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Aesthetic Plast Surg 2009 Mar 27;33(2):163-6. Epub 2008 Sep 27.

Department of Plastic Surgery, University Medical Center, Freiburg, Germany.

Tear troughs in combination with midfacial ptosis may be early and synergistic signs of aging. Premaxillary and suborbicularis oculi fat (SOOF) descent decreases soft tissue volume covering the orbital rim, while prolapsing retroseptal fat actually underscores the resulting tear trough shadow. This volume change precedes skin redundancy. Read More

Aesthetic Plast Surg 2008 Sep 9;32(5):785-9. Epub 2008 Jul 9.

Department of Plastic Surgery, University Medical Center Freiburg, Freiburg, Germany.

Resection of intraorbital fat compartments in lower-lid blepharoplasty has been widely replaced by their realignment over the orbital rim. For older patients this usually includes an open subciliary approach with skin resection and orbicularis muscle modification. In younger patients this may be done transconjunctivally. Read More

Aesthetic Plast Surg 2004 Nov-Dec;28(6):359-72; discussion 373-4. Epub 2005 Jan 17.

French Society of Plastic and Reconstructive Surgery, 59 rue Spontini, 75116, Paris, France.

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. Read More

Aesthetic Plast Surg 2004 Jul-Aug;28(4):197-202

Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Improvements have been made throughout the history of medicine, causing physicians to abandon a technique or medications clearly shown to be suboptimal. Unfortunately, this has not happened with rejuvenative surgery. Conventional lower eyelid procedures continue to include removal of orbital fat in most cases, and facelift procedures remain primarily a lateral vector pull. Read More