Management of malar folds in blepharoplasty^†

Objectives/Hypothesis: To define the anatomy and location of malar folds as distinguished from lower eyelid skin and orbital fat and to teach a new surgical technique for the management of the aging eye. Study Design: Retrospective report of a surgical procedure designed to address the malar folds. Methods: Analysis of preoperative and postoperative photographic documentation for surgical planning and long-term result. Results: Patient satisfaction and lack of recurrence, without the requirement of direct excision, were noted in all patients studied. Conclusion: This presentation describes a new simple technique for the management of the folds and cutaneous and subcutaneous prominences that occur inferior to the lower eyelid skin. The operation addresses the correction by a combination of skin/muscle flap lower eyelid blepharoplasty with immediately subcutaneous (skin flap) elevations over the carefully delineated malar prominences; the removal of the deep fat that may or may not be associated with dehiscence of fat through the thin inferior fibers of the orbicularis muscle; and finally suspension of the remaining subcutaneous tissue and the muscle to the periosteum of the inferior orbital rim as well as suspension of the orbicularis muscle margin to the lateral orbital periosteum or the lateral canthal ligament area. The technique is designed to manage the more commonly found malar prominences but can be applied in the management of more pronounced festoons involving skin, muscle, and fat. Laryngoscope, 108:1659–1663, 1998