Smoothening the Lid-Cheek Junction in Lower Blepharoplasty | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 6, Volume 44, Issue 4, October 2020, Page 505-511 PDF (26.04 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2020.140018 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Mohamed Ashraf  ; Ayman Noaman; Ahmed El Naggar*
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| The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Cairo University, Egypt | ||||
| 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 | ||||
| Blepharoplasty; Orbitomalar ligament; Orbicularis retaining ligament; Periorbital rejuvenation | ||||
| References | ||||
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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 | ||||
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