Smoothening the Lid-Cheek Junction in Lower Blepharoplasty

Ashraf, Mohamed; Noaman, Ayman; El Naggar, Ahmed

doi:10.21608/ejprs.2020.140018

Smoothening the Lid-Cheek Junction in Lower Blepharoplasty

Document Type : Original Article

Authors

The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Cairo University, Egypt

10.21608/ejprs.2020.140018

Abstract

Aim: Transcutaneous lower blepharoplasty is more convenient
for its easier learning curve, its better visibility and
access to the lower periorbital structures. Conventional techniques
entail fat removal to improve the lower eyelid contour.
In this study we adopted the extended transcutaneous lower
eyelid blepharoplasty that included dissection below the extent
of the inferior orbital margin to correct the tear trough deformity
that is usually missed in traditional techniques.
Methods: From December 2017 to December 2018, 25
patients were subjected to this procedure via a transcutaneous
stair-step incision. A retrospective analysis was implemented.
On the medial side, palpebral, orbital orbicularis oculi muscle
and the orbitomalar ligament were freed with dissection
approaching to the premaxillary space. On the lateral side,
release of the orbitomalar ligament was done, followed by
dissection reaching to the prezygomatic space. Fat pads were
dealt with either by excision or redistribution.
Results: The mean follow-up was 12 months. High degree
of patient's satisfaction was noted after using this technique.
No major complications in term of lid malposition or scleral
show or infection.
Conclusion: Extended transcutaneous lower blepharoplasty
is a safe and effective approach and a very powerful modality
for blending the lid-cheek junction and periorbital rejuvenation.
Level of Evidence: Therapeutic, V.

Keywords

Main Subjects

Aesthetics

References

Carraway J.H.: Volume correction for nasojugal groove
with blepharoplasty. Aesthetic Plast. Surg., 30: 101-109,
2010.
2- Kikkawa D.O., Lemke B.N. and Dortzbach R.K.: Relations
of the superficial musculoaponeurotic system to the orbit
and characterization of the orbitomalar ligament. Ophthal.
Plast. Reconstr. Surg., 12: 77-88, 1996.
3- Haddock N.T., Saadeh P.B., Boutros S. and Thorne C.H.:
The tear trough and lid/cheek junction: Anatomy and
implications for surgical correction. Plast. Reconstr. Surg.,
123: 1332-1340; discussion 1341-1342, 2009.
4- Maf T.R., Chang S. and Friedland J.A.: Traditional lower
blepharoplasty: Is additional support necessary? A 30-
year review. Plast. Reconstr. Surg., 128: 265-273, 2011.
5- Hidalgo D.A.: An integrated approach to lower blepharoplasty.
Plast. Reconstr. Surg., 127: 386-395, 2011.
6- Codner M.A., Wol I J.N. and Anzarut A.: Primary transcutaneous
lower blepharoplasty with routine lateral canthal
support: A comprehensive 10-year review. Plast. Reconstr.
Surg., 121: 241-250, 2008.
7- Moss C.J., Mendelson B.C. and Taylor G.I.: Surgical
anatomy of the ligamentous attachments in the temple
and periorbital regions. Plast Reconstr Surg., 105: 1475-
1490; discussion 1491, 2000.
Egypt, J. Plast. Reconstr. Surg., October 2020 511
8- Ghavami A., Pessa J.E., Janis J., Khosla R., Reece E.M.
and Rohrich R.J.: The orbicularis retaining ligament of
the medial orbit: Closing the circle. Plast. Reconstr. Surg.,
121: 994-1001, 2008.
9- Wong C.H., Hsieh M.K. and Mendelson B.: The tear trough
ligament: anatomical basis for the tear trough deformity.
Plast Reconstr Surg. Jun., 129 (6): 1392-402. doi:
10.1097/PRS.0b013e31824ecd77. PMID: 22634656, 2012.
10- Stutman R.L. and Codner M.A.: Tear trough deformity:
Review of anatomy and treatment options. Aesthet. Surg.
J., 32: 426-440, 2012.
11- Kpodzo D.S., Nahai F. and McCord C.D.: Malar mounds
and festoons: Review of current management. Aesthet.
Surg. J., 34: 235-248, 2014.
12- Alghoul M.: Blepharoplasty: Anatomy, Planning, Techniques,
and Safety. Aesthetic Surg J. Jan 1; 39 (1): 10-
28. doi: 10.1093/asj/sjy034. PMID: 29474509, 2019.
13- Rohrich R.J. and Pessa J.E.: The fat compartments of the
face: Anatomy and clinical implications for cosmetic
surgery. Plast Reconstr Surg., 119: 2219-2227; discussion
2228-2231, 2007.
14- Rohrich R.J., Pessa J.E. and Ristow B.: The youthful
cheek and the deep medial fat compartment. Plast. Reconstr.
Surg., 121: 2107-2112, 2008.
15- Rohrich R.J., Arbique G.M., Wong C., Brown S. and Pessa
J.E.: The anatomy of suborbicularis fat: Implications for
periorbital rejuvenation. Plast. Reconstr. Surg., 124: 946-
951, 2009.
16- Hamra S.T.: Repositioning the orbicularis oculi muscle
in the composite rhytidectomy. Plast. Reconstr. Surg., 90:
14-22, 1992.
17- McCord C.D. Jr., Codner M.A. and Hester T.R.: Redraping
the inferior orbicularis arc. Plast. Reconstr. Surg., 102:
2471-2479, 1998.
18- Rohrich R.J., Ghavami A. and Mojallal A.: The five-step
lower blepharoplasty: Blending the eyelid-cheek junction.
Plast. Reconstr. Surg., 128: 775-783, 2011.
19- Wong C.H. and Mendelson B.C.: Reply: Extended
transconjunctival lower eyelid blepharoplasty with release
of the tear trough ligament and fat redistribution. Plast.
Reconstr. Surg., 142 (2): 236e-237e, 2018.
20- Hester T.R. Jr., Codner M.A., McCord C.D., Nahai F. and
Gianno-Poulos A.: Evolution of technique of the direct
trans-blepharoplasty approach for the correction of lower
lid and midfacial aging: Maximizing results and minimizing
complications in a 5-year experience. Plast, Reconstr,
Surg., 105: 393-406; discussion 407-408, 2000