Lower blepharoplasty with emphasis on the orbicularis muscle

The skin-muscle flap technique in blepharoplasty has, in our opinion, distinct advantages over the classic skin flap operation. Morbidity is diminished by avoiding dead space and preserving the integrity of the skin-muscle intimate attachments. Excessive muscle, an entity of which we are becoming more aware, can be handled simultaneously by cautious excision. Finally, secondary operations to correct recurrent skin excess can be performed in virgin territory at the level of the skin-muscle interface. Even though this technique is applicable to the vast majority of patients, certain deformities in which a marked excess of skin is the chief anatomic problem are best corrected with a classic skin flap procedure.