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. 2000 Dec;84(12):1401–1406. doi: 10.1136/bjo.84.12.1401

Raising the suborbicularis oculi fat (SOOF): its role in chronic facial palsy

J Olver 1
PMCID: PMC1723366  PMID: 11090482

Abstract

AIMS—To determine the adjuvant role of unilateral suborbicularis oculi fat (SOOF) lift in the periorbital rehabilitation of patients with chronic facial palsy.
METHODS—In a non-comparative prospective case series nine adult patients (seven male, two female) aged 34-90 years (mean 60.5) with chronic unrecovered facial palsy (over 1 year), who had not had any previous rehabilitative periorbital surgery, were studied. Lateral tarsal strip and adjuvant transconjunctival approach subperiosteal SOOF lift under local or general anaesthesia were performed; medial canthoplasty was performed where indicated. There was clinical observation of the long term (over 1 year) effect on the ptotic palpebral-malar sulcus and lower eyelid retraction.
RESULTS—The patients were followed up for 12-24 months (mean 16). Seven patients (77%) had sustained clinical reduction of palpebral-malar sulcus ptosis. All patients had sustained reduction of lagophthalmos. Early postoperative complications included conjunctival cheimosis in 77%. Three patients with persistent keratitis required further surgical procedures on their upper eyelid to reduce the palpebral aperture. There were no cases of infraorbital nerve anaesthesia or recurrent lower eyelid retraction.
CONCLUSIONS—The SOOF lift has an adjuvant role in chronic facial palsy with lower eyelid retraction and ptotic-palpebral malar sulcus. It supports the lower eyelid elevation and tightening achieved with the lateral tarsal strip. The best results were obtained in congenital facial palsy.



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Figure 1  .

Figure 1  

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Diagram showing facial changes from lower motor neuron facial palsy.

Figure 2  .

Figure 2  

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(A) Right congenital facial palsy. (B) Effect of digitally pushing the upper lateral cheek superior, mimicking the predicted effect of a SOOF lift.

Figure 3  .

Figure 3  

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Cross section of a normal lower eyelid showing the location of the suborbicularis oculi fat (SOOF).

Figure 4  .

Figure 4  

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(A) Diagram showing transconjunctival approach to the inferior orbital rim and suborbicularis oculi fat (SOOF). The dissection continues posterior to the SOOF in the subperiosteal plane. (B) Diagram of left orbit showing location of SOOF in relation to the infraorbital nerve. The SOOF usually lies just above the infraorbital rim, but is shown lower here, mimicking involutional or paralytic changes.

Figure 5  .

Figure 5  

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(A) Preoperative clinical findings. (B) Combination of procedures performed. SOOF = suborbicularis oculi fat, LTS = lateral tarsal strip, Lee = Lee medial canthoplasty. Other is orbital fat excision (1) and medial canthal tendon stabilisation for medial canthal tendon laxity (1). (C) Measurement of preoperative lagophthalmos and residual lagophthalmos 6 months after surgery, in mm. (D) Early postoperative complications.

Figure 6  .

Figure 6  

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(A) Preoperative appearance of right congenital facial palsy with prominent palpebral-malar ptosis. (B) Same patient, 1 year after left LTS, Lee medial canthoplasty, and SOOF lift, showing sustained improvement in palpebral-malar symmetry.

Figure 7  .

Figure 7  

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(A) Preoperative appearance of left acquired facial palsy with lower eyelid retraction and palpebral malar ptosis. (B) Same patient, showing a good result 1 year after left LTS and SOOF lift.

Figure 8  .

Figure 8  

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(A, B) Preoperative appearance of right long standing Bell's palsy with marked lower eyelid retraction and ptotic palpebral-malar ptosis. (C, D) One month postoperative appearance with improved lower eyelid position and elevated upper cheek after right LTS and SOOF lift. There was a neuropathic cornea and this patient required later upper eyelid lowering for corneal protection.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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