Combined skin and skin-muscle flap technique in lower blepharoplasty: a 10-year experience

Because of the important function of the pretarsal orbicularis muscle in blinking and tear drainage, the skin and skin-muscle flap technique for lower blepharoplasty was conceived to preserve the anatomical integrity of this muscle as well as its intimate relationship with the tarsal plate. The procedure involves elevating a skin flap over the pretarsal part of the orbicularis muscle followed by a skin-muscle flap at the preseptal part of the orbicularis muscle. This technique permits easy access to orbital fat pads while leaving the pretarsal orbicularis muscle intact and, in turn, facilitates the lateral suspension of the preseptal orbicularis muscle only. Trimming of the excess muscle is performed at the level of the preseptal orbicularis muscle, which is much less important functionally than the pretarsal orbicularis muscle, the part removed in the McIndoe-Beare muscle flap technique. This procedure, which has been performed on 700 eyelids (350 patients) from 1979 to the present, has successfully corrected lower eyelid deformity as a result of aging, particularly lower eyelid atonicity and infrapalpebral crease. The method also offers a safe and fast approach to the infraorbital bony structures in patients undergoing trauma operations or other surgical procedures.