Repositioning the orbicularis oculi muscle in the composite rhytidectomy.

While blepharoplasties are routinely done with face lift procedures, the improvement is accomplished by removing excess orbital fat with eyelid skin and muscle along the incisional line. The orbicularis oculi muscle remains intact as its inferior border, which has become ptotic and redundant with aging, and actually remains in the same position following a conventional lower lid blepharoplasty and rhytidectomy. However, by elevating the orbicularis oculi with the cheek fat and platysma in a composite face lift flap, and by excising the redundant inferior border of the orbicularis muscle, a total rejuvenation of the malar area is accomplished. The descent of the orbicularis oculi muscle is in an inferolateral vector, whereas the vector of facial aging is inferomedial. Thus, repositioning the orbicularis oculi is in a superomedial vector and is obligatory in a composite rhytidectomy.