Top Articles

Lower blepharoplasty is a common periorbital surgical technique that can be associated with increased scleral show and some lid retraction. While contemporary lower blepharoplasty techniques strive to avoid these problems through conservative skin removal and increased support to the corner of the eye (lateral canthopexy, muscle resuspension), not all surgeons employ them and even with the best efforts, lower lid malpositions are still potential risks.

In addition, aging of the face is not limited to just the lower eyelid and cheek/midfacial tissue descent and deflation has long been recognized. This has risen to the emergence decades ago of the cheek or midface lift through a lower blepharopasty incision. While once more popular than today, it has fallen into some disfavor because the subperiosteal cheek dissection became associated with a risk of lower eyelid malposition.

In the June 2018 issue of the journal Aesthetic Plastic Surgery, an article was published entitled ‘Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective on 342 Cases , 13 Years After the First Publication’. In this paper the authors describe their clinical experience with the concenteric malar lift technique. This is a vertical midface lift with the basic components of: 1) subciliary lower eyelid incision with small lateral canthal extension, 2) complete subperiosteal malar release, 3) lateral and orbital rim drill holes, 4) concentric elevation of the malar tissues with barbed suture fixation to the drill holes, 5) lower eyelid skin excision limited to the mid-pupillary and 6) a lateral canthopexy and orbicularis muscle suspension during closure.

In this retrospective clinical study, 342 patients over a six year period were operated on with this cheek lift technique. The majority were done (75%, 256 cases) for aesthetic midface lifting while 25% (86 cases) were for reconstruction of lower eyelid retraction. One-third of the lower eyelid malposition cases required a concurrent spacer graft. All had successful outcomes and few complications occurred. (infraorbital nerve paresthesia, loss of lateral canthal support)

The cheek lift is an incredibly technique sensitive procedure that basically is a battle between lifting up the lower eyelid/cheek and treating/protecting against lower eyelid retraction. It has a definitive and quantifiable endpoint which is the position of the lower eyelid against the eyeball. Ultimately that is the most important measurement of procedure success. Despite a very large number of patients treated the complications were remarkably few….a testament to the number of maneuvers done intraoperatively to protect against it.

Dr. Barry Eppley

Indianapolis, Indiana

Top Articles