Orbicularis transposition flap for muscle suspension in lower blepharoplasty.

Different problems can be encountered when planning a lower blepharoplasty, such as festoons, prominent fat bags, and a conspicuous transition from eyelid to cheek. Frequently, they occur simultaneously. In such cases, a larger amount of skin excision is needed to achieve an adequate correction. This carries an increased risk of eyelid retraction when dealing with hypotonic eyelids. Orbicularis muscle suspension can provide vertical support to the eyelid and so achieve a safer, more effective correction. Several techniques have been reported to obtain this effect. We have found a laterally based transposition orbicularis flap to be a safe end effective method to transmit a controlled amount of traction to the lower lid.