Skip to main content
SpringerLink
Log in

Lower Blepharoplasty and Surgery of the Midface

  • Living reference work entry
  • First Online:
Albert and Jakobiec's Principles and Practice of Ophthalmology

  • 112 Accesses

Abstract

Lower eyelid-cheek continuum morphology varies widely among individuals and endures progressive senescent changes resulting in characteristic cosmetic problems, including eyelid bags, malar bags, tear trough deformities, and other contour deficits. Fat atrophy, gravitational effects/support-loss, bone resorption, and photo-aging all contribute to this process, and rejuvenative techniques are aimed at addressing these elements and restoring youthful contours. Expanding knowledge of anatomy together with recognition of the changes caused by the aging process allows the surgeon to make use of ever-evolving surgical and non-surgical techniques for lower eyelid and midfacial rejuvenation. Methods of lower blepharoplasty for fat resection and/or transfer together with midface-lifting have progressed to address these interrelated components of lower eyelid and midfacial aging, while augmentation with autologous fat and commercially available filler materials and collagen stimulants addresses volume deficits and facial/periorbital hollows.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Powell N, Humphreys B. Proportions of the aesthetic face. New York: Thieme-Stratton; 1984.

    Google Scholar 

  2. Shorr N, Cohen MS. Cosmetic blepharoplasty. Ophthalmol Cl North Am. 1991;4:17–33.

    Google Scholar 

  3. Shorr N, Enzer Y. Considerations in aesthetic eye surgery. J Dermatol Surg Oncol. 1992;18:1081–95.

    CAS  PubMed  Google Scholar 

  4. Massry G, Murphy M, Azizzadeh B. Master techniques in blepharoplasty and periorbital rejuvenation. New York: Springer; 2011.

    Google Scholar 

  5. Pessa JE, Ado VP, Adrian EK, et al. Anatomy of a black eye: a newly described fascial system of the lower eyelid. Clin Anat. 1998;11:157–61.

    CAS  PubMed  Google Scholar 

  6. Dutton JJ, Waldrop TG. Atlas of clinical and surgical orbital anatomy. Philadelphia: WB Saunders; 1994.

    Google Scholar 

  7. Doxannas MT, Anderson RT, editors. Clinical orbital anatomy. Baltimore: Williams & Wilkins; 1984.

    Google Scholar 

  8. Zide BM, Jelks GW. Surgical anatomy of the orbit. New York: Raven Press; 1985.

    Google Scholar 

  9. Kontis TC, Papel ID, Larrabee WF. Surgical anatomy of the eyelids. Fac Plast Surg. 1994;10:1–5.

    CAS  Google Scholar 

  10. Lucarelli M, Khwarg S, Lemke B, et al. The anatomy of midface ptosis. Ophth Plast Reconstr Surg. 2000;16:7–22.

    CAS  Google Scholar 

  11. Pessa JE, Garza JR. The malar septum: the anatomic basis of malar mounds and malar edema. Aesthetic Surg J. 1997;17:11–7.

    CAS  Google Scholar 

  12. Muzaffar AR, Mendelson BC, Adams WP Jr. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg. 2002;10:873–84.

    Google Scholar 

  13. Mendelson BC, Muzaffar AR, Adams WP. Surgical anatomy of midcheek and malar mounds. Plast Reconstr Surg. 2002;110:885–96.

    PubMed  Google Scholar 

  14. Hamra ST. The suborbicularis oculi fat pads. Plast Reconstr Surg. 1996;97:484–6.

    CAS  PubMed  Google Scholar 

  15. Hoenig JA, Shorr N, Shorr J. The suborbicularis oculi fat in aesthetic and reconstructive surgery. Int Ophthalmol Clin. 1997;37:179–91.

    CAS  PubMed  Google Scholar 

  16. Furnas DW. Festoons of orbicularis muscle as a cause of baggy eyelids. Plast Reconstr Surg. 1978;61:540–6.

    CAS  PubMed  Google Scholar 

  17. Aiache AE, Ramirez OH. The sub-orbicularis oculi fat pads: an anatomic and clinical study. Plast Reconstr Surg. 1995;95:37–42.

