Orbicularis muscle position during lower blepharoplasty with fat repositioning

Objective: To evaluate intraoperative changes in the position of the orbicularis muscle edge, which defines the tear trough during lower eyelid blepharoplasty with supraperiosteal fat repositioning. Methods: Thirty consecutive patients undergoing transconjunctival lower eyelid blepharoplasty with a supraperiosteal fat repositioning technique underwent intraoperative measurement of the elevation of the released orbicularis muscle edge. Using a "dipstick" method, the distance between the midinferior orbital rim and the inferior orbicularis muscle edge, which was previously located below the orbital rim, was measured after fixation of the repositioned orbital fat. Age, associated procedures, length of follow-up, and complications were noted. Results: The released orbicularis muscle edge was elevated between 6 and 12 mm above the orbital rim (average elevation, 8.8 mm). All measurements were within 2 mmbetween the 2 sides for a given patient, with 24 of the cases being within 1mm. No apparent difference was seen between the muscle elevation achieved with externalized suture fixation of repositioned fat (22 patients) and that achieved with internal suture fixation (8 patients). Conclusions: The orbicularis oculi muscle fusion to the maxilla below the arcus marginalis defines the junction between the eyelid and the cheek, and it provides an anchor for the tear trough. The eyelid-cheek interface is significantly elevated with our surgical technique of fat repositioning in the supraperiosteal plane. Elevation of the orbicularis muscle edge may contribute to improved blepharoplasty results in treating the aging midface.