Composite Septo-Retractor Recession; A Surgical Technique for Lower-Eyelid Retraction and Review of the Literature

Norris, Jonathan H.; Malhotra, Raman

doi:10.1097/iop.0b013e3182286962

Cited by 13 publications

(6 citation statements)

References 31 publications

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“…We find that in the particular patient population who manifest LER and reduced orbicularis strength, preserving postoperative dynamic lower eyelid muscular support makes attaining satisfactory outcomes more predictable. Reports of lower eyelid retractor recession from the conjunc-tiva with release of the lateral horn of the retractors 15 and closed canthal suspension [12][13][14] have been described separately. These individual procedures have resulted in excellent outcomes with few complications.…”

Section: Discussionmentioning

confidence: 99%

“…In 2011, Norris and Malhotra 15 described a true lower eyelid retractor recession with dissection and release of the retractors from the conjunctiva as part of a more complex eyelid recession technique. The lateral horn of the retractors is specifically identified and cut.…”

Section: Discussionmentioning

confidence: 99%

“…In our present series, the retractor recession and lateral horn lysis is similar to those described by Norris and Malhotra. 15 However, Norris and Malhotra performed the retractor recession and canthal suspension, when added, through an open transcutaneous and canthal approach. In our report, retractor recession is performed through a transconjunctival entry, and canthal suspension is performed through an upper eyelid crease incision.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of 2 such innovations, closed canthal suspension and true lower eyelid retractor recession, have led to the MIOS lower eyelid recession, which combines and adapts ideas from others. 12,13,15 The technique shows promise as a safe and effective means of recessing retracted lower eyelids with orbicularis weakness in a consistent, reproducible, and reliable manner.…”

Section: Discussionmentioning

confidence: 99%

“…A closed canthal suspension [12][13][14] with true transconjunctival lower eyelid retractor recession 15 provides a means of lower eyelid recession without undue lower orbicularis muscle trauma. We have termed this combined technique the minimally invasive, orbicularis-sparing (MIOS), lower eyelid recession.…”

mentioning

confidence: 99%

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The Minimally Invasive, Orbicularis-Sparing, Lower Eyelid Recession for Mild to Moderate Lower Eyelid Retraction With Reduced Orbicularis Strength

Yoo

Griffin

Azizzadeh

2014

JAMA Facial Plast Surg

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to address lower eyelid retraction (LER) in the presence of an orbicularis deficit is a useful tool for aesthetic and reconstructive eyelid surgery. OBJECTIVE To describe and evaluate a surgical technique consisting of a closed canthal suspension and true lower eyelid retractor recession to address LER in the setting of orbicularis weakness. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of patients who underwent the minimally invasive, orbicularis-sparing, lower eyelid recession from January 1, 2010, to October 1, 2012, by one of us (G.G.M.) in an ophthalmic plastic surgical practice. We included 29 patients with reduced orbicularis strength and LER resulting from eyelid paresis related to facial nerve disease, surgical trauma (after blepharoplasty), involutional change, or idiopathic causes. INTERVENTIONS Surgical intervention consisting of closed canthal suspension and lower eyelid retractor recession. MAIN OUTCOMES AND MEASURES Surgical results, complications, and patient satisfaction. RESULTS The 29 patients included 18 women and 11 men. The mean patient age was 52 (range, 6-72) years; mean follow-up, 11 (range, 6-21) months; and mean preoperative orbicularis strength, 2.7 (on a scale of 0-4, where 0 indicates no function and 4, normal function). The causes of orbicularis weakness included eyelid paresis related to facial nerve disease (11 patients), surgical trauma (13 patients), involutional change (4 patients), and an isolated idiopathic finding (1 patient). In 12 patients, the eyelid retraction was unilateral; in 17, bilateral. A small tarsorrhaphy was added to the surgery in 6 patients with facial nerve disease. The mean eyelid elevation after surgery was 1.80 mm, with only minor complications. Patient and surgeon satisfaction were high. CONCLUSIONS AND RELEVANCE Recent publications have demonstrated the utility of closed canthal suspension and true lower eyelid retractor recession as separate procedures. In the setting of LER with reduced orbicularis strength and/or tone, the techniques can be combined to recess the lower eyelid without disturbing the already compromised lower orbicularis muscle (minimally invasive, orbicularis-sparing, lower eyelid recession). The combination technique is safe and effective and yields excellent results. LEVEL OF EVIDENCE 4

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