    CAS  PubMed  Google Scholar 

  18. Furnas DW. Festoons, mounds and bags of the eyelids and cheek. Clin Plast Surg. 1993;20:367–85.

    CAS  PubMed  Google Scholar 

  19. Andretto Amodeo C, Casasco A, et al. The suborbicularis oculi fat (SOOF) and the fascial planes: has everything already been explained? JAMA Facial Plast Surg. 2014;16(1):36–41.

    PubMed  Google Scholar 

  20. Koornneef L. Orbital septa: anatomy and function. Ophthalmology. 1979;86:876–80.

    CAS  PubMed  Google Scholar 

  21. Koornneef L. New insights in the human orbital connective tissue. Arch Ophthalmol. 1977;95:1269–73.

    CAS  PubMed  Google Scholar 

  22. Shorr N, Goldberg RA. Lower eyelid reconstruction following blepharoplasty. J Cosmetic Surg. 1989;6:77–82.

    Google Scholar 

  23. Shorr N (1990) Management of the post blepharoplasty lower eyelid retraction with palate mucosal grafts. In: Eyelid aesthetics: 21st annual scientific symposium of the American society of ophthalmic plastic and reconstructive surgery, October 26, 1990; Atlanta, p 62.

    Google Scholar 

  24. Yousif NJ, Mendelson BC. Anatomy of the midface. Clin Plast Surg. 1995;22:227–40.

    CAS  PubMed  Google Scholar 

  25. Dubin B, Jackson IT, Halim A, et al. Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1989;83:253–62.

    Google Scholar 

  26. Ruess W, Owsley JQ. The anatomy of the skin and facial layers of the face in aesthetic surgery. Clin Plast Surg. 1987;14:677–82.

    CAS  PubMed  Google Scholar 

  27. Dzubow LM. The fasciae of the face: an anatomic and histologic analysis. J Am Acad Dermatol. 1986;14:502–7.

    CAS  PubMed  Google Scholar 

  28. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89:441–9.

    CAS  PubMed  Google Scholar 

  29. Moss C, Mendelson B, Taylor G. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg. 2000;105(4):1491–4.

    Google Scholar 

  30. Mitz V, Peyronie M. The superficial musculoaponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58:80–8.

    CAS  PubMed  Google Scholar 

  31. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. 1989;83:11–6.

    CAS  PubMed  Google Scholar 

  32. Gosain AK, Yousif NJ, Madiedo G, et al. Surgical anatomy of the SMAS, a reinvestigation. Plast Reconstr Surg. 1993;92:1254–63.

    CAS  PubMed  Google Scholar 

  33. Barton FE Jr. The SMAS and the nasolabial fold. Plast Reconstr Surg. 1992;89:1054–9.

    PubMed  Google Scholar 

  34. Yousif NJ, Gosain A, Matloub HS, et al. The nasolabial fold: an anatomic and histologic reappraisal. Plast Reconstr Surg. 1994;93:60–9.

    CAS  PubMed  Google Scholar 

  35. Thaller SR, Kim S, Patterson H, et al. The submusculoapaoneurotic system (SMAS): a histologic and comparative anatomy evaluation. Plast Reconstr Surg. 1990;86:690–6.

    CAS  PubMed  Google Scholar 

  36. Rubin LR, Mishriki Y, Lee G. Anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg. 1989;83:1–10.

    CAS  PubMed  Google Scholar 

  37. Yousif NJ, Gosain A, Sanger JR, et al. The nasolabial fold: a photogrammetric analysis. Plast Reconstr Surg. 1994;93:70–7.

    CAS  PubMed  Google Scholar 

  38. Pensler JM, Ward JW, Parry SW. The superficial aponeurotic system in the upper lip: an anatomic study in cadavers. Plast Reconstr Surg. 1985;75:488–94.

    CAS  PubMed  Google Scholar 

  39. Pessa J. SMAS fusion zones determine the subfascial and subcutaneous anatomy of the human face: fascial spaces, fat compartments, and models of facial aging. Aesthet Surg J. 2016;36(5):515–26.

    PubMed  Google Scholar 

  40. Schiller JD. Lysis of the orbicularis retaining ligament and orbicularis oculi insertion: a powerful modality for lower eyelid and cheek rejuvenation. Plast Reconstr Surg. 2012;129:692e–700e.

