Blending the lid/cheek junction

Abstract

Rejuvenation of the periorbital area requires an understanding of the morphologic changes that occur with aging. Blending the lid/cheek junction is a goal of periorbital rejuvenation. Transblepharoplasty techniques are proposed to achieve aesthetic periorbital rejuvenation with predictable improvement and minimal morbidity. Techniques of blending the lid/cheek junction are presented that include septal advancement with both septal tightening and subseptal fat pad contouring when indicated, or complete release of the orbital orbicularis oculi muscle, along with vascularized and/or free fat transfer over the inferior orbital rim, to produce a youthful contour. Lid support was enhanced with a medially based orbicularis oculi muscle sling, which further improves the contour of the lid/cheek junction through muscle release to the medial inferior orbital rim. Fifty-eight consecutive cases were reviewed that included lower lid blepharoplasties with or without a concomitant midface lift. Four cases of midface lift did not require any lower eyelid procedures. Septal reset or aggressive orbicularis oculi release with fat transfer were performed in 30 patients. A medially based orbicularis oculi flap was developed to support the lid, and canthopexy or canthoplasty was performed as indicated. Complete release of the medial fibers of the orbital orbicularis oculi muscle allowed for tension-free placement of vascularized fat or free fat grafts and a more profound blending of the lid/cheek junction, since the flap advancement acted as a handle to carry the upper midface soft tissues. Transblepharoplasty options for repositioning periorbital soft tissues are reliable means for blending the lid/cheek junction.