title: Use of the orbicularis retaining ligament in lower eyelid reconstruction.
abstract: BACKGROUND
  The orbicularis retaining ligament (ORL) is a distinct anatomical structure that has only been recently characterised. A variety of techniques, based on Hamra's concepts, now divide this ligament during lower lid blepharoplasty. This often produces a substantial skin excess which is discarded. We set out to investigate the validity of this surgical manoeuvre as a means of recruiting anterior lamella for the purposes of lower lid reconstruction.
  
  
  METHODS
  Between September 2002 and August 2004, 23 patients underwent reconstruction of the anterior lamella of their lower eyelid using this technique. The mean age of the patients was 56 years (range 26-86 years). The mean follow-up time was 20 months (range 12-36 months). Clinical evaluation was carried out preoperatively and postoperatively to assess the presence of palpebral non occlusion, epiphora, the sensation of a dry eye, ectropion, conjunctivitis and keratitis. Assessment of the tissue deficit was made clinically and with standardised digital photographs.
  
  
  RESULTS
  Satisfactory reconstruction of the anterior lamella of the lower eyelid was achieved in 19/23 patients. Preoperative symptoms of epiphora and lower lid position were improved. The visual analogue scale of appearance was improved postoperatively. In some cases, particularly in the atrophic lower lid, the results were short lived and further surgery was required to achieve optimal results.
  
  
  CONCLUSIONS
  In cases of isolated cutaneous deficit where the lid support mechanisms are intact, the procedure is both successful and aesthetically favourable for resurfacing this challenging area.
authors.affiliation: Oculoplastic Unit, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. joskillman@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Skillman
authors.forename: T
authors.initials: T
authors.lastname: Hardy
authors.forename: N
authors.initials: N
authors.lastname: Kirkpatrick
authors.forename: N
authors.initials: N
authors.lastname: Joshi
authors.forename: M
authors.initials: M
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods* / Q000639:trends; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome