Midface Lift Plus Lipofilling Preferential in Patients with Negative Lower Eyelid Vectors: A Randomized Controlled Trial.

In conducting this study, it was our presumption that lipofilling is a necessary and simultaneous adjunct to lifting the middle third of the face in patients with negative lower eyelid vectors, enabling satisfactory and enduring aesthetic results. Eligible patients met the following criteria: (1) primary midface lift in subperiosteal plane; (2) negative inferior eyelid vectors at preoperative baseline; (3) postoperative monitoring for ~ 2 years; (4) standard pre- and postoperative photo-documentation; (5) proficiency in Italian language; and (6) signed consent for study participation. Informed consent pertaining to photography allowed for subsequent publication. Pertinent patient data were also collected as follows: age, sex, duration of follow-up, type of surgical procedure, related secondary procedures, quantity of fat injected, nature of incision, and patient satisfaction level. Complete randomness was thus conferred during computer-assisted patient assignment to one of two study arms: midface lift only (group 1) or midface lift plus facial lipofilling as a concurrent operation (group 2). All patients completed Italian versions of the FACE-Q module, which were issued by e-mail approximately 2 years postoperatively. Two plastic surgeons reviewed all postoperative photographs of treated patients and rated outcomes on a scale of 1-5. Statistical analysis was powered by standard software expressing categorical data as numbers and percentages and quantitative data as means ± standard deviations. Between January 2016 and March 2018, a total of 56 patients (women 48; men 8) subjected to primary midface lifts in subperiosteal plane at our Plastic Surgery Department met all criteria for study enrollment. Mean patient age was 56.5 years (range 40-70 years), and the mean follow-up period was 2.1 years (range 2-5 years). Differences in postoperative FACE-Q scoring by the two groups were significant (p < 0.01) across all domains. Outcomes in patients of group 2 remained stable during long-term follow-up, whereas significantly more secondary procedures were pursued by patients of group 1 (p < 0.01). Compared with group 1, the two reviewers encountered significantly greater satisfaction with surgical outcomes among patients of group 2 (p < 0.01). In FACE-Q scoring, those undergoing lift-and-fill procedures reported the highest satisfaction levels. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .