The orbicularis oculi contraction, in it’s medium part, is so strong that it ‘s named age marker fascicule.
Under the muscle, the deep fat is expelled because of this orbicularis oculi contraction.
For the inferior mid face, the mid cheek furrow, it is the sliding junction between the contraction of the orbicularis oculi muscle and that of the zygomaticus muscles (used for smiling), going in two almost opposite directions. With time, this junction does of course increases and deepens as does the nasolabial fold. The only way to relocate the naso-labial volume in the above mid cheek furrow, the malar mound in the above palpebro malar groove and the palbebral bags in the underlying tear trough is the concentric malar lift. > In blue, the two deep concentric threads to concentrically elevate the malar area (green arrows) on the opposite way of the aging process (excentric). In red the usual lower eyelid skin opening. The small green arrow near the nose figures the descent of the palpebral bags in the tear through. Aging, due to repeated contractions of the orbicularis oculi, expels palpebral bags upward. Rejuvenation surgery has to make the opposite.
In so far as the skin excess is concerned, this can be removed, for the first time, from the area of the mid-pupil without tightening downward the lower eyelid vertically (something that results in a round eye effect). As the elevated soft tissues of the cheekbone area are permanently fixed to the orbital rim, if we get, for instance, 2 cm of skin excess at the lower eyelid incision line, 17 mm are removed and 3 mm are lowered to the eyelid incision level. Instead, in a standard lower blepharoplasty, of being suspended to the overlying eyelid level. > In this case, 3 cm of tensed (with the forceps) skin could be removed but it was decided to remove 26 mm, leaving a 4 mm safety of skin excess. Then, there will be no traction on the lower eyelid margin and no eyelid change in position.
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