[Orbicular myorraphy for correction of bags and wrinkles of the lower eyelids].

The lower eyelid consists of four planes. The deepest plane is the orbital fat, followed by the septum, orbicularis muscle and the skin. Pouches are classically treated by resection of the fat, i.e. reduction of the orbital contents De La Plazza proposed a new method by tightening the septum which retains the orbital fat posteriorly. This idea of preservation of the orbital fat led me to consider the third plane: the orbicularis muscle. By comparing orbicularis myorraphy with median myorraphy of abdominal plasties. I propose reinforcement of the orbicularis muscle to retain the orbital fat and to reduce the pouches without resection of the fat. The fourth plane, the skin, is classically draped over the muscular layer, but as the height of the muscle plane is reduced by this myorraphy, this skin will be less involved in smiling, which improves the wrinkles. As the skin is traditionally detached from the muscle, autoplication of the orbicularis muscle is performed, taking care not to modify the position of the free edge in order not to create muscular ectropion. This suture is composed of inverted 6/0 Dexon sutures. The advantages are preservation of the orbicularis fat which prevents loss of this fat and the risk of senile enophthalmia in the long-term. The indications are of three orders: a) pouches when they are not excessive; b) static wrinkles; c) dynamic wrinkles of smiling. A muscular roll must be avoided by a very careful suture technique. Orbicularis myorraphy appears to be a new contribution to the various therapeutic procedures proposed for aesthetic blepharoplasty and may improve some of the results.