Temporal Modified Orbicularis Repositioning for Correction of Lower Eyelid Displacement Following Cosmetic Blepharoplasty: A Prospective Study of 117 Patients

Michele Pascali; Luca Savani; Marco Gratteri; Carlo Mirra; Gloria Marchese; Flavia Pascali; Paolo Persichetti;

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ABSTRACT

Lower eyelid displacement is one of the most feared complications following lower blepharoplasty. To properly plan revision surgery, it is crucial to understand which lamella is involved in the retraction, since different techniques may be used depending on it. The authors report their experience using a particular temporal and midface lift approach, called temporal modified orbicularis repositioning, to correct lower eyelid displacement mainly due to a deficit of the anterior lamella. A prospective study was carried out on 117 patients operated on between January of 2021 and October of 2023 for bilateral lower eyelid displacement after lower blepharoplasty. The temporal modified orbicularis repositioning technique was combined with lateral canthal tightening and lower lid fat grafting in all analyzed cases. Outcomes were assessed through subjective (patient questionnaires) and objective evaluations (5 independent surgeons evaluating preoperative and postoperative pictures). Complications were recorded. Patient questionnaires showed high satisfaction with ocular symptom improvement (decreasing from 74.91 to 9.03 out of 100) and cosmetic results (53.67 out of 60). Surgeons rated the postoperative changes positively as well (51.97 out of 60). As far as complications are concerned, 6 patients (5.13%) had mild chemosis; 3 patients (2.56%) had hypertrophic temporal scars; 2 patients (1.71%) had transient frontal nerve palsy; 1 patient (0.85%) had a temporal hematoma; 2 patients had slight asymmetry; and in 2 patients, relapse of the lower eyelid displacement was seen. The combination of temporal modified orbicularis repositioning, lateral canthal tightening, and fat grafting has proven to be a highly effective procedure in the correction of lower eyelid displacement caused by anterior lamella deficiency.

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