The aging appearance of the lower eyelid involves a combination of degenerative changes including excess lower eyelid skin, “bags” from lower eyelid fat pseudoherniation, under-eye circles from devolumization of the soft tissues overlying the infraorbital rim, and upper midface ptosis from redundant orbicularis oculi muscle. Our lower blepharoplasty technique addresses all these changes while preserving a robust orbicularis oculi sling and maintaining lower eyelid position with periosteal fixation of the lateral canthus and skin-muscle flap (Figure 1A). This technique should be avoided in patients with negative vector lower eyelids and poor orbicularis muscle strength because they are at increased risk for lower eyelid malposition postoperatively.1 The technique can be viewed in the Video.
Jacono AA, Malone MH. Extended Submuscular Blepharoplasty With Orbitomalar Ligament Release and Orbital Fat Repositioning. JAMA Facial Plast Surg. 2017;19(1):72-73. doi:10.1001/jamafacial.2016.1047