Lysis of the orbicularis retaining ligament and orbicularis oculi insertion: a powerful modality for lower eyelid and cheek rejuvenation.

BACKGROUND The techniques of lower blepharoplasty are evolving to reflect the concept that the lower eyelid contour does not stop at the inferior orbital rim, and that the lid-cheek junction must often be modified to restore the midface to a youthful configuration. Multiple procedures have been proposed to smooth the lid-cheek junction and tear trough. The author proposes a technique of carbon dioxide laser lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion onto the maxilla to release the tethering of the lower lid and cheek and allow recontouring of the lid-cheek junction in an extended transcutaneous lower blepharoplasty. METHODS Retrospective review of 80 extended lower blepharoplasty procedures with carbon dioxide laser lysis of the orbicularis retaining ligament and of the orbicularis oculi insertion performed in the past 3 years was undertaken. Follow-up ranged from 4 to 26 months, with an average of 7.2 months. The efficacy, risks, and complications of this procedure were assessed. RESULTS The complication rate for this procedure is not significantly higher than that for standard transcutaneous blepharoplasty, and the procedure allows significant improvement of the lid-cheek junction and rejuvenation of the upper midface. CONCLUSIONS Lysis of the orbicularis retaining ligament and lower orbicularis oculi insertion is a safe and effective adjunct to lower blepharoplasty. It is a powerful modality that allows significant rejuvenation of the lid-cheek complex and upper cheek. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.