Use of the orbicularis muscle flap for complex lower lid problems: a 6-year analysis.

There are several groups of patients seeking lower lid blepharoplasty who present with the potential for unsatisfactory postoperative results, such as those presenting with atonic eyelids, patients with severe blepharochalasis alone or with large fat bags, patients with festoons, those with abnormal anatomy, and patients with deformity due to prior surgery. The orbicularis muscle flap technique provides good results in patients with potentially problematic lower eyelids. Of 600 blepharoplasties, 8.5 percent underwent the orbicularis muscle flap procedure. Follow-up time was 1.3 years, and average patient age was 54 years. Details of this technique are described together with results, including illustrative photographs. Of 51 patients, 49 had excellent or acceptable results and 2 had unacceptable results, 1 of whom required a small correction. This method produces a "minilift" of the lower eyelid and upper cheek skin that cannot be achieved with the standard lower eyelid blepharoplasty as described to date.