Lower blepharoplasty with release orbital malar ligament? (Photo)

Question

I am 46 years old and have protruding lower eyelid fat along with a pronounced demarcation along the orbital bone. I've had two consultations: the first surgeon has recommended a simple procedure to remove fat, and the second a release of the orbital malar ligament along with a tightening of the lower lids through a corner stitch. I wish to minimize risk of any change in shape of eyes or malposition of lower eyelids. How common/risky is release of the orbitomalar ligament?

Mehryar (Ray) Taban, MD, FACS · Answer

Best technique to address under eye bags without changing the eye shape or causing lower eyelid retraction or causing hollowness is transconjunctival lower blepharoplasty with fat/bags repositioning. That involves releasing the ligament in a safe way. See following link.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  In order to avoid risk of lower eyelid malposition, I would recommend a transconjunctival approach with fat repositioning.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

John J. Martin, Jr., MD · Answer

You have some mild fat prolapse.  I prefer to reposition fat to avoid hollowing post-op.  When we do this, the orbital and tear trough ligaments are elevated and the fat placed below these.  If you have excess skin this can be removed.  Depending on the amount of actual lid laxity you have, the lid may need to be tightened in the corner.  When done correctly this should have minimal change in the eye shape.  Make sure you see someone who does a lot of lower lid eyelid cosmetic surgery.

Sean Freeman, MD · Answer

mirliton, Only an exam can tell me exactly what I would recommend but based only on your photo I would be recommending a "SOOF lift blepharoplasty". See an experienced plastic surgeon that specializes in "onlyfaces" and has decades of experience and hopefully is familiar with the SOOF lift technique. See the video and good luck!

Robert T. Buchanan, MD (retired) · Answer

Of the 2 methods of dealing with the lower eyelids, removal of the fat is not generally a good idea. It will look good initially, but will significantly age the area over further time. Release of the orbit-malar ligament with movement of the fat over the orbital rim corrects the problem and maintains the correction much longer than other methods. For you, however, you appear to be a better candidate for filler. I would suggest seeing a plastic surgeon who has significant experience in perioccular rejuvenation using both surgery and fillers.

Brooke R. Seckel, MD, FACS (retired) · Answer

Arcus marginalis release (Ive never heard it called orbitomalar ligament-it is not a ligament but a condensation of the orbital septum-been doing this for over 20 years) is part of every transconjunctival blepharoplasty I do to remove or re position lower eyelid fat. This maneuver reduces the depression underneath the eyelid which can accentuate puffy eyes and dark circles. Based on your photo you do not need the skin pinch which can alter eyelid shape. To learn more read below:

Lower blepharoplasty with release orbital malar ligament? (Photo)

Answers (6)

More Eyelid Surgery Questions

Is surgery required to achieve a double eyelid for only one eye? (Photos)

Eyelids swollen shut after facelift. Have been using cold compresses. No help. What to do? (Photo)

I have moderate-severe psoriasis. Can I have plastic surgery for my sagging eyelids?

Under eye bag only on one eye, how can I get rid of it? (Photo)

WE SEND PRETTY
EMAILS