A Novel, Minimally Invasive Festoon Surgery: Mini Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12 Year Analysis.

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Plastic and Reconstructive Surgery




BACKGROUND: Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The author presents outcomes with subjective and objective evaluation of an office-based novel, minimally invasive (1 cm incision) festoon repair: MIDFACE (Mini-Incision Direct Festoon Access, Cauterization and Excision).

METHODS: Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 who met inclusionary criteria were evaluated by 3 expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from 4 different views-close-up, profile, full-frontal, and worm's eye) using paired student t-tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation.

RESULTS: There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of 39 patients (78 eyes, 35 women; 4 men; mean 58±7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same pre- and post-op, indicating incisions could not be detected by photography. Average patient satisfaction was 9.5 on a Likert scale of 0-10. Possible factors for festoon formation or exacerbation included genetic (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%).

CONCLUSIONS: MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence.



Peer Reviewed