Extended Lower Eyelid Skin Muscle Blepharoplasty

Abstract

A patient presenting to a facial plastic surgeon with lower eyelid aging often has accompanying midface descent. Many surgical options exist to address these deformities. Blepharoplasty techniques include both the transcutaneous skin-muscle flap as well as the transconjunctival approach. The midface can be addressed via a multitude of techniques, including percutaneous suspension of the malar fat pad, deep plane dissections, subperiosteal and endoscopic midface lifts, and transorbital approaches. Patients who have some midface ptosis but do not meet the standard criteria for formal midface lifting, or who want to avoid the extended recovery associated with such techniques, could benefit from less invasive procedures. We propose the extended skin muscle blepharoplasty to address midface descent and lower lid aging to patients as an alternative to formal midface lifting. The extended skin muscle blepharoplasty is an excellent technique for patients with orbicularis hypertrophy, skin redundancy, a tear trough deformity, and premalar ptosis, as it addresses each of these deformities with minimal downtime. Results for patients with mild but visible midface descent are gratifying.

A Quantitative Analysis of Lateral Canthal Position Following Endoscopic Forehead-Midface–Lift Surgery

“…The amount of lateral canthal displacement continues to be one of the most controversial components of midface procedures. [7][8][9] The present study was designed to objectively evaluate the change in lateral canthal position following endoscopic forehead-midface-lift surgery.…”

“…The superolateral vector of pull created by using the deep temporal fascia as the point of fixation has led to prominent lateral canthal displacement. [7][8][9] Most literature citing lateral canthal distortion relies on anecdotal experience and potential risks of midface surgery. To our knowledge, only 1 published study 10 has objectively evaluated the change in lateral canthal position after midface surgery.…”

“…The relative lack of change in canthal position reported in this study would seem contrary to previously cited anecdotal evidence regarding lateral canthal distortion after midface-lifts. [7][8][9] A review of the statistical methods might explain this disparity. Williams et al 10 analyzed the mean displacement, which may not entirely explain the true amount of lateral canthal distortion.…”

Acellular Dermal Grafts for Tear Trough Deformity in Revision Lower Blepharoplasty

“…In these patients, the loss of orbital fat results in loss of support for the globe and a prominent infraorbital rim. 1 Revision blepharoplasty is complex, since autologous fat is not available for repositioning in the lower eyelids.…”

“…2 An extended skin muscle flap with lateral suspension addresses gravitational descent but does not resolve the issue of volume loss. 1 Fat repositioning is not an option in revision blepharoplasties in which fat has already been aggressively resected.…”