Fig. 4.23 (a) Patient with signs of aging process in the lower eyelids. Examination reveals notching and a suspicious pearly lesion affecting left lower eyelid margin. (b, c) After left lower eyelid basal cell carcinoma excision (with frozen section control) and reconstruction

(tarso-conjunctival posterior lamella flap with skin and orbicularis cheek advancement flap). This unilateral reconstructive case demonstrates effect of midface lifting procedures in restoring the single unit appearance of the eyelid and cheek

inferolaterally. The medial half of the nasojugal fold is also referred to as a tear trough deformity. The presence of soft tissue folds (malar mounds) and skin folds (festoons) may be found in the triangular zone formed at the junction of the lateral inferior orbital rim and cheek (Figs. 4.22 and 4.23) [29, 30]. Midface descent also contributes to deepening of the perioral “laugh lines,” also known as “marionette lines,” which may be corrected with cheek lifting or facial filling strategies.

4.5Conclusion

The critical aesthetic assessment of the periorbital face includes knowledge of periocular and ophthalmic anatomy, as well as an understanding of morphologic changes that occur with age and variations among sex and race. Consideration of the orbitoskeleton and globe, the forehead and upper eyelid complex, and the lower eyelid and midface

complex may assist in delivering aesthetically pleasing and functionally sound interventions. Importantly, the assessment of these units is not limited to inspection but may include palpation and digital manipulation. Additionally, dialogue and patient involvement is essential. With a structured assessment, optimal results can be achieved.

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