Clinical effectiveness of minimally invasive subciliary techniques in midface soft tissue correction

Objective. To analyze clinical efficacy of minimally invasive subciliary techniques for midfacial soft tissue correction, their advantages, limitations, and unresolved issues; to substantiate further improvement in this area of surgery. Material and methods. We reviewed the PubMed, Scopus, Web of Science, Google Scholar, and eLibrary databases. At the first stage, 186 publications were identified. After removing duplicates and screening of titles and abstracts, 38 manuscripts were selected for full-text evaluation. After applying inclusion and exclusion criteria, 24 publications were included in final review. Results. Techniques combining a short approach with deep anatomically sound mobilization of midfacial tissues are of greatest clinical interest. The most effective technologies are based on subciliary approach, vertical and cranial tissue repositioning, release of retaining structures, subperiosteal mobilization, and periorbital fixation. Their advantages include simultaneous correction of the lower eyelid, eyelid-cheek transition, malar bags, elimination of skeletonization of inferior orbital rim and midface ptosis. Conclusion. Despite high clinical efficacy of minimally invasive subciliary techniques, the issues related to optimal dissection level, tissue fixation method, prevention of lower eyelid-related complication and objective evaluation of long-term results remain unresolved. These data confirm the relevance of further development of minimally invasive subciliary surgical techniques.