24.0: Thursday, March 17, 2005

Periorbital Soft Tissue Augmentation Rejuvenation

Johnny Diaz, MD and Zachary E. Gerut, MD.

Historically, surgical rejuvenation of the upper eyelid involved resection of redundant tissues. Recent papers have reevaluated the aesthetics of the periorbita. Maintaining volume is now thought critical to successful rejuvenation. A new technique of upper eyelid rejuvenation is presented that applies these concepts. A standard blepharoplasty incision is used. The orbicularis and septum orbitale are divided. The medial and lateral fat compartments are teased upward but are not resected. The superior aspect of the orbital septum and its attachment to the superior orbital rim at the level of the arcus marginalis are carefully dissected and elevated cephalad. This is the pocket for augmentation. The pseudoherniated fat is placed within the pocket and then the brow fat pad and fascia are folded into the pocket, thus augmenting the infrabrow area. If there is significant redundant orbicularis muscle, it is used as a sling to further strengthen the “pexy” of the closure.This procedure has been performed on forty-three patients, all with good to excellent cosmetic results. The blepharopexy technique yields consistent results that for many patients cannot be achieved with current techniques. It is technically simple and safe. We believe it is a useful new method for upper eyelid rejuvenation.