    CAS  PubMed  Google Scholar 

  41. Kikkawa DO, Lemke BN, Dortzbach RK. Relations of the superficial aponeurotic system to the orbit and characterization of the orbitomalar ligament. Ophth Plast Reconstr Surg. 1996;12:77–88.

    CAS  Google Scholar 

  42. Chan NJ, Nazemzadeh M, Hartstein ME, Holds JB, Massry GG, Wulc AE. Orbicularis retaining ligament release in lower blepharoplasty: assessing efficacy and complications. Ophthalmic Plast Reconstr Surg. 2018;34(2):155–61.

    PubMed  Google Scholar 

  43. Freilinger G, Gruber H, Happak W, Pechmann U. Surgical anatomy of the mimic muscle system and the facial nerve: importance for reconstructive and aesthetic surgery. Plast Reconstr Surg. 1987;80:686–90.

    CAS  PubMed  Google Scholar 

  44. Ramirez OM, Santomarina R. Spatial orientation of motor innervation to the lower orbicularis oculi muscle. Aesthetic Surg J. 2000;20:107–13.

    Google Scholar 

  45. Gosain AK. Surgical anatomy of the facial nerve. Clin Plast Surg. 1995;22:241–51.

    CAS  PubMed  Google Scholar 

  46. Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in facelifting. Plast Reconstr Surg. 1966;38:352–6.

    CAS  PubMed  Google Scholar 

  47. Agarwal C, Mendenhall S, Foreman O. The course of the frontal branch of the facial nerve in relation to fascial planes: an anatomic study. J Plast Reconstr Surg. 2010;125(2):532–7.

    CAS  Google Scholar 

  48. David RA, Anson BJ, Budinger JM, Kurth LE. Surgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. Surg Gynecol Obstet. 1956;102:385–412.

    Google Scholar 

  49. Putterman AM. Evaluation of the cosmetic oculoplastic surgery patient. In: Putterman AM, editor. Cosmetic oculoplastic surgery: eyelid, forehead and facial techniques. 3rd ed. Philadelphia: Saunders; 1999. p. 11–22.

    Google Scholar 

  50. Goldberg RA, Charonis GC, Baylis HI, Brazzo BG. Upper and lower eyelid blepharoplasty. In: Nesi FA, Lisman RD, Levine MR, editors. Smith’s ophthalmic plastic and reconstructive surgery. 2nd ed. St Louis: Mosby; 1998. p. 416–35.

    Google Scholar 

  51. Hester TR, Codner MA, McCord CD, Nahai F. Transorbital lower-lid and midface rejuvenation. Op Tech Plast Reconstr Surg. 1998;5:163–85.

    Google Scholar 

  52. Mally P, Czyz CN, Wulc AE. The role of gravity in periorbital and midfacial aging. Aesthet Surg J. 2014;34(6):809–22.

    PubMed  Google Scholar 

  53. Gosain AK, Amarente MTJ, Hyde JS, Yousif NJ. A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery. Plast Reconstr Surg. 1996;98:622–36.

    CAS  PubMed  Google Scholar 

  54. Ellis DA, Ward DK. The aging face. J Otolaryngol. 1986;15:217–23.

    CAS  PubMed  Google Scholar 

  55. Yousif NJ. Changes in the midface with age. Clin Plast Surg. 1995;22:213–26.

    CAS  PubMed  Google Scholar 

  56. Rohrich R, Pessa J. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27; discussion 2228-2231

    CAS  PubMed  Google Scholar 

  57. Kahn D, Shaw R. Overview of current thoughts on facial volume and aging. Facial Plast Surg. 2010;26(5):350–5.

    PubMed  Google Scholar 

  58. Pessa J, Desvigne L, et al. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesth Plast Surg. 1999;23:337–42.

    CAS  Google Scholar 

  59. Putterman AM. Evaluation of the cosmetic oculoplastic surgery patient (chapter 3). In: Fagien S, editor. Putterman’s cosmetic oculoplastic surgery. 4th ed. Philadelphia: Saunders; 2007.

