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Lysis of the Orbicularis Retaining Ligament and Orbicularis Oculi Insertion: A Powerful Modality for Lower Eyelid and Cheek Rejuvenation

Schiller, Jeffrey D. M.D.

Plastic and Reconstructive Surgery: April 2012 - Volume 129 - Issue 4 - p 692e–700e
doi: 10.1097/PRS.0b013e31824423c7
Cosmetic: Original Articles

Background: The techniques of lower blepharoplasty are evolving to reflect the concept that the lower eyelid contour does not stop at the inferior orbital rim, and that the lid-cheek junction must often be modified to restore the midface to a youthful configuration. Multiple procedures have been proposed to smooth the lid-cheek junction and tear trough. The author proposes a technique of carbon dioxide laser lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion onto the maxilla to release the tethering of the lower lid and cheek and allow recontouring of the lid-cheek junction in an extended transcutaneous lower blepharoplasty.

Methods: Retrospective review of 80 extended lower blepharoplasty procedures with carbon dioxide laser lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion performed in the past 3 years was undertaken. Follow-up ranged from 4 to 26 months, with an average of 7.2 months. The efficacy, risks, and complications of this procedure were assessed.

Results: The complication rate for this procedure is not significantly higher than that for standard transcutaneous blepharoplasty, and the procedure allows significant improvement of the lid-cheek junction and rejuvenation of the upper midface.

Conclusions: Lysis of the orbicularis retaining ligament and lower orbicularis oculi insertion is a safe and effective adjunct to lower blepharoplasty. It is a powerful modality that allows significant rejuvenation of the lid-cheek complex and upper cheek.


New York, N.Y.

From private practice.

Received for publication April 13, 2011; accepted October 3, 2011.

Disclosure: The author has no financial interest to declare in relation to the content of this article. No external funding was received.

Jeffrey D. Schiller, M.D.; 452 West 19th Street, Suite 3C, New York, N.Y. 10011,

©2012American Society of Plastic Surgeons