Simplified Muscle-Suspension Lower Blepharoplasty by Orbicularis Hitch

The suspension of orbicularis oculi during lower blepharoplasty presents a logical surgical addition for further support of the lid, as well as further improvement to its contour profile. It has traditionally been performed as an extension of the skin-muscle flap procedure, but more recently, and aggressively, as a muscle strap-flap separated from the orbicularis sheet by myotomy. Many benefits of suspension, however, can be achieved without incision into muscle (beyond a single stab-wound "button-hole") and without delamination of the lid, as a safe, simple, single-suture suspension of preseptal muscle to lateral orbital rim. The purpose of this report was to evaluate the results of a simplified approach to muscle suspension during lower blepharoplasty. One hundred lower blepharoplasties by orbicularis hitch, performed as two consecutive series of 50, one by a plastic surgeon, the other by an oculoplastic surgeon, were reviewed retrospectively. Skin was resected from all lids, with a mean skin excision of 8 mm and 5 mm, respectively. Average follow-up was 17 and 16 months. Lateral canthal support was added to 2.5% of lids. There was one lid malposition (0.5%), leading to surgical revision, and no other complication or reoperation. Lower blepharoplasty by orbicularis hitch provides the benefits of muscle suspension by way of a simple, single-suture elevation of descended muscle, without the need for significant myotomy or lateral canthal manipulation. Despite its limited surgical invasiveness, it has proven both safe and effective in reversing muscle descent with skin redundancy, while maintaining lid support and lateral canthal integrity.