• Bobby S Korn, Don O Kikkawa, and Steven R Cohen.
• Division of Ophthalmic Plastic and Reconstructive Surgery and the Department of Ophthalmology, University of California San Diego, School of Medicine, La Jolla, Calif. 92093-0946, USA. bkorn@ucsd.edu
• Plast. Reconstr. Surg. 2010 Jan 1; 125 (1): 315-23.

BackgroundMidfacial aging is associated with increased demarcation of the nasolabial, malar, and nasojugal folds; deflation of facial soft tissues and bones; and descent of the midface. The latter is primarily attributable to attenuation of the orbitomalar ligament. Traditional surgery of the lower eyelid and midface often requires removal of excess skin, orbicularis oculi muscle, and orbital fat, which can be complicated by postoperative lower eyelid malposition. The authors describe a novel adjunct to transcutaneous lower eyelid blepharoplasty that rejuvenates the lower eyelid and midface by reconstituting the orbitomalar ligament and minimizes the development of postoperative eyelid malposition.MethodsThis study was a retrospective, consecutive, nonrandomized, interventional case series. The authors reviewed the medical records of 212 consecutive patients who underwent transcutaneous lower eyelid blepharoplasty with orbitomalar suspension. The aesthetic outcome, patient satisfaction, and development of eyelid malposition were evaluated.ResultsTranscutaneous lower eyelid blepharoplasty with orbitomalar suspension resulted in improved lower eyelid dermatochalasis, contour, midfacial ptosis, and appearance of the nasojugal and malar folds. All patients reported satisfaction with the aesthetic outcome. One patient (0.5 percent) developed lower eyelid retraction requiring subsequent lower eyelid tightening. Three patients (1.4 percent) developed transient lagophthalmos from lower eyelid orbicularis paresis that resolved spontaneously.ConclusionsTranscutaneous lower eyelid blepharoplasty combined with orbitomalar suspension is a powerful technique that can be performed concomitantly with facial rejuvenative procedures. Orbitomalar suspension addresses midfacial ptosis by restoring the natural function of the orbitomalar ligament and minimizes the development of postoperative lower eyelid malposition.

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