Lower Lid Blepharoplasty: The Use of Lockwood’s Ligament for Orbicularis Oculi Suspension and Orbital Fat Preservation—A New Technique

Abstract

A new technique of lower lid blepharoplasty is presented. The technique consists of suspending the skin-muscle flap of the lower lid on the suspensory Lockwood's ligament in all the orbit length, with preservation of the orbital fat behind the created anatomic layer. The anatomic base of the technique is analyzed by a study of the literature, by personal observations of the changes in the anatomic elements of the orbit in a large number of operations the authors performed for patients with endocrinic exophthalmos using Olivari's method (transpalpepral orbital decompression by removal of the orbital fat), and by fresh cadaver dissections. The technique is described in detail, and the results are presented. After 8 years of follow-up evaluation, it can be confidently said that the proposed technique can solve almost all the problems associated with lower lid laxity and can be applied for the majority of patients.