Abstract
Background
Blepharoplasty is a very requested surgery for aesthetic rejuvenation of the eyes with grateful results. Lower blepharoplasty involving a variety of different techniques can be considered to refresh the oculopalpebral area. The approach of the treatment of the tear trough as releasing the tear trough ligament and plication of orbicularis oculi muscle in the palpebral portion to fill the tear trough concavity is essential in our surgical technique demonstrated here.
Methods
From July 2014 to January 2020, 435 patients were submitted to blepharoplasty surgery for rejuvenation of the eyes. Lower blepharoplasty was performed with releasing of the tear trough ligament and suspension and fixation of the palpebral part of the orbicularis oculi muscle in the medial part of orbital bone corresponding to the tear trough area. The follow-up was 12 months.
Results
Patient satisfaction was high, and no complications were observed. Ten patients (2.2%) needed the addition of hyaluronic acid fillers in the tear trough 12 months after the surgery.
Conclusion
We conclude that the use of the orbicularis oculi muscle suspension improves the long-term aesthetic results for the tear trough and the technique is easy to perform.
Level of Evidence IV
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References
Wong CH, Mendelson B (2019) The long-term static and dynamic effects of surgical release of the tear trough ligament and origins of the orbicularis oculi in lower eyelid blepharoplasty. Plast Reconstr Surg 144:583–591
Jaishree S (2012) Dermal fillers for the treatment of tear trough deformity: a review of anatomy, treatment techniques, and their outcomes. J Cutan Aesthet Surg 5(4):229–238
Hashem AM, Couto RA, Duraes EFR, Çakmakoglu Ç, Swanson M, Surek C, Zins J (2020) Facelift part I: history, anatomy, and clinical assessment. Ahesthetic Surg J 40(1):1–18
Wong CH, Hsieh MKH, Mendelson B (2012) The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg 129:1392–1402
Wong CH, Mendelson B (2013) Facial soft-tissue spaces and retaining ligaments of the midcheek: defining the premaxillary space. Plast Reconstr Surg 132:49–56
Graf RM, Ono MCC, Armon O, Pace DHT, Balbinot P (2016) Midface lift through lower lid blepharoplasty incision. Clin Surg 1:1254
Wong CH, Mendelson B (2017) Extended transconjuntival lower eyelid blepharoplasty with release of the tear trough ligament and fat redistribution. Plast Reconstr Surg 140:273–282
Chan NJ, Nazemzadeh M, Hartstein ME, Holds J, Massry GG, Wulc AE (2018) Orbicularis retaining ligament release in lower blepharoplasty: assessing efficacy and complications. Ophthalmic Plast Reconstr Surg 34(2):155–161
Espinoza GM, Holds J (2007) Evaluation and treatment of the tear trough deformity in lower blepharoplasty. Semin Plast Surg 21(1):57–64
Rohrich RJ, Ghavami A, Mojallal A (2011) The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg 128(3):775–783
Haddock NT, Saadeh PB, Boutros S, Thorne CH (2009) The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg 123(4):1332–1340
Jehoon O, Kwon HJ, Choi YJ, Cho TH, Yang HM (2018) Three-dimensional structure of the orbicularis retaining ligament: an anatomical study using micro-computed tomography. Sci Rep 8:17042. https://doi.org/10.1038/s41598-018-35425-0
Pelle-Ceravolo M, Angelini M (2020) Properly diluted fat (PDF): an easy and safe approach to periocular fat grafting. Aesthetic Surg J 40(1):19–33
Huang Z, Lee Y, Yan G, Wang K (2019) Downward rotation of the capsulopalpebral fascia, orbital septum, and orbital fat complex: a new technique for lower eyelid rejuvenation. PRS Glob Open. https://doi.org/10.1097/GOX.0000000000002335
Lee JH, Hong G (2018) Definitions of groove and hollowness of the infra-orbital region and clinical treatment using soft-tissue filler. Arch Plast Surg 45:214–221
Kim SK, Choi CW, Youn SW (2019) Effectiveness of transconjuntival fat removal and resected fat grafting for lower eye bag and tear trough deformity. JAMA Facial Plast Surg 21(2):118–124
Choo PH, Rathbun JE (2003) Cautery of the orbital septum during blepharoplasty. Ophthal Plast Reconstr Surg 19:1–4
Choi Y, Kang HG, Nam YS, Kang JG, Kim IB (2017) Facial nerve supply to the orbicularis oculi around the lower eyelid: anatomy and its clinical implications. Plast Reconstr Surg 140:261–271
Rohrich RJ, Ghavami A, Mojallal A (2011) The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg 128:775–783
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Graf, R., Pace, D. Tear Trough Treatment with Orbicularis Oculi Muscle Suspension. Aesth Plast Surg 45, 546–553 (2021). https://doi.org/10.1007/s00266-020-01922-9
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DOI: https://doi.org/10.1007/s00266-020-01922-9