What orbicularis muscle tightening treats

This procedure addresses looseness or sagging in the muscle under the skin of the lower eyelid, the orbicularis oculus. Orbicularis muscle laxity may not be a true stretching of the muscle, but can be an apparent looseness due to thinning of the eyelid skin and loss of fat around the muscle that provides needed support. Tightening of the orbicularis muscle during lower blepharoplasty can improve the lower eyelid contour, creating more a taught, smoother lid.

How an orbicularis suspension is performed

Local anesthetic

A fine needle is used to inject a numbing solution under the skin of the lower eyelid, consisting of lidocaine with a small amount of epinephrine.

Skin incision

An incision is created below the eyelash line of the lower eyelid. This may be performed at the same time as a skin pinch lower blepharoplasty, which uses the same incision site. The incision typically extends past the level of the outer corner of the eyelids into a smile crease.

Orbicularis muscle exposure

A section of skin of the lower eyelid is elevated to expose the underlying orbicularis muscle fibers.

Orbicularis suspension

The orbicularis muscle below the outer ⅓ of the lower eyelid is tightened using stitches. It may be cinched on itself with a circular stitch (“o” suture), a redundant section may be removed before tightening, or a flap may be created before tightening. The anchor point is on the covering of the bone (periosteum) on the outside of the orbital rim, above the level of the lateral canthal angle. The tightening stitches act to lift the muscle in an upward and outward direction.

Skin closure

The skin incision is closed with thin stitches.

Follow-up care

An ophthalmic antibiotic is applied at scheduled intervals. Cool compresses aid with swelling reduction in the first 48 hours, followed by warm compresses. Sutures are removed at 5 – 14 days. Swelling and bruising are expected in the early post-operative period.


Bleeding, infection, unsightly or thickened scars, bulging or pleating at the outer corner of the eyelid, recurrence of sagging, wound dihiscence.