Correction of a Hollow Lower Eyelid with Hypertrophy of the Pretarsal Portion of the Orbicularis Oculi Muscle

1 SummaRy Our method of correcting the hollow lower eyelid is based on fabrication of the triangular flap from the pretarsal portion of the orbicularis oculi muscle of the lower eyelid and its transposition downward. The reasons for the “hollow” lower eyelid can be the involutive changes in the periorbital area, ptosis of the midface soft tissues, or the excessive removal of fatty hernia during the lower blepharoplasty. This concavity of the lower eyelids is particularly evident if it is adjacent with the convexity above it, which forms the pretarsal roll. This bulging roll may be inherited, or resultant of a classic lower blepharoplasty, when a thick muscle flap is juxtapositioned onto the pretarsal orbicularis oculi muscle (OOM). Such a deformation may be expected whenever an excessive amount of OOM is left at surgery. A number of surgical corrections have been proposed, including simple excision of the skin and muscle roll under the ciliary margin, lifting the soft tissues of the midface, and filling volume deficit of the lower eyelid by the transfer of a pedicled musculofascial flap from the upper eyelid and by the fillers or lipofilling.1–4 We had always been intuitively reluctant to discard a piece of OOM at traditional lower blepharoplasty.