Orbicularis muscleplasty and face lift: a better orbital contour.

In the course of aging, the jugopalpebral tegumentary continuity disappears, and the orbital rim becomes more visible with the appearance of the palpebrojugal fold and the wrinkles of crow's feet. The deepening crease just above the sulcus cannot be well assessed because of the palpebral bags and the depression below the cheek due to ptosis of the premalar fat pad that comes down into the nasolabial fold. Repositioning of these volumes can be ensured by raising the cutaneous muscular and fat structures en bloc. Following an anatomic study of the aging process, I propose to section the fibers of the orbicularis muscle and to include them in the large cheek flap. This manipulation of the orbicularis will consolidate a weakened orbital septum. Resectioning of the fat pads under these conditions may not be necessary or at least may be more moderate because the deserted zones will be filled, which is what is desired. The cutaneous and capillary incisions adapted to the requirements of this technique are described. The results obtained with 123 patients over a period of 3 years by the same surgeon appear to be more complete and more natural because the transitional zones between the closed techniques of face lift on the one hand and of lower blepharoplasty on the other cease to exist.