eMedicine Specialties > Plastic Surgery > Eyelids

Blepharoplasty, Lower Lid Arcus Marginalis Release: Multimedia

Author: Steven L Henry, MD, Staff Physician, Division of Plastic Surgery, University of Missouri Hospital & Clinics
Coauthor(s): Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Contributor Information and Disclosures

Updated: Feb 7, 2008

Multimedia

Anatomy of the lower lid. The orbicularis oculi (...
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Media file 1: Anatomy of the lower lid. The orbicularis oculi (O) overlies the orbital septum (S), which retains the orbital fat pads (F) within the orbit. The septum fuses with the maxillary periosteum (P) inferiorly and the tarsus (T) superiorly. The capsulopalpebral fascia (C) arises from the fascial sheaths of the inferior rectus (R) and inferior oblique (Q) and merges with the septum at the tarsus. The inferior tarsal muscle (M) is contained within the capsulopalpebral fascia.
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Anatomy of the lower lid. The orbicularis oculi (...

Anatomy of the lower lid. The orbicularis oculi (O) overlies the orbital septum (S), which retains the orbital fat pads (F) within the orbit. The septum fuses with the maxillary periosteum (P) inferiorly and the tarsus (T) superiorly. The capsulopalpebral fascia (C) arises from the fascial sheaths of the inferior rectus (R) and inferior oblique (Q) and merges with the septum at the tarsus. The inferior tarsal muscle (M) is contained within the capsulopalpebral fascia.

Top. Drawback of traditional lower blepharoplasty...
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Media file 2: Top. Drawback of traditional lower blepharoplasty. In the youthful face, the lower lid has a smooth contour, and the underlying infraorbital rim is invisible (A). With age, the orbital septum becomes slack, permitting the herniation of orbital fat into bags (B). Traditional lower blepharoplasty calls for resection of protruding fat; the result can be accentuation of the infraorbital rim and hollowing of the orbit (C).Bottom. Arcus marginalis release. After dissecting the orbicularis off the septum, cutting cautery is used to release the arcus marginalis (A). Orbital fat is advanced, and the orbital septum is reset onto the facial aspect of the maxilla. Both fat and septum are secured to periosteum with multiple interrupted 5-0 polyglactin sutures (B). The result is a smooth contour that obscures the infraorbital rim and resembles the contour of youth (C).
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Top. Drawback of traditional lower blepharoplasty...

Top. Drawback of traditional lower blepharoplasty. In the youthful face, the lower lid has a smooth contour, and the underlying infraorbital rim is invisible (A). With age, the orbital septum becomes slack, permitting the herniation of orbital fat into bags (B). Traditional lower blepharoplasty calls for resection of protruding fat; the result can be accentuation of the infraorbital rim and hollowing of the orbit (C).Bottom. Arcus marginalis release. After dissecting the orbicularis off the septum, cutting cautery is used to release the arcus marginalis (A). Orbital fat is advanced, and the orbital septum is reset onto the facial aspect of the maxilla. Both fat and septum are secured to periosteum with multiple interrupted 5-0 polyglactin sutures (B). The result is a smooth contour that obscures the infraorbital rim and resembles the contour of youth (C).

More on Blepharoplasty, Lower Lid Arcus Marginalis Release

Overview: Blepharoplasty, Lower Lid Arcus Marginalis Release
Treatment: Blepharoplasty, Lower Lid Arcus Marginalis Release
Multimedia: Blepharoplasty, Lower Lid Arcus Marginalis Release
References
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References

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  2. Loeb R. Fat pad sliding and fat grafting for leveling lid depressions. Clin Plast Surg. Oct 1981;8(4):757-76. [Medline].

  3. Goldberg RA, McCann JD, Fiaschetti D, Simon GJ. What causes eyelid bags? Analysis of 114 consecutive patients. Plast Reconstr Surg. Apr 15 2005;115(5):1395-402; discussion 1403-4. [Medline].

  4. Sadove RC. Transconjunctival septal suture repair for lower lid blepharoplasty. Plast Reconstr Surg. Aug 2007;120(2):521-9. [Medline].

  5. Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg. Aug 1995;96(2):354-62. [Medline].

  6. Barton FE, Ha R, Awada M. Fat extrusion and septal reset in patients with the tear trough triad: a critical appraisal. Plast Reconstr Surg. Jun 2004;113(7):2115-21; discussion 2122-3. [Medline].

  7. Mendelson BC. Herniated fat and the orbital septum of the lower lid. Clin Plast Surg. Apr 1993;20(2):323-30. [Medline].

  8. Loeb R. Naso-jugal groove leveling with fat tissue. Clin Plast Surg. Apr 1993;20(2):393-400. [Medline].

  9. Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. Jun 2004;113(7):2124-41; discussion 2142-4. [Medline].

  10. Rohrich RJ, Janis JE, Adams WP. Subciliary versus subtarsal approaches to orbitozygomatic fractures. Plast Reconstr Surg. Apr 15 2003;111(5):1708-14. [Medline].

  11. Nassif PS. Evolution in techniques for endoscopic brow lift with deep temporal fixation only and lower blepharoplasty-transconjunctival fat repositioning. Facial Plast Surg. Feb 2007;23(1):27-42. [Medline].

  12. DiFrancesco LM, Anjema CM, Codner MA, McCord CD, English J. Evaluation of conventional subciliary incision used in blepharoplasty: preoperative and postoperative videography and electromyography findings. Plast Reconstr Surg. Aug 2005;116(2):632-9. [Medline].

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Further Reading

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Keywords

septal reset, orbital fat, periorbital surgery, rhytidectomy, face-lift, facelift, face lift, arcus marginalis, arcus marginalis release, lower lid, lower eyelid, blepharoplasty, lower lid blepharoplasty, sagging eyelid, eyelid atrophy, orbital fat resection, herniating orbital fat, advance orbital fat

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Contributor Information and Disclosures

Author

Steven L Henry, MD, Staff Physician, Division of Plastic Surgery, University of Missouri Hospital & Clinics
Steven L Henry, MD is a member of the following medical societies: American Society for Surgery of the Hand and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Medical Editor

Neal R Reisman, MD, JD, Chief of Plastic Surgery, St Luke's Episcopal Hospital; Clinical Professor of Plastic Surgery, Baylor College of Medicine
Neal R Reisman, MD, JD is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Lipoplasty Society of North America, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Lars M Vistnes, MD, FRCSC, FACS, Professor of Surgery, Emeritus, Stanford University Medical Center
Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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