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Midface-lift With Lateral Orbicularis Oculi Flap Excision or Imbrication

Hirabayashi, Kristin E. MD; Tao, Jeremiah P. MD*

doi: 10.1111/dsu.0000000000000025
Original Article

BACKGROUND The orbicularis oculi advancement midface-lift treats rhytides and infraorbital grooves. The muscle flap smoothes the subciliary lid and cheek zone but may produce contour abnormalities laterally.

OBJECTIVE To describe a technique of orbicularis flap midface-lift with excision or imbrication of muscle and to evaluate the results—to include characterizing the lateral contour abnormalities—in a large series.

MATERIALS and METHODS A total of 108 patients received a primary aesthetic orbicularis advancement flap midface-lift. Two masked observers scored each patient's result based on preoperative and postoperative images. Patients also scored their satisfaction of the results of their procedures. Patient age, sex, surgical technique specifics (i.e., excision or imbrication), and complications were recorded.

RESULTS All patients had favorable aesthetic improvement scores with no significant complications. In patients who received orbicularis excision (N = 33), lateral hollowing occurred in 3 patients; none desired correction. With an imbrication technique (N = 75), lateral mounding occurred in 6 patients; 3 of these patients were treated with elliptical excision.

CONCLUSION Orbicularis advancement midface-lifting was safe and effective in rejuvenating the midface in this series. Aesthetic complications were infrequent but include lateral hollowing when orbicularis is excised and lateral mounding with muscle imbrication.

*Both the authors are affiliated with the Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine

Address correspondence and reprint requests to: Kristin E. Hirabayashi, BA, Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, 850 Health Sciences Road, Irvine, CA 92617-4375, or e-mail:

The authors have indicated no significant interest with commercial supporters.

© 2014 by the American Society for Dermatologic Surgery, Inc. Published by Lippincott Williams & Wilkins
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