measurements of soft tissue redundancy. The subgaleal surgical dissection is done endoscopically. The arcus marginalis is preserved, eliminating risk of eyebrow malpositioning. In addition, the resection of the calculated limited strip and endoscopic dissection restores prior anatomy while reducing scarring, numbness, and hair shedding inherent in many open forehead techniques.

Hairline-lowering surgery (HLS) serves as an alternative option to hair transplantation for lowering an overly high hairline. There are several advantages to the surgery, including immediate results and significant density fulfillment. The best candidates for HLS are usually women with stable frontal hairlines and mobile scalps. Enhanced scalp mobility allows for more easily achieved advancement during the procedure. This article reviews the important steps of the surgery to achieve consistent and safe results.

Rhytidectomy is one of the most effective procedures for facial rejuvenation. The extended deep plane facelift technique and structural neck contouring are powerful surgical tools that require advanced anatomic knowledge and technical skills to be performed optimally and safely. With thorough anatomic knowledge, proper patient evaluation and preparation, and the use of appropriate techniques, a well-prepared surgeon can achieve satisfactory outcomes while effectively addressing the common challenges associated with these procedures.

In recent years, endoscopic upper and midface rejuvenation techniques have advanced dramatically with the advent of endoscopic dissection in the sub-SMAS plane. The temporal tunnel approach exploits this tissue plane in the midface via a small incision in the temporal hair. The author has used this approach to elevate the midface, manipulate the position of the lateral canthus, and perform endoscopic upper blepharoplasty without the need for skin removal. The temporal tunnel can be used as a stand-alone procedure or as an adjunct to endoscopic brow and face lifting. This article presents the technique and its advantages compared with other approaches.

The cleft nose treatment algorithm is nuanced and evolving. Management requires an individualized surgical approach, balancing early intervention with considerations for nasal and facial growth. Primary cleft rhinoplasty is now routinely practiced with improved outcomes when performed thoughtfully, while intermediate and definitive procedures allow for refinement as patients grow. Successful outcomes rely on precise surgical planning, meticulous perioperative care, managing expectations, and a multidisciplinary approach to address both functional and aesthetic goals.

After completing care within a cleft/craniofacial team, most young adults have achieved the dental care, psychologic support, speech services, and surgical repairs that are designed to optimize their long-term outcomes. Some patients, however, continue to have ongoing health needs. These can be in the same realms as were present during their childhood years and may be difficult to address outside of a multidisciplinary team. In addition, new challenges can arise when entering the workplace or starting a family. This article explores the potential ongoing treatment needs that may exist and recommends strategies to address these.