An Update on Subciliary Lower Eyelid Blepharoplasty

Complete Preservation of Orbital Fat by Restoration of Attenuated Orbital Septa Using an Acellular Dermal Matrix in Lower Blepharoplasty

BACKGROUND

We hypothesized that application of acellular dermal matrix (ADM) over the orbital septum overlying the herniated orbital fat to tighten and strengthen the attenuated orbital septum in lower blepharoplasty would allow successful repositioning of the herniated orbital fat within the bony orbit.

METHODS

The author prospectively compared the cosmetic outcomes of lower blepharoplasty using ADM with standard blepharoplasty. We evaluated recurrence of eyelid bulging and tear trough deformity, volume of the lower periorbital region, and enophthalmos and eyelid droop 1 year after surgery.

RESULTS

Twenty-two of the 24 enrolled patients completed the study. There was no significant difference in recurrence of eyelid bulging and tear trough deformity between standard blepharoplasty and blepharoplasty with ADM graft groups. In the standard blepharoplasty group, the volume of the lower periorbital region decreased significantly after surgery. In the blepharoplasty with ADM graft group, there was no significant change in the volume of the lower periorbital region after surgery. In the standard blepharoplasty group, there was no significant change in eyelid droop on either side after surgery. In the blepharoplasty with ADM graft group, the eyelid droop decreased significantly after surgery on the right side but showed no significant change on the left side. There was no significant change in enophthalmos after surgery for either group.

CONCLUSIONS

This study demonstrated that ADM graft provided effective support for maintaining the replaced orbital fat in lower blepharoplasty. In the long-term, blepharoplasty with ADM graft might be effective in slowing development of age-related enophthalmos.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension

This study aimed to evaluate the effectiveness and safety of a double-suspension technique using the lateral orbital thickening (LOT) and the lateral brow thickening (LBT) in patients with lower eyelid defects. A total of 5 cadavers (4 males and 1 female) ranging in age from 50 to 78 years was subjected to observe the distribution of the orbicularis retaining ligament (ORL) and its characteristics. The ORL is a closed-loop structure that forms the LBT outside the supraorbital rim and forms the LOT in the lateral canthal region. A total of 17 patients (12 females and 5 males) with an average age of 12.3 years who underwent the ORL-assisted lower eyelid reconstruction were included in this retrospective study. After the ORL was completely released on the infraorbital rim for reducing down traction, the subocularis oculi fat and the orbicularis oculi were fixed to the LBT and the LOT for increasing the upward traction. The lower eyelid defects in 17 patients were reduced in different degrees. The defects were closed directly in 3 patients and were resurfaced by skin graft or flap in the other 14 patients. Physicians and patients were all satisfied with the final cosmetic results. Thus, the ORL is a rigid and restrictive internal connected structure, and the ORL-assisted technique decreases the defect size and reconstructs vertical force balance. The LOT and the LBT are strong and safe enough as new fixation choices for lower eyelid suspension.