Minimal Undermining Suspension Technique (MUST): Combined Eyebrow and Mid-face Lift via Temporal Access

Alessandro Gualdi, Janos Cambiaso-Daniel, Jonatann Gatti, Dario Bertossi, Giorgio Pietramaggiori, Saja S. Scherer, Paul Wurzer, David B. Lumenta

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Less downtime following esthetic interventions leads to the popularity of injectable solutions for facial rejuvenation treatments. Surgical interventions for esthetic purposes are usually associated with higher complication rates and longer recovery times when compared to less invasive treatments. Here we present for the first time a minimally invasive surgical technique for a simultaneous mid-face and eyebrow lift using one small temporal incision. Materials and Methods: We prospectively studied patients who underwent facial rejuvenation using a minimal undermining suspension technique (MUST) in an outpatient setting. Postoperatively, surgical complications were classified according to the Clavien–Dindo classification. Preoperatively and at 12-month post-intervention, patient-reported outcomes were described using the FACE-Q questionnaire. Pre- and postoperative pictures were compared using MERZ Aesthetic Scales. Results: Fifty-five patients (50 females and 5 males) with a mean age of 47 years were studied. The overall complication rate was 19%, whereas 18 patients (15%) developed an ecchymosis of the orbicular temporal region and two patients (4%) developed a dimple caused by the anchor of the suture. No displacements of the palpebral rim or injuries to the facial nerve were observed. Recovery time was in average 7 days and no long-term complications were seen. Both, the FACE-Q and the MERZ Aesthetic Scales showed significant improvements at 12-month post-surgery (p < 0.01). Conclusions: The MUST can be used as a minimal invasive procedure for facial rejuvenation with a short downtime and low complication rate. The discreet temporal access and the MUST dissector allowed a safe dissection of anatomical tissue planes to perform safely a mid-face and eyebrow lift. Further studies are warranted to prove long-term outcomes. Level of Evidence IV: 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 A3 online Instructions to

Original languageEnglish (US)
Pages (from-to)40-46
Number of pages7
JournalAesthetic Plastic Surgery
Issue number1
StatePublished - Feb 1 2017
Externally publishedYes


  • Clavien–Dindo classification
  • Combined lift
  • Eyebrow lift
  • FACE-Q
  • MERZ Aesthetic Scales
  • Mid-face lift

ASJC Scopus subject areas

  • Surgery


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