SOOF lift and lateral retinacular canthoplasty

Eyelid rejuvenation surgery may be slowly shifting from pure fat removal techniques to those that preserve and reposition the periorbital fat. The traditional subciliary incision blepharoplasty was fraught with minor and major complications, and while the transconjunctival blepharoplasty afforded lower morbidity, its inability to address all aspects of periorbital rejuvenation eventually limited its popularity. Coincidentally, a search by aesthetic surgeons was on for better techniques to lift the midface, soften the nasolabial fold, and efface the tear trough deformity. In an effort to avoid the lid malposition complications that often accompany transblepharoplasty cheek lifting, innovative canthoplasty and canthopexy techniques were developed, which paved the way for a safe return to subciliary blepharoplasty surgery. Effacement of the tear trough deformity, now considered to be a major determinant in successful periorbital rejuvenation, could be achieved through fat repositioning and without the use of alloplastic implants or free fat grafts, thus improving reliability while minimizing complications. By preserving periorbital fat the hollowed out orbit, often seen after traditional blepharoplasty, could be avoided. The technique described in this article is a composite of several previously published approaches, is simple for the experienced blepharoplasty surgeon to master, and has been used with safety and reliability over the past 18 months in the senior author's practice.