eMedicine Specialties > Plastic Surgery > Eyelids

Blepharoplasty, Lower Lid Subciliary: Multimedia

Author: W John Kitzmiller, MD, Chief, Division of Plastic Surgery, Program Director, Plastic Surgery Residency Program
Coauthor(s): Lauren P Archer, MD, BA, Staff Physician, All Children's Hospital-St. Petersburg, FL, Largo Medical Center, Largo, FL
Contributor Information and Disclosures

Updated: Apr 2, 2008

Multimedia

Anatomy of the periorbital region.
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Media file 1: Anatomy of the periorbital region.
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Anatomy of the periorbital region.

Anatomy of the periorbital region.

Cross-sectional anatomy of the mid face.
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Media file 2: Cross-sectional anatomy of the mid face.
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Cross-sectional anatomy of the mid face.

Cross-sectional anatomy of the mid face.

Cross-sectional anatomy of the mid face. SOOF ind...
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Media file 3: Cross-sectional anatomy of the mid face. SOOF indicates suborbicularis oculi fat; SMAS indicates superficial musculoaponeurotic system.
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Cross-sectional anatomy of the mid face. SOOF ind...

Cross-sectional anatomy of the mid face. SOOF indicates suborbicularis oculi fat; SMAS indicates superficial musculoaponeurotic system.

Topographic anatomy of the eyelid. No. 1 is super...
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Media file 4: Topographic anatomy of the eyelid. No. 1 is superior eyelid fold, 2 is inferior eyelid fold, 3 is malar fold, 4 is nasojugal fold, and 5 is nasolabial fold. Adapted from Jelks, 1993.
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Topographic anatomy of the eyelid. No. 1 is super...

Topographic anatomy of the eyelid. No. 1 is superior eyelid fold, 2 is inferior eyelid fold, 3 is malar fold, 4 is nasojugal fold, and 5 is nasolabial fold. Adapted from Jelks, 1993.

Classification of midfacial aging by Hester et al.
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Media file 5: Classification of midfacial aging by Hester et al.
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Classification of midfacial aging by Hester et al.

Classification of midfacial aging by Hester et al.

Lateral view showing positive, neutral, and negat...
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Media file 6: Lateral view showing positive, neutral, and negative vector relationships between the globe and orbit.
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Lateral view showing positive, neutral, and negat...

Lateral view showing positive, neutral, and negative vector relationships between the globe and orbit.

Incision marking for subciliary approach as repor...
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Media file 7: Incision marking for subciliary approach as reported by Rees and Dupuis.
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Incision marking for subciliary approach as repor...

Incision marking for subciliary approach as reported by Rees and Dupuis.

Technique of flap elevation from Rees and Dupuis....
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Media file 8: Technique of flap elevation from Rees and Dupuis. Note that this sketch depicts elevation of muscle flap. The author would like to use this perspective of depicting the skin muscle as shown and for elevation of the skin flap. For the skin muscle flap, the only other modification the author would make is to allow more pretarsal orbicularis to be left on the tarsus. For the skin flap, the incision is subcutaneous down to the orbital rim, and orbicularis is left intact.
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Technique of flap elevation from Rees and Dupuis....

Technique of flap elevation from Rees and Dupuis. Note that this sketch depicts elevation of muscle flap. The author would like to use this perspective of depicting the skin muscle as shown and for elevation of the skin flap. For the skin muscle flap, the only other modification the author would make is to allow more pretarsal orbicularis to be left on the tarsus. For the skin flap, the incision is subcutaneous down to the orbital rim, and orbicularis is left intact.

Fat resection.
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Media file 9: Fat resection.
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Fat resection.

Fat resection.

Huang's technique for septum plication.
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Media file 10: Huang's technique for septum plication.
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Huang's technique for septum plication.

Huang's technique for septum plication.

Huang's technique for septum plication.
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Media file 11: Huang's technique for septum plication.
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Huang's technique for septum plication.

Huang's technique for septum plication.

Hamra's arcus marginalis release.
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Media file 12: Hamra's arcus marginalis release.
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Hamra's arcus marginalis release.

Hamra's arcus marginalis release.

Furnas' orbicularis resection and suspension.
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Media file 13: Furnas' orbicularis resection and suspension.
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Furnas' orbicularis resection and suspension.

Furnas' orbicularis resection and suspension.

Furnas' orbicularis resection and suspension.
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Media file 14: Furnas' orbicularis resection and suspension.
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Furnas' orbicularis resection and suspension.

Furnas' orbicularis resection and suspension.

Hamra's lateral orbicularis orbital suspension.
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Media file 15: Hamra's lateral orbicularis orbital suspension.
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Hamra's lateral orbicularis orbital suspension.

Hamra's lateral orbicularis orbital suspension.

Modified cheek lift from Hester et al.
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Media file 16: Modified cheek lift from Hester et al.
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Modified cheek lift from Hester et al.

Modified cheek lift from Hester et al.

Modified cheek lift from Hester et al. SOOF indic...
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Media file 17: Modified cheek lift from Hester et al. SOOF indicates suborbicularis oculi fat; SMAS indicates superficial musculoaponeurotic system.
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Modified cheek lift from Hester et al. SOOF indic...

Modified cheek lift from Hester et al. SOOF indicates suborbicularis oculi fat; SMAS indicates superficial musculoaponeurotic system.

Fagien's lateral canthoplasty.
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Media file 18: Fagien's lateral canthoplasty.
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Fagien's lateral canthoplasty.

Fagien's lateral canthoplasty.

Fagien's simplified lateral canthopexy.
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Media file 19: Fagien's simplified lateral canthopexy.
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Fagien's simplified lateral canthopexy.