    Google Scholar 

  60. McCord CD, Shore JW. Avoidance of complications in lower lid blepharoplasty. Ophthalmology. 1983;90:1039–46.

    PubMed  Google Scholar 

  61. Jelks GW, Jelks EB. The influence of orbital and eyelid anatomy of the palpebral aperature. Clin Plast Surg. 1991;18:183–95.

    CAS  PubMed  Google Scholar 

  62. Rees TD, Latrenta GS. The role of the Schirmer’s test and orbital morphology in predicting dry eye syndrome after blepharoplasty. Plast Reconstr Surg. 1988;82:619–25.

    CAS  PubMed  Google Scholar 

  63. Thomas JR, Tardy ME Jr, Przekop H. Uniform photographic documentation in facial plastic surgery. Otolaryngol Clin N Am. 1980;13(2):367–81.

    CAS  Google Scholar 

  64. Shorr N, Fallor MK. ‘Madam Butterfly’ procedure: combined with cheek and lateral canthal suspension for postblepharoplasty ‘round eye’ and lower eyelid retraction. Ophthalmic Plast Reconstr Surg. 1985;1:229–35.

    CAS  PubMed  Google Scholar 

  65. Wulc A, Foster J. Evaluation of the lower eyelids and midface. In: Hartstein M, Wulc A, Holck D, editors. Midfacial rejuvenation. New York: Springer; 2012.

    Google Scholar 

  66. Stutman RL, Codner MA. Tear trough deformity: review of anatomy and treatment options. Aesthet Surg J. 2012;32(4):426–40.

    PubMed  Google Scholar 

  67. Wong CH, Mendelson B. Extended transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament and fat redistribution. Plast Reconstr Surg. 2017;140(2):273–82.

    CAS  PubMed  Google Scholar 

  68. Lee JH, Hong G. Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler. Arch Plast Surg. 2018;45(3):214–21.

    PubMed  PubMed Central  Google Scholar 

  69. Steinsapir KD. Aesthetic and restorative midface lifting with hand-carved, expanded polytetrafluoroethylene orbital rim implants. Plast Reconstr Surg. 2003;111(5):1727–37.

    PubMed  Google Scholar 

  70. Wong C, Mendelson B. Newer understanding of specific anatomic targets in the aging face as applied to injectables: aging changes in the craniofacial skeleton and facial ligaments. Plast Reconstr Surg. 2015;136(5 Suppl):44S–8S.

    CAS  PubMed  Google Scholar 

  71. Tantawi D, Eberlin S, Calvert J. Midface implants: surgical and nonsurgical alternatives. Clin Plast Surg. 2015;42(1):123–7.

    PubMed  Google Scholar 

  72. Hester TR, Codner MA, McCord CD, Nahai F. Transorbital lower-lid and midface rejuvenation. Op Tech in Plast Reconstr Surg. 1998;5:163–85.

    Google Scholar 

  73. Marten T. High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface. Clin Plast Surg. 2008;35(4):569–603.

    PubMed  Google Scholar 

  74. Owsley JQ. Lifting the malar fat pad for correction of prominent nasolabial folds. Plast Reconstr Surg. 1993;91:463–74.

    CAS  PubMed  Google Scholar 

  75. Owsley JQ. Elevation of the malar fat pad superficial to the orbicularis oculi muscle for correction of prominent nasolabial folds. Clin Plast Surg. 1995;22:279–93.

    CAS  PubMed  Google Scholar 

  76. Ivy EJ, Lorenc P, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS facelifts with extended SMAS and composite rhytidectomies. Plast Reconstr Surg. 1996;98:1135–47.

    CAS  PubMed  Google Scholar 

  77. Hamra ST. The deep plane rhytidectomy. Plast Reconstr Surg. 1990;86:53–61.

    CAS  PubMed  Google Scholar 

  78. Le Louarn C. The concentric malar lift: malar and lower eyelid rejuvenation. Aesthet Plast Surg. 2004;28(6):359–72.

    Google Scholar 

  79. Le Louarn C. Concentric malar lift in the management of lower eyelid rejuvenation or retraction: a clinical retrospective study on 342 cases, 13 years after the first publication. Aesthet Plast Surg. 2018;42(3):725–42.

