Infrabrow excision with septo-myocutaneous flap repositioning in aged eyelids in Asians

Asian eyelids are characteristically puffy, with a fold, and have bulging of the orbital fat and septum. Moreover, with the aging process, the orbital septum and skin lose elasticity and orbital fat atrophy proceeds, thus resulting in dermatochalasis and a sunken eyelid. We introduce a modified technique of infrabrow excision with septo-myocutaneous flap repositioning. An upper incision was made along the lower margin of the eyebrow and the placement of the lower incision was decided according to the amount of skin excision needed. After skin removal, the orbicularis oculi muscle (OOM) was incised 2 mm above the lower margin and dissected to expose the orbital septum. Additional dissection was performed along the preseptal plane to the supraorbital rim periosteum. Then, the lower flap (septo-myocutaneous flap) was anchored to the supraorbital rim periosteum. The overlapping OOM and subcutaneous layers were sutured separately. This technique makes it possible to correct the cause of an aging eyelid appearance. Additionally, an overlapping OOM aids in correcting sunken eyelids, and by tensioning the orbital septum, a puffy eyelid is corrected. As an advantage over the conventional infrabrow excision, our method prevents recurrence and corrects orbital septum laxity. Therefore, it can achieve more natural outcomes and lower recurrence rates.