Lower blepharoplasty with a combination of release and lift of the fascia ligament of orbicularis oculi.

Abstract

The inferolateral orbicularis oculi of the lower eyelid can be divided into 2 layers. The inner layer is a true ligament and referred to as the "fascia ligament of orbicularis oculi." Releasing this ligament can improve the aesthetic result of lower blepharoplasty. The anatomy of the fascia ligament of orbicularis oculi was investigated in cadaveric and histologic studies. Additionally, thousand cases of lower blepharoplasty were performed utilizing a combination of release and lift of this ligament from 1996 to 2009. Cadaver study demonstrated the fascia ligament of orbicularis oculi is a distinct fibro-structure. Its origin is from the periosteum of the inferolateral orbital rim and extends superomedially and inserts into the deep surface of the orbicularis oculi at the junction of the muscle's middle and lateral thirds. This ligament is 13.5 ± 2.5 mm in length and 11 ± 2.0 mm in width. In the clinical study, by releasing this ligament, 3 to 6 mm more redundant lower eyelid skin can be removed compared with traditional lower blepharoplasty, which can improve the outcome of periorbital rejuvenation and achieve better long-standing aesthetic results. The fascia ligament of orbicularis oculi is a structure connecting the orbicularis oculi to the periosteum of inferolateral orbital rim. The lower blepharoplasty with combination of release and lift of this ligament can improve the outcome of lower blepharoplasty, which is a minimally traumatic procedure with long-standing results of orbital rejuvenation.