    Google Scholar 

  80. Anderson RD, Lo MW. Endoscopic malar/midface suspension procedure. Plast Reconstr Surg. 1998;102(6):2196–208.

    CAS  PubMed  Google Scholar 

  81. Quatela V, Antunes M. Transtemporal midface lifting to blend the lower eyelid-cheek junction. Clin Plast Surg. 2015;42(1):103–14.

    PubMed  Google Scholar 

  82. Yin V, Chou E, Nakra T. The transeyelid midface lift. Clin Plast Surg. 2015;42(1):95–101.

    PubMed  Google Scholar 

  83. Nakra T. Biplanar contour-oriented approach to lower eyelid and midface rejuvenation. JAMA Facial Plast Surg. 2015;17(5):374–81.

    PubMed  Google Scholar 

  84. Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg. 1991;88(2):215–20.

    CAS  PubMed  Google Scholar 

  85. Tomlinson F, Hovey L. Transconjunctival lower lid blepharoplasty for removal of fat. Plast Reconstr Surg. 1975;56(3):314–8.

    CAS  PubMed  Google Scholar 

  86. Baylis H, Long J, Groth M. Transconjunctival lower eyelid blepharoplasty: technique and complications. Ophthalmology. 1989;96(7):1027–32.

    CAS  PubMed  Google Scholar 

  87. Small RG. Extended lower eyelid blepharoplasty. Arch Ophthalmol. 1981;99(8):1402–5.

    CAS  PubMed  Google Scholar 

  88. Couch SM, Holds JB. Lower eyelid blepharoplasty with fat repositioning. In: Hartstein M, Wulc A, Holck, editors. Midfacial rejuvenation. New York: Springer; 2012. p. 187–94.

    Google Scholar 

  89. Putterman AM. Transconjunctival approach to resection of lower eyelid herniated orbital fat. In: Fagien S, editor. Putterman's cosmetic oculoplastic surgery. 4th ed. Philadelphia: Saunders Elsevier; 2007.

    Google Scholar 

  90. Hester JT, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg. 2000;105(1):393–406.

    PubMed  Google Scholar 

  91. Couch SM, Buchanan AG, Holds JB. Orbicularis muscle position during lower blepharoplasty with fat repositioning. Arch Facial Plast Surg. 2011;13(6):387–91.

    PubMed  Google Scholar 

  92. Espinoza GM, Holds JB. Evaluation and treatment of the tear trough deformity in lower blepharoplasty. Semin Plast Surg. 2007;21(1):57–64.

    PubMed  PubMed Central  Google Scholar 

  93. Goldberg RA. Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg. 2000;105(2):743–8.

    CAS  PubMed  Google Scholar 

  94. Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning: a retrospective comparison of transposing fat to the subperiosteal vs supraperiosteal planes. JAMA Facial Plast Surg. 2013;15(3):176–81.

    PubMed  Google Scholar 

  95. Ramesh S, Goldberg R, Wulc A, Brackup A. Objective comparison of nasojugal fold depth and lower eyelid length after fat excision versus fat transpositional lower blepharoplasty. Aesth Surg J. (In Press) 2019;39(10):1048–54.

    Google Scholar 

  96. Shorr N, Goldberg RA, Eshaghian B, Cook T. Lateral canthoplasty. Ophthal Plast Reconstr Surg. 2003;19:345–52.

    PubMed  Google Scholar 

  97. Flowers R. Canthopexy as a routine blepharoplasty component. Clin Plast Surg. 1993;20(2):351–65.

    CAS  PubMed  Google Scholar 

  98. Hester TR. Evolution of lower lid support following lower lid/midface rejuvenation: the pretarsal orbicularis lateral canthopexy. Clin Plast Surg. 2001;28:639–52.

    PubMed  Google Scholar 

  99. Fagien S. Lower-eyelid rejuvenation via transconjunctival blepharoplasty and lateral retinacular suspension: a simplified suture canthopexy and algorithm for treatment of the anterior lower eyelid lamella. Op Tech Plast Reconstr Surg. 1998;5:121–8.

