Date Published: February 20, 2018
Publisher: Springer US
Author(s): Claude Le Louarn.
Lower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition.
The concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359–372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure.
None of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure.
The concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring.
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Blepharoplasty is one of the most common cosmetic surgical procedures requested, yet malposition of the lower eyelid remains a frequent complication [2, 3]. In fact, even removing a small skin excess from the lower eyelid via a subciliary incision can induce an ectropion or scleral show.
This retrospective study includes patients operated on by the author between January 2010 and January 2016, 342 patients. Patients were selected from the author’s database, which includes patient demographic data, clinical pictures, pre-, per and postoperative analysis and complications. Women account for 232 patients, and men, 110 cases. Patient ages ranged from 21 to 89 years, with a mean age of 55.3 years.
This study has been carried out on 342 patients (684 eyelids) who underwent concentric malar lift with barbed sutures from 2010 to 2016. A total of 256 cases (75%) were aesthetic mid-face lifts, whereas 86 cases (25%) were for lower eyelid retraction. A spacer graft was used in 30 of these 86 cases (35%).
The first part of the discussion covers the indications for the concentric malar lift in cases of lower eyelid and mid-face aging, compared to other surgical rejuvenation techniques (e.g., standard lower eyelid surgery with fat grafting, other types of mid-face lift).
Since publication in 2004, the concentric malar lift has demonstrated its efficiency and reliability in both aesthetic rejuvenation and also reconstructive cases of lower eyelid retraction. The procedure has evolved, and the concentric malar lift is now a well-defined, safe and replicable technique.