Helal, H., Boughdadi, N., Mahmoud, H. (2019). Enhancing Aesthetic Outcomes in Lower Eyelid Blepharoplasty. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), 79-83. doi: 10.21608/ejprs.2019.65160
Hesham A Helal; Nahed Samir Boughdadi; Hany S Mahmoud. "Enhancing Aesthetic Outcomes in Lower Eyelid Blepharoplasty". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 1, 2019, 79-83. doi: 10.21608/ejprs.2019.65160
Helal, H., Boughdadi, N., Mahmoud, H. (2019). 'Enhancing Aesthetic Outcomes in Lower Eyelid Blepharoplasty', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(1), pp. 79-83. doi: 10.21608/ejprs.2019.65160
Helal, H., Boughdadi, N., Mahmoud, H. Enhancing Aesthetic Outcomes in Lower Eyelid Blepharoplasty. The Egyptian Journal of Plastic and Reconstructive Surgery, 2019; 43(1): 79-83. doi: 10.21608/ejprs.2019.65160
Enhancing Aesthetic Outcomes in Lower Eyelid Blepharoplasty
The Department of Plastic Surgery, Faculty of Medicine, Ain Shams University
Abstract
Background: Blepharoplasty is one of the most commonly performed facial cosmetic procedures and can play a vital positive role in facial harmony and the perception of aging. Lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion has been proposed to smooth the lid-cheek junction and tear trough. We aim to assess the usefulness and hazards of this procedure in comparison to the standard lower eye lid blepharoplasty. Methods: 20 patients seeking lower eyelid rejuvenation; 10 having trans-cutaneous lower blepharoplasty with lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion performed (group A) and the other 10 patients having standard trans-cutaneous blepharoplasty (group B). Final result, patients' satisfaction and complications were compared. Results: Patients' age ranged between 30 and 65 years. Follow-up ranged from 2 to 16 months, with an average of 9 months. In group A: All patients reported excellent satisfaction with the aesthetic outcome, one patient developed early lower eye lid retraction which resolved spontaneously after 15 days with no other complications. In group B: 7 patients reported excellent satisfaction, while the other 3 showed mild improvement; two cases suffered lateral canthus rounding, one case had lid retraction which required lateral canthopexy. Conclusion: The procedure seems to improve the harmony of the lid-cheek junction in the treatment of upper mid-face aging features
1- Grant J.R. and LaFerriere K.A.: Periocular rejuvenation: lower eyelid blepharoplasty with fat repositioning and the suborbicularis oculi fat. Facial Plast. Surg. Clin. N. Am., 18: 399-409, 2010. 2- Lambros V.: Observations on periorbital and midface aging. Plast. Reconstr. Surg., 120: 1367-1376; discussion 1377, 2007. 3- Carraway J.H.: Volume correction for nasojugal groove with blepharoplasty. Aesthetic Plast. Surg., 30: 101-109, 2010. 4- 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. 5- Pessa J.E., Zadoo V.P., Adrian E.K., Woodwards R. and Garza J.R.: Anatomy of a “black eye”: A newly described fascial system of the lower eyelid. Clin. Anat., 11: 157- 161, 1998. 6- Moss J.M., 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 1491-1498, 2000. 7- 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. 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, 2008. 9- Loeb R.: Fat pad sliding and fat grafting for leveling lid depressions. Clin. Plast. Surg., 8: 757, 1981. 10- Wong C.H., Hsieh M.K.H. and Mendelson: The tear trough ligament: Anatomical basis for the tear trough deformity. Plast. Reconstr. Surg., 129: 1392, 2012. 11- Schiller J.D.: Lysis of the Orbicularis Retaining Ligament and Orbicularis Oculi Insertion: A Powerful Modality for Lower Eyelid and Cheek Rejuvenation. Plast. Reconstr. Surg., 129: 692e, 2012. Egypt, J. Plast. Reconstr. Surg., January 2019 83 12- Ilankovan V.: Aesthetic blepharoplasty. British Journal of Oral and Maxillofacial Surgery, 48: 493-497, 2010. 13- Muzaffar A.R., Mendelson B.C. and Adams W.P.: Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast. Reconstr. Surg., 101: 873-884, 2002. 14- Baylis H.I., Long J.A. and Groth M.J.: Transconjunctival lower eyelid blepharoplasty: Technique and complications. Ophthalmology, 96: 1027-32, 1989. 15- Goldberg R.A., Lesner A.M., Shorr N., et al.: The transconjunctival approach to the orbital floor and orbital fat: A prospective study. Ophthalmic. Plast. Reconstr. Surg., 6: 241-6, 1990. 16- Baylis H.I., Goldberg R.A. and Groth M.J.: Complications of lower blepharoplasty. In: Putterman AM, editor. Cosmetic oculoplastic surgery: Eyelid, forehead, and facial techniques. 3rd edition. Philadelphia: WB Saunders, p. 429-56, 1999. 17- Goldberg R.A.: Transconjunctival orbital fat repositioning: Transposition of orbital fat pedicles into a subperiosteal pocket. Plast. Reconstr. Surg., 105: 743-8, 2000
View on SCiNiTO
Top