Arcus Marginalis Release and Orbital Fat Preservation in Midface Rejuvenation

TLDR

Aging exposes periorbital skeletal anatomy, and recent cheek fat and orbicularis repositioning techniques have improved midface rejuvenation, but conventional lower blepharoplasty that removes lower eyelid fat can create a concave contour deformity. This paper introduces a technique that preserves lower eyelid fat and advances it beyond the infraorbital rim. The technique involves an arcus marginalis release, advancing subseptal fat beyond the infraorbital rim and suturing it under repositioned orbicularis, and is applied in composite rhytidectomies, isolated blepharoplasty, and secondary corrections of orbital fat overresection or malar augmentation deformities. Camouflaging the lower orbital rim anatomy yields more complete midface rejuvenation, as demonstrated in 152 cases over three years with impressive results and minimal complications.

Abstract

With aging, the periorbital area reveals progressive exposure of underlying skeletal anatomy as compared with the lower areas of the face, whose thicker soft tissues continue to cover underlying bony landmarks. With recent techniques in cheek fat repositioning and orbicularis muscle repositioning, rejuvenation results of the midface have been markedly improved. Conventional lower blepharoplasty techniques that remove lower eyelid fat can create a concave contour deformity of the lower eyelids that causes the "operated" appearance. This paper describes a new technique to preserve the lower eyelid fat and to advance it beyond the infraorbital rim. An arcus marginalis release is accomplished, and the subseptal fat is advanced and sutured beyond the entire infraorbital rim and under the repositioned orbicularis muscle. By camouflaging the lower orbital rim anatomy, rejuvenation of the midface is more complete. A total of 152 cases have been done over a 3-year period with impressive results and minimal complications. This procedure is done in all composite rhytidectomies and in isolated blepharoplasty patients without advanced facial aging. It is particularly indicated in secondary procedures correcting overresection of orbital fat or deformities resulting from malar augmentation.