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There are many features to the eyes which create either a positive (youthful) or negative (aging) appearance. Some are present naturally while others develop from the effects of time and movement. While the upper eyelid has the important topographic features of a well defined lid crease and supra tarsal fold, the lower eyelid has less surface features. It is prone to develop bags well below the lid margin down closer to the infraorbital rim.

One unique feature of the lower eyelid is the orbicularis roll. This is a visible bulge of muscle just under the lashline. In certain ethnicities having a prominent orbicularis roll, known as ‘love bands’, is a desirable lower eyelid feature. Such plumpness helps reduce the appearance of fine lines under the eyes and is associated with a younger appearance. With aging the orbicularis muscle under the eyes thins and sags and can cause the eyes to look more sunken and older. 

Recreating a lost love band or augmenting an existing small one can be done with either non-surgical injections or surgically implanted grafts. Fat injections is also another good option although their smoothness and persistence is always unpredictable. 

When it comes to achieving a more assured smoother and longer lasting result, tissue grafts can be placed. While there are various autologous grafts that can be harvested from the patient (e.g., dermis, fascia), the use of tissue bank dermis (e.g., Alloderm) is more popular due to the avoidance of a harvest site. This is done by making two small 3mm incisions at the lateral canthus and the right under the lashline medially.

The Alldoerm graft is then threaded into the lower eyelid pocket using curved alligator forever. The graft ends are trimmed and the incisions closed with tiny dissolvable sutures.

love band surgery dr barry eppley indianapolis indianaPassing the graft through a very thin pocket right under the skin and above the orbicularis muscle by a threading technique avoids the needs for an open incision for graft placement in Love Band Surgery. 

Dr. Barry Eppley

Indianapolis, Indiana

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