title: The minimally invasive, orbicularis-sparing, lower eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength.
abstract: IMPORTANCE Identifying a procedure to address lower eyelid retraction (LER) in the presence of an orbicularis deficit is a useful tool for aesthetic and reconstructive eyelid surgery. OBJECTIVE To describe and evaluate a surgical technique consisting of a closed canthal suspension and true lower eyelid retractor recession to address LER in the setting of orbicularis weakness. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of patients who underwent the minimally invasive, orbicularis-sparing, lower eyelid recession from January 1, 2010, to October 1, 2012, by one of us (G.G.M.) in an ophthalmic plastic surgical practice. We included 29 patients with reduced orbicularis strength and LER resulting from eyelid paresis related to facial nerve disease, surgical trauma (after blepharoplasty), involutional change, or idiopathic causes. INTERVENTIONS Surgical intervention consisting of closed canthal suspension and lower eyelid retractor recession. MAIN OUTCOMES AND MEASURES Surgical results, complications, and patient satisfaction. RESULTS The 29 patients included 18 women and 11 men. The mean patient age was 52 (range, 6-72) years; mean follow-up, 11 (range, 6-21) months; and mean preoperative orbicularis strength, 2.7 (on a scale of 0-4, where 0 indicates no function and 4, normal function). The causes of orbicularis weakness included eyelid paresis related to facial nerve disease (11 patients), surgical trauma (13 patients), involutional change (4 patients), and an isolated idiopathic finding (1 patient). In 12 patients, the eyelid retraction was unilateral; in 17, bilateral. A small tarsorrhaphy was added to the surgery in 6 patients with facial nerve disease. The mean eyelid elevation after surgery was 1.80 mm, with only minor complications. Patient and surgeon satisfaction were high. CONCLUSIONS AND RELEVANCE Recent publications have demonstrated the utility of closed canthal suspension and true lower eyelid retractor recession as separate procedures. In the setting of LER with reduced orbicularis strength and/or tone, the techniques can be combined to recess the lower eyelid without disturbing the already compromised lower orbicularis muscle (minimally invasive, orbicularis-sparing, lower eyelid recession). The combination technique is safe and effective and yields excellent results. LEVEL OF EVIDENCE 4.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles.
authors.forename: Donald B
authors.initials: DB
authors.lastname: Yoo
authors.affiliation: Facial Plastic and Reconstructive Surgery, Spalding Drive Cosmetic Surgery and Dermatology, Center for Advanced Facial Plastic Surgery, Beverly Hills, California.
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Griffin
authors.affiliation: Facial Plastic and Reconstructive Surgery, The Facial Paralysis Institute, Beverly Hills, California4Facial Plastic and Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California5Department of Facial Plastic and Reconstr.
authors.forename: Babak
authors.initials: B
authors.lastname: Azizzadeh
authors.affiliation: Ophthalmic Plastic and Reconstructive Surgery, The Facial Paralysis Institute, Beverly Hills, California7Ophthalmic Plastic and Reconstructive Surgery, Beverly Hills Ophthalmic Plastic Surgery, Beverly Hills, California.
authors.forename: Guy G
authors.initials: GG
authors.lastname: Massry
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005141:Eyelid Diseases / Q000175:diagnosis / Q000601:surgery*; D005143:Eyelids / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome