Effects of orbicularis oculi flap anchorage on the lower eyelid position in trans-cutaneous blepharoplasty. Statistical analysis of clinical outcome

Background: The aging process affects skin, muscle, fat of the eyes in a different manner. Their individual rejuvenation would require specific surgical treatment according to their particular demands. The authors analyzed the effect of an orbicularis oculi muscle flap fixed to the superior orbital rim to prevent lower eyelid dislocation during transcutaneous blepharoplasty. Methods: The study was conducted retrospectively comparing pre and post op images of two different groups of patients: group A (20 patients) treated with orbicularis oculi flap and group B (17 patients) without. Pre and post op distance between the center of the pupil and the upper border of the lower lid at the middle pupil line was measured in each photo and then compared and statistically analyzed. Results: The mean age of the 37 patients was 57 years old. From the estimated Linear Mixed Model, we observe a significant effect of the presence of the flap (p-value < 0.0001). All the patients treated with the orbicularis oculi flap (group A) showed a cranial movement of the lower eyelid, even though minimally. All patients treated without muscle flap (Group B) showed a caudal movement of the lower eyelid. The 47% of eyes in group B showed a positive variation greater than 10 %. Conclusion: The study suggests that the anchorage of the orbicularis muscle flap to the upper orbital rim reinforces the lower eyelid’s anterior lamellae. It works efficiently to stabilize lower eyelid position after transcutaneous blepharoplasty confirming clinical results, improving surgical outcomes even in patients with minimal or no eyelid laxity .