Fagien's simplified lateral canthopexy.

Skin excision and closure.
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Media file 20: Skin excision and closure.
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Skin excision and closure.

Skin excision and closure.

More on Blepharoplasty, Lower Lid Subciliary

Overview: Blepharoplasty, Lower Lid Subciliary
Treatment: Blepharoplasty, Lower Lid Subciliary
Multimedia: Blepharoplasty, Lower Lid Subciliary
References
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References

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  4. Noel A. La chirurgie esthetique. Clermont (Oise); Theron et cie. 1928.

  5. Castanares S. Blepharoplasty for herniated intraorbital fat; anatomical basis for a new approach. Plast reconstr surg (1946). Jul 1951;8(1):46-58. [Medline].

  6. Furnas DW. The orbicularis oculi muscle. Management in blepharoplasty. Clin Plast Surg. Oct 1981;8(4):687-715. [Medline].

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

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  9. Seckel BR, Kovanda CJ, Cetrulo CL Jr, Passmore AK, Meneses PG, White T. Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique. Plast Reconstr Surg. Oct 2000;106(5):1127-41; discussion 1142-5. [Medline].

  10. Netscher DT, Patrinely JR, Peltier M, Polsen C, Thornby J. Transconjunctival versus transcutaneous lower eyelid blepharoplasty: a prospective study. Plast Reconstr Surg. Oct 1995;96(5):1053-60. [Medline].

  11. Zarem HA, Resnick JI. Minimizing deformity in lower blepharoplasty. The transconjunctival approach. Clin Plast Surg. Apr 1993;20(2):317-21. [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].

  13. Glat PM, Jelks GW, Jelks EB, Wood M, Gadangi P, Longaker MT. Evolution of the lateral canthoplasty: techniques and indications. Plast Reconstr Surg. Nov 1997;100(6):1396-405; discussion 1406-8. [Medline].

  14. Jelks GW, Glat PM, Jelks EB, Longaker MT. The inferior retinacular lateral canthoplasty: a new technique. Plast Reconstr Surg. Oct 1997;100(5):1262-70; discussion 1271-5. [Medline].

  15. Fagien S. Algorithm for canthoplasty: the lateral retinacular suspension: a simplified suture canthopexy. Plast Reconstr Surg. Jun 1999;103(7):2042-53; discussion 2054-8. [Medline].

  16. Huang T. Reduction of lower palpebral bulge by plicating attenuated orbital septa: a technical modification in cosmetic blepharoplasty. Plast Reconstr Surg. Jun 2000;105(7):2552-8; discussion 2559-60. [Medline].

  17. May JW Jr, Zenn MR, Zingarelli P. Subciliary malar augmentation and cheek advancement: a 6-year study in 22 patients undergoing blepharoplasty. Plast Reconstr Surg. Dec 1995;96(7):1553-9. [Medline].

  18. Ellenbogen R. Fat transfer: current use in practice. Clin Plast Surg. Oct 2000;27(4):545-56. [Medline].

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  21. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg. Jan 2000;105(1):393-406; discussion 407-8. [Medline].

  22. Mowlavi A, Neumeister MW, Wilhelmi BJ. Lower blepharoplasty using bony anatomical landmarks to identify and avoid injury to the inferior oblique muscle. Plast Reconstr Surg. Oct 2002;110(5):1318-22; discussion 1323-4. [Medline].

  23. Hass AN, Penne RB, Stefanyszyn MA, Flanagan JC. Incidence of postblepharoplasty orbital hemorrhage and associated visual loss. Ophthal Plast Reconstr Surg. Nov 2004;20(6):426-32. [Medline].

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

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  27. Beare R. Surgical treatment of senile changes in the eyelids the McIndoe-Beare Technique. In: Smith B, Converse JM, eds. Proceedings of the Second International Symposium on Plastic and Reconstructive Surgery of the Eye and Adnexia. CV Mosby: St. Louis, Mo; 1967.

  28. Mahaffey PJ, Wallace AF. Blindness following cosmetic blepharoplasty--a review. Br J Plast Surg. Apr 1986;39(2):213-21. [Medline].

  29. Rees TD, Dupuis CC. Baggy eyelids in young adults. Plast Reconstr Surg. Apr 1969;43(4):381-7. [Medline].

  30. Rees TD, Tabbal N. Lower blepharoplasty with emphasis on the orbicularis muscle. Clin Plast Surg. Oct 1981;8(4):643-62. [Medline].

  31. Von Graefe CF. De Rhinoplastice. Berlin, Germany: Reime; 1818.

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Further Reading

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Keywords

lower blepharoplasty, eye tuck, subciliary skin incision, transcutaneous lower blepharoplasty, lower lid blepharoplasty, lower eyelid surgery, cosmetic eye surgery, transcutaneous lower lid blepharoplasty, lower lid subcilliary, lower lid subciliary

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Contributor Information and Disclosures

Author

W John Kitzmiller, MD, Chief, Division of Plastic Surgery, Program Director, Plastic Surgery Residency Program
W John Kitzmiller, MD is a member of the following medical societies: American Association for Hand Surgery, American Burn Association, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Lauren P Archer, MD, BA, Staff Physician, All Children's Hospital-St. Petersburg, FL, Largo Medical Center, Largo, FL
Lauren P Archer, MD, BA is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Neal R Reisman, MD, JD, Associate Chief, Department of Plastic Surgery, Clinical Associate Professor, St Luke's Episcopal Hospital, 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 Medical Quality, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, 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: Nothing to disclose.

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, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, 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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