The entire midface should be evaluated in a patient presenting for lower eyelid blepharoplasty. With age, cheek tissue descends, and orbital fat herniates, creating a double-convexity deformity (Fig 13-3). Attenuation of the orbitomalar, masseteric cutaneous, and zygomatic ligaments are the pathologic changes that occur with midfacial ptosis. Elevation of the suborbicularis oculi fat (SOOF) and midface, combined with conservative fat removal or redistribution, can restore the youthful anterior projection of the midface. Midface elevation can be achieved through a preperiosteal or subperiosteal approach.
Figure 13-3 Lower eyelid blepharoplasty with orbital fat redraping. A, Image taken before surgery demonstrates the double convexity deformity with orbital fat prolapse and unmasking of the inferior orbital rim (arrow).B, Image taken after surgery shows resolution of the double-convexity deformity and a smooth eyelid and cheek junction.
(Courtesy of Bobby S. Korn, MD, PhD.)
The preperiosteal plane can be accessed through the lower eyelid, with or without release of the lateral canthal tendon, or by using the temporal scalp incision employed in an endoscopic brow-lift (endobrow). The subperiosteal midface can also be accessed through these incisions or through a superior gingival sulcus incision (Fig 13-4). The goal of these procedures is to provide release of the midface tissues, followed by elevation and resuspension. Midface elevation is commonly combined with additional procedures such as a brow-lift, lower face-lift, or volume augmentation.
Lucarelli MJ, Khwarg SI, Lemke BN, Kozel JS, Dortzbach RK. The anatomy of midfacial ptosis. Ophthalmic Plast Reconstr Surg. 2000;16(1):7–22.
Williams EF III, Lam SM. Midfacial rejuvenation via an endoscopic browlift approach: a review of technique. Facial Plast Surg. 2003;19(2):147–156.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.