What it means for a patient
- This eyelid technique lifts the muscle of the lower lid, which also lifts the cheek fat attached to it.
- It is paired with a procedure that secures the outer corner of the eye so the eyelid keeps its shape.
- Patients with prominent eyes or loose lower lids need changes to the technique.
- It is also used to repair a lower lid that has been pulled down, including after earlier cosmetic surgery.
- This is a technique description. The abstract reports no results in a group of patients.
Why this paper matters
It described a lower lid and midface technique based on the attachment of the midface fat to the orbicularis muscle. It set out canthal support steps for eyes with a higher risk of lid problems.
Overview
Redraping the inferior arc of the orbicularis oculi muscle is used mainly to smooth the lower lid and midface in patients having aesthetic surgery. The midface fat compartments, the suborbicularis oculi fat and the malar fat, are bound to the orbicularis muscle by the superficial musculoaponeurotic system (SMAS). Redraping the muscle therefore also repositions the midface. The article describes the technique, the canthoplasty that goes with it, and changes for specific eye types and for reconstructive cases. The abstract reports no patient numbers or outcome rates.
Findings
- Redraping the orbicularis muscle also repositions the midface, because the suborbicularis oculi fat and malar fat are bound to it by the SMAS.
- Lateral canthoplasty should accompany the redraping to keep the shape of the eyelid opening stable after surgery.
- Patients with prominent eyes need canthal fixation placed higher (supraplacement).
- Patients with distensible lower lids need lid shortening.
- The technique can be used in reconstructive surgery to correct lower lid retraction, because it recruits periorbital skin upward into the lower lid.
- For more severe lower lid retraction after aesthetic surgery, spacer implants in the lower lid and periosteal flap canthoplasty can be added.
- The abstract gives no numbers.
Terms
- Orbicularis oculi: the ring-shaped muscle around the eye.
- Inferior arc: the lower part of the orbicularis ring, in the lower lid and upper cheek.
- Redraping: lifting and repositioning tissue.
- Lateral canthoplasty: surgery that tightens and reattaches the outer corner of the eyelids.
- Canthal fixation: securing the outer corner of the eye to bone.
- SMAS (superficial musculoaponeurotic system): the layer of fibrous tissue and muscle under the skin and fat of the face.
- Malar fat: the fat pad of the cheek.
- Lower lid retraction: a lower eyelid pulled down from its normal position.
- Distensible lid: a lid that can be pulled away from the eye easily because it is loose.
- Spacer implant: material placed in the lid to add height.