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Special Communication
Sept/Oct 2015

Biplanar Contour-Oriented Approach to Lower Eyelid and Midface Rejuvenation

Author Affiliations
  • 1TOC Eye and Face, Austin, Texas
JAMA Facial Plast Surg. 2015;17(5):374-381. doi:10.1001/jamafacial.2015.0860

Importance  Cosmetic rejuvenation of the lower eyelid-midface complex has evolved as our understanding of 3-dimensional midfacial aging and anatomy has become more sophisticated. Treating the lower eyelid and the midface as a single aesthetic unit leads to a more effective and natural-appearing rejuvenation.

Observations  This is a review of midfacial anatomy and a 5-step approach to lower blepharoplasty and midface rejuvenation: (1) midfacial autologous fat transfer, (2) canthoplasty, (3) transconjunctival orbicularis-retaining ligament release and orbital fat manipulation, (4) transcutaneous midface–superficial muscular aponeurotic system elevation and orbicularis contouring, and (5) skin treatment. In addition, long-term aesthetic outcomes and complications are reviewed for 43 patients (86 eyelids) who underwent the 5-step biplanar approach lower blepharoplasty and midfacial rejuvenation (40 women and 3 men, with a mean age of 60 years). Follow-up averaged 10.8 months. Forty-one patients rated their outcome as “excellent,” and 3 patients rated their outcome as “good.” No patients rated their outcome as “fair,” “no improvement,” or “worsening.” Seven patients (7 eyelids) had unilateral complications requiring postoperative intervention.

Conclusions and Relevance  The biplanar contour-oriented approach to lower blepharoplasty and midfacial rejuvenation is an option for treatment for aging of the lower eyelid-midface complex. The aesthetic outcomes appear natural owing to the synergy of reconstructing the aging changes of multiple lower eyelid and midface structures.