title: Orbicularis suspension flap and its effect on lower eyelid position: a digital image analysis.
abstract: OBJECTIVE
  To evaluate changes in lower eyelid position using digital image analysis in patients who have undergone an orbicularis suspension flap combined with blepharoplasty.
  
  
  METHODS
  A total of 68 patients (136 eyes) underwent a lower eyelid orbicularis oculi suspension flap combined with blepharoplasty. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs for accurate objective comparison. The photographs were analyzed for lower eyelid position.
  
  
  RESULTS
  The mean (SD) preoperative standardized distance from the center of the pupil to the lower eyelid margin (MRD2) in all procedures was 5.53 (0.74) mm. The mean (SD) postoperative standardized MRD2 was 5.22 (1.0) mm. There was a statistically significant difference in MRD2 position such that the postoperative MRD2 position decreased or the lower eyelid position was elevated by an average of 0.31 mm in comparison to the preoperative position (P < .001).
  
  
  CONCLUSIONS
  A well-performed suspension flap can elevate the lower eyelid position to a more natural and anatomically appropriate position. By resuspending the ptotic orbicularis muscle, the suspension flap also reinforces the underlying attenuated orbital septum. Such cases may not achieve the optimum level of rejuvenation if isolated lower eyelid blepharoplasty is performed.
authors.affiliation: Department of Ophthalmology, New York University School of Medicine, NY 10016, USA. czoumalan@gmail.com
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Zoumalan
authors.forename: Jessica
authors.initials: J
authors.lastname: Lattman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Zoumalan
authors.forename: David B
authors.initials: DB
authors.lastname: Rosenberg
mesh_terms: D000375:Aging / Q000502:physiology; D019882:Blepharoplasty / Q000379:methods; D005123:Eye; D005143:Eyelids / Q000294:innervation* / Q000601:surgery*; D006801:Humans; D010525:Peripheral Nerves / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps