Orbicularis Muscle Position During Lower Blepharoplasty With Fat Repositioning

Abstract

The orbicularis oculi muscle fusion to the maxilla below the arcus marginalis defines the junction between the eyelid and the cheek, and it provides an anchor for the tear trough. The eyelid-cheek interface is significantly elevated with our surgical technique of fat repositioning in the supraperiosteal plane. Elevation of the orbicularis muscle edge may contribute to improved blepharoplasty results in treating the aging midface.

Transconjunctival Lower Lid Blepharoplasty with and Without Fat Repositioning

“…The supraperiosteal technique is faster but associated with more bleeding, a more prolonged Passing suture from externally to secure fat with a bolster over the skin recovery, and a higher rate of granulomas. The supraperiosteal technique does release the orbitomalar ligament, which Couch et al surmise may allow the orbicularis oculi to be lifted superiorly, thereby helping to fi ll the tear trough (Couch et al 2011 ). Again, we saw no difference in the aesthetic results and typically favor subperiosteal dissection since completing this study.…”

Transconjunctival Pre-periosteal Fat Repositioning Blepharoplasty

“…The authors have noted that this technique is particularly effective in patients with a prominent eye, such as thyroid eye disease patients, or negative vector eyelids. The authors have reported (Couch et al 2011 ) that the muscle edge close to the arcus marginalis rises almost 9 mm superiorly during the procedure (Fig. 68.4 ).…”

Effacing the Orbitoglabellar Groove With Transposed Upper Eyelid Fat

“…1,14 Over the last decade, there have been significant strides in improving lower blepharoplasty results with the development of procedures which preserve and/or augment volume and recreate the youthful smooth transitions of the eyelid to the cheek. [1][2][3][4][5][6] This paradigm shift from tissue subtraction to tissue preservation and/or augmentation has been less emphasized with upper blepharoplasty surgery until very recently, when similar fat translocation and augmentations procedures have been described. 9,[14][15][16][17][18] In the lower eyelid's interface with the cheek, depressions become apparent from age-related anatomic changes which unmask the bony orbital rim.…”

“…These changes include relative fat prominence, volume loss over the inferior orbital rim, and midface decent and/or deflation. 1,2,5,6,22 In continuity, these factors convert the lower eyelid/cheek topography from a concavity/convexity to a double convexity. The depressions that center the two convexities are generally referred to as periorbital hollows.…”