    Google Scholar 

  100. Paul MD, Calvert JW, Evans GR. The evolution of the midface lift in aesthetic plastic surgery. Plast Reconstr Surg. 2006;117(6):1809–27.

    CAS  PubMed  Google Scholar 

  101. Wulc A, Sharma P. Preperiosteal midface lift: transtemporal approach. In: Hartstein M, Wulc A, Holck D, editors. Midfacial rejuvenation. New York: Springer Science; 2012.

    Google Scholar 

  102. Holck DBC, Cole H. The transtemporal subperiosteal approach for midface lifting. In: Hartstein M, Wulc A, Holck D, editors. Midfacial rejuvenation. New York: Springer Science; 2012.

    Google Scholar 

  103. Saltz R, Ohana B. Thirteen years of experience with the endoscopic midface lift. Aesthet Surg J. 2012;32(8):927–36.

    PubMed  Google Scholar 

  104. Engle R, Pollei T, Williams E. Endoscopic midfacial rejuvenation. Facial Plast Surg Clin North Am. 2015;23(2):201–8.

    PubMed  Google Scholar 

  105. LaFerriere K, Kilpatrick J. Transblepharoplasty: subperiosteal approach to rejuvenation of the aging midface. Facial Plast Surg. 2003;19(02):157–70.

    PubMed  Google Scholar 

  106. Sclafani A, Dibelius G. Transpalpebral midface lift. Facial Plast Surg Clin North Am. 2015;23(2):209–19.

    PubMed  Google Scholar 

  107. Williams J. Transblepharoplasty endoscopic subperiosteal midface lift. Plast Reconstr Surg. 2002;110(7):1769–75.

    PubMed  Google Scholar 

  108. Sullivan P, Drolet B. Extended lower lid blepharoplasty for eyelid and midface rejuvenation. Plast Reconstr Surg. 2013;132(5):1093–101.

    CAS  PubMed  Google Scholar 

  109. Kpodzo D, Nahai F, McCord C. Malar mounds and festoons: review of current management. Aesthet Surg J. 2014;34(2):235–48.

    PubMed  Google Scholar 

  110. Hoenig J, Knutti D, de la Fuente A. Vertical subperiosteal mid-face-lift for treatment of malar festoons. Aesthet Plast Surg. 2011;35(4):522–9.

    Google Scholar 

  111. Endara M, Oh C, Davison S, Baker S. The management of festoons. Clin Plast Surg. 2015;42(1):87–94.

    PubMed  Google Scholar 

  112. Delaney S, Kridel R. Enhancing facelift with simultaneous submalar implant augmentation. Aesthet Surg J. 2019;39(4):351–62.

    PubMed  Google Scholar 

  113. Dhir K, Binder W. Solid midfacial implants: when fillers are not enough. Facial Plast Surg. 2016;32(5):480–7.

    CAS  PubMed  Google Scholar 

  114. Morley AM, Malhotra R. Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery. Ophth Plast Reconstr Surg. 2011;27(2):69–73.

    Google Scholar 

  115. Steinsapir K, Steinsapir S. Deep-fill hyaluronic acid for the temporary treatment of the naso-jugal groove: a report of 303 consecutive treatments. Ophth Plast Reconstr Surg. 2006;22(5):344–8.

    Google Scholar 

  116. Lambros V. Hyaluronic acid injections for correction of the tear trough deformity. Plast Reconstr Surg. 2007;120(6S):74–80.

    Google Scholar 

  117. Cotofana S, Schenck TL, Trevidic P, et al. Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):219S–34S.

    CAS  PubMed  Google Scholar 

  118. Pontius A, Williams E. The evolution of midface rejuvenation: combining the midface-lift and fat transfer. Arch Facial Plast Surg. 2006;8(5):300–5.

    PubMed  Google Scholar 

  119. Mack WP. Complications in periocular rejuvenation. Facial Plast Surg Clin North Am. 2010;18(3):435–56.

    PubMed  Google Scholar 

  120. Lelli G, Lisman R. Blepharoplasty complications. Plast Reconstr Surg. 2010;125(3):1007–17.

    CAS  PubMed  Google Scholar 

  121. Pacella S, Codner M. Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show. Plast Reconstr Surg. 2010;125(2):709–18.

