Tear Trough Treatment with Orbicularis Oculi Muscle Suspension.

BACKGROUND: Blepharoplasty is a very requested surgery for aesthetic rejuvenation of the eyes with grateful results. Lower blepharoplasty involving a variety of different techniques can be considered to refresh the oculopalpebral area. The approach of the treatment of the tear trough as releasing the tear trough ligament and plication of orbicularis oculi muscle in the palpebral portion to fill the tear trough concavity is essential in our surgical technique demonstrated here. METHODS: From July 2014 to January 2020, 435 patients were submitted to blepharoplasty surgery for rejuvenation of the eyes. Lower blepharoplasty was performed with releasing of the tear trough ligament and suspension and fixation of the palpebral part of the orbicularis oculi muscle in the medial part of orbital bone corresponding to the tear trough area. The follow-up was 12 months. RESULTS: Patient satisfaction was high, and no complications were observed. Ten patients (2.2%) needed the addition of hyaluronic acid fillers in the tear trough 12 months after the surgery. CONCLUSION: We conclude that the use of the orbicularis oculi muscle suspension improves the long-term aesthetic results for the tear trough and the technique is easy to perform. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inversão da porção lateral do músculo orbicular para tratamento das rítides perioculares (pés-de-galinha) / Inversion of the lateral portion of the orbicularis oculi muscle for the treatment of periocular rhytides (crow's feet)

INTRODUÇÃO: A cirurgia plástica, sempre em busca de resultados cada vez mais expressivo, vem associando às técnicas já consagradas aos novos tempos intraoperatórios. Este trabalho descreve uma técnica cirúrgica para ser associada às ritidoplastias baseada na ressecção da porção lateral do músculo orbicular, seguida pela enxertia do próprio músculo, porém invertido, sobre a área ressecada. MÉTODO: Em um período de 5 anos, foram realizadas 54 ritidoplastias associadas a técnica descrita. RESULTADOS: O seguimento no pós-operatório tardio (5 anos) mostrou-se satisfatório com permanente desaparecimento das ritides perioculares por neutralizar as forças exercidas pelo músculo nesta área. Não houve insatisfação por parte dos pacientes. Logo, trata-se de um procedimento com excelentes resultados na resolução das ritides perioculares e na elevação da porção caudal da sobrancelha em relação a orbita. CONCLUSÃO: A técnica descrita gera resultados permanentes e satisfatórios.

INTRODUCTION:In the continued search for increasingly expressive results, plastic surgeons are combining established techniques with new intraoperative times. This article describes a surgical technique associated with rhytidoplasties based on the resection of the lateral portion of the orbicularis oculi muscle, followed by grafting the muscle itself, however inverted, on the resected area. METHOD: In a 5-year period, 54 rhytidoplasties associated with the described technique were performed. RESULTS: The follow-up in the late postoperative period (5 years) was satisfactory, with the permanent disappearance of periocular rhytides due to the neutralization of the forces exerted by the muscle in this area. There was no dissatisfaction on the part of the patients. Consequently, the procedure had excellent results in the resolution of periocular rhytides and in lifting the caudal part of the eyebrow in relation to the orbit. CONCLUSION: The technique described generates permanent and satisfactory results.