Correction of Crow's Feet by the Expansion of Orbicularis Oculi Muscle Flap

Shim, Jae Sun; Park, Seung Ha; Koo, Sang Hwan; Choi, Eung Ok; Chung, Heung Soo

Abstract

As people grow older, many aging phenomena occur in the facial skin and soft tissues, including crow's feet, glabellar frown lines, jowls, depression of malar fat pads, brow ptosis, Marionette lines, and more. Among these results, the authors focused on crow's feet(Lateral. periorbital wrinkles), which are one of the major causes of facial rejuvenation in the periorbital area. Upper & lower blepharoplasty do not always improve crow's feet to one's satisfaction, and above that, surgery sometimes accentuates rather than improves these wrinkles. Consequently, the authors proposed a new operative method for lateral. periorbital wrinkle correction, which could be summarized as dissection of the orbicularis oculi muscle, below the subcutaneous tissue above the temporal fascia, elevation of the muscle flap, advancement of the flap to the upper-lateral direction, and excision of redundant skin. After laying the patient down on the operation table and exposing both ears, the whole face was cleansed with an antiseptic solution. Incision lines were designed as temporal W-shaped. After dissecting through the subcutaneous fat layer and elevating the flap from the temporal fascia, the orbicularis oculi muscle was incised at the lateral margin of orbicularis muscle. The orbicularis oculi muscle flap was then elevated, and pulled into the upper- lateral direction with smooth forceps to find the point which would make the patient's eyes look the most natural. The lateral margin of orbicularis muscle was fixed to the deep temporal fascia of temporal hairline. with 4-0 Nylon suture. Redundant skin was excised and wound was closed with 6-0 Black silk by W- plasty technique. Between 2001 and 2006, 63 patients were operated on using the technique mentioned above, with favorable aesthetic and functional results. Several patients complained about the W-plasty scar but those were aesthetically accepted. Crow's feet are not always corrected with satisfactory results, and sometimes are accentuated, by upper & lower blepharoplasty. In order to solve these problems, an operative technique was conceived that dissects the orbicularis oculi muscle, elevates and advances the muscle flap, and then excises the redundant skin. This technique showed favorable patient satisfaction scores in both functional and aesthetic aspects, with satisfactory results even in long-term follow up, and also had the effect of a central- facial face lift.