MANAGEMENT OF MALAR FOLDS IN BLEPHAROPLASTY

Objectives/Hypothesis: To define the anatomy and location of malar fol ds as distinguished from lower eyelid skin and orbital fat and to teac h a new surgical technique for the management of the aging eye. Study Design: Retrospective report of a surgical procedure designed to addre ss the malar folds. Methods: Analysis of preoperative and postoperativ e photographic documentation for surgical planning and long-term resul t. Results: Patient satisfaction and lack of recurrence, without the r equirement of direct excision, were noted in all patients studied. Con clusion: This presentation describes a new simple technique for the ma nagement of the folds and cutaneous and subcutaneous prominences that occur inferior to the lower eyelid skin. The operation addresses the c orrection by a combination of skin/muscle flap lower eyelid blepharopl asty with immediately subcutaneous (skin flap) elevations over the car efully delineated malar prominences; the removal of the deep fat that may or may not be associated with dehiscence of fat through the thin i nferior fibers of the orbicularis muscle; and finally suspension of th e remaining subcutaneous tissue and the muscle to the periosteum of th e inferior orbital rim as well as suspension of the orbicularis muscle margin to the lateral orbital periosteum or the lateral canthal ligam ent area. The technique is designed to manage the more commonly found malar prominences but can be applied in the management of more pronoun ced festoons involving skin, muscle, and fat.