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Transcutaneous Lower Eyelid Blepharoplasty with Orbitomalar Suspension: Retrospective Review of 212 Consecutive Cases

Korn, Bobby S. M.D., Ph.D.; Kikkawa, Don O. M.D.; Cohen, Steven R. M.D.

Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 315-323
doi: 10.1097/PRS.0b013e3181c2a515
Cosmetic: Original Articles

Background: Midfacial aging is associated with increased demarcation of the nasolabial, malar, and nasojugal folds; deflation of facial soft tissues and bones; and descent of the midface. The latter is primarily attributable to attenuation of the orbitomalar ligament. Traditional surgery of the lower eyelid and midface often requires removal of excess skin, orbicularis oculi muscle, and orbital fat, which can be complicated by postoperative lower eyelid malposition. The authors describe a novel adjunct to transcutaneous lower eyelid blepharoplasty that rejuvenates the lower eyelid and midface by reconstituting the orbitomalar ligament and minimizes the development of postoperative eyelid malposition.

Methods: This study was a retrospective, consecutive, nonrandomized, interventional case series. The authors reviewed the medical records of 212 consecutive patients who underwent transcutaneous lower eyelid blepharoplasty with orbitomalar suspension. The aesthetic outcome, patient satisfaction, and development of eyelid malposition were evaluated.

Results: Transcutaneous lower eyelid blepharoplasty with orbitomalar suspension resulted in improved lower eyelid dermatochalasis, contour, midfacial ptosis, and appearance of the nasojugal and malar folds. All patients reported satisfaction with the aesthetic outcome. One patient (0.5 percent) developed lower eyelid retraction requiring subsequent lower eyelid tightening. Three patients (1.4 percent) developed transient lagophthalmos from lower eyelid orbicularis paresis that resolved spontaneously.

Conclusions: Transcutaneous lower eyelid blepharoplasty combined with orbitomalar suspension is a powerful technique that can be performed concomitantly with facial rejuvenative procedures. Orbitomalar suspension addresses midfacial ptosis by restoring the natural function of the orbitomalar ligament and minimizes the development of postoperative lower eyelid malposition.


La Jolla, Calif.

From the Division of Ophthalmic Plastic and Reconstructive Surgery and the Department of Ophthalmology, and the Division of Plastic Surgery, University of California San Diego, School of Medicine.

Received for publication February 4, 2009; accepted July 20, 2009.

Disclosures: None of the authors has stock or ownership of a business entity connected to any product described in the article, paid consultation for the company or competing companies, or patent rights to a drug or piece of equipment. No author claims personal or family ownership or potential rights to more than 1 percent of the company or competing companies and no interest in marketing any product, drug, instrument, or piece of equipment discussed in the article.

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Bobby S. Korn, M.D., Ph.D.; Department of Ophthalmology; Division of Ophthalmic Plastic and Reconstructive Surgery; Shiley Eye Center; University of California San Diego; 9415 Campus Point Drive; La Jolla, Calif. 92093-0946;

©2010American Society of Plastic Surgeons