OOM-ORL-ROOF Composite Flap Suspension (ORRCS) to the Lateral Orbital Thickening for Lateral Hooding.

BACKGROUND

Lateral hooding of the upper eyelid is a common yet frequently undertreated aspect of periorbital aging in East Asians. This study aimed to investigate the roles of the orbicularis oculi muscle (OOM), retro-orbicularis oculi fat (ROOF), orbicularis retaining ligament (ORL), and lateral orbital thickening (LOT) in the pathogenesis and to evaluate the novel OOM-ORL-ROOF composite suspension (ORRCS) technique.

METHODS

Anatomical analyses were conducted on 6 cadaveric heads and 18 plastinated specimens. Clinical outcomes of the ORRCS procedure were retrospectively reviewed in 85 East Asian patients with lateral dermatochalasis (LDC grade ≥1). Assessments included LDC grade, lateral canthal tilt, brow position, complications, and patient satisfaction preoperatively and at 6 and 12 months postoperatively.

RESULTS

Anatomically, the age-related descent of the continuous OOM-ORL-ROOF composite is primarily due to the attenuation of its deep retaining structures, the ORL-LOT retaining complex. Clinically, ORRCS significantly improved the mean LDC grade from 2.24±0.77 to 0.40±0.49 (p<0.001) and increased lateral canthal tilt by ~5° (from 3.0° ± 1.13° to 8.0° ± 1.25°). Brow position remained stable ( p >0.05). Scars were inconspicuous, with no major complications and high patient satisfaction (4.7/5).

CONCLUSIONS

Lateral hooding primarily results from the descent of the OOM-ORL-ROOF composite unit due to the attenuation of the deep ORL-LOT retaining complex. The ORRCS technique corrects this deformity by re-suspending the complex to the robust LOT, providing a promising anatomy-guided deep-plane approach with favorable early outcomes in this cohort while restoring a natural contour and preserving brow dynamics.

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