Orbitomalar suspension during high SMAS facelift.

BACKGROUND Traditional facelift techniques have some limitations: superficial musculo-aponeurotic system (SMAS) dissection may be incomplete in the superior medial orbitomalar region, and the centrofacial approach does not incorporate SMAS elevation. OBJECTIVES Orbitomalar suspension (OMS) during high SMAS facelift combines the best of other techniques and may enhance aesthetic results and improve blending of the eyelid-cheek junction while minimizing the risk of lower eyelid ectropion. The authors examine the efficacy and complication rates of the OMS procedure. METHODS Sixty patients underwent OMS as a primary component of high SMAS facelift and lower blepharoplasty. The technique is designed to accomplish superior-medial repositioning of the cheek while stabilizing lower eyelid position, reducing the risk of postoperative ectropion. RESULTS Minor complications related to the OMS procedure occurred in three patients, all of whom had palpable and slightly visible Vicryl knots on one or both lateral upper eyelids. In one patient, the right side was reopened with a limited incision and the knot was removed. One case of lower eyelid malposition occurred and required revision. This patient presented on day three with unilateral left ectropion (2 mm), but the broken suture was easily replaced under local anesthesia, and the patient had no further ectropion. Two patients had transient lower eyelid malposition, which resolved within four weeks of surgery after gentle massage and lateral eyelid support with steri-strips. Two patients with prominent eyes and inferior orbital rim recession (negative vector) were not fully corrected; however, their lid position was no worse than the preoperative position and curvature. CONCLUSIONS OMS during high SMAS facelift complements the deeper plane by adding a medial and superior vector of elevation to the cheek. Blending of the lower eyelid-cheek junction is accomplished with little risk of lower eyelid malposition.