    CAS  PubMed  Google Scholar 

  122. Yachouh J, Amaud D, Psomas C, et al. Amaurosis after lower eyelid laser blepharoplasty. Ophth Plast Reconstr Surg. 2006;22:214–5.

    Google Scholar 

  123. Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophth Plast Reconstr Surg. 2004;20:426–32.

    Google Scholar 

  124. Goldberg RA, Li TG. Postoperative infection with group A beta-hemolytic Streptococcus after blepharoplasty. Am J Ophthalmol. 2002;134(6):908–10.

    PubMed  Google Scholar 

  125. Weinfeld AB, Burke R, Codner M. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg. 2008;122(2):579–86.

    CAS  PubMed  Google Scholar 

  126. Harley RD, Nelson L, Flanagan JC, Calhoun JH. Ocular motility disturbances following cosmetic blepharoplasty. Arch Ophthalmol. 1986;104(4):542–4.

    CAS  PubMed  Google Scholar 

  127. Carter SR, Seiff SR, Choo P, Vallabhanath P. Lower eyelid CO(2) laser rejuvenation: a randomized prospective clinical study. Ophthalmology. 2001;108:437–41.

    CAS  PubMed  Google Scholar 

  128. Krakauer M, Aakalu VK, Putterman AM. Treatment of malar festoon using modified subperiosteal midface lift. Ophthalmic Plast Reconstr Surg. 2012;28(6):459–62.

    PubMed  Google Scholar 

  129. Patel BC, Patipa M, Anderson RA, McLeish W. Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip. Plast Reconstr Surg. 1997;99:1251–60.

    CAS  PubMed  Google Scholar 

  130. Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg. 2000;106(2):438–53; discussion 454-9

    CAS  PubMed  Google Scholar 

  131. Chang HS, Lee D, Taban M, Douglas RS, Goldberg RA. "En-glove" lysis of lower eyelid retractors with AlloDerm and dermis-fat grafts in lower eyelid retraction surgery. Ophthalmic Plast Reconstr Surg. 2011;27(2):137–41.

    PubMed  Google Scholar 

  132. Taban MR. Lower eyelid retraction surgery without internal spacer graft. Aesthet Surg J. 2017;37(2):133–6.

    PubMed  Google Scholar 

  133. Yoo DB, Griffin GR, Azizzadeh B, Massry GG. The minimally invasive, orbicularis-sparing, lower eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength. JAMA Facial Plast Surg. 2014;16(2):140–6.

    PubMed  Google Scholar 

  134. Patipa M. Transblepharoplasty lower eyelid and midface rejuvenation: part I. Avoiding complications by utilizing lessons learned from the treatment of complications. Plast Reconstr Surg. 2004;113(5):1459–68.

    PubMed  Google Scholar 

  135. Patipa M. Transblepharoplasty lower eyelid and midface rejuvenation: part II. Functional applications of midface elevation. Plast Reconstr Surg. 2004;113(5):1469–74.

    PubMed  Google Scholar 

  136. Schwarcz RM, Kotlus B. Complications of lower blepharoplasty and midface lifting. Clin Plast Surg. 2015;42(1):63–71.

    PubMed  Google Scholar 

  137. Jacono A, Ransom E. Anatomic predictors of unsatisfactory outcomes in surgical rejuvenation of the midface. JAMA Facial Plast Surg. 2013;15(2):101–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Eyeplastx, San Antonio, TX, USA

    Christopher M. DeBacker & Hans Barron Heymann

Authors
  1. Christopher M. DeBacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans Barron Heymann
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Oregon Health & Science University Department of Ophthalmology, Portland, OR, USA

    Daniel Albert

  2. Massachusetts Eye and Ear, Boston, MA, USA

    Joan Miller

  3. Department of Ophthalmology, University of Illinois at Chicago Department of Ophthalmology, Chicago, IL, USA

    Dimitri Azar

  4. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. No affiliation provided

    Eric Steele

  2. No affiliation provided

    John Ng

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

DeBacker, C.M., Heymann, H.B. (2020). Lower Blepharoplasty and Surgery of the Midface. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_90-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90495-5_90-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90495-5

  • Online ISBN: 978-3-319-90495-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation