ArticleAesthetic plastic surgery2026
OOM-ORL-ROOF Composite Flap Suspension (ORRCS) to the Lateral Orbital Thickening for Lateral Hooding.
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
backgroundLateral hooding of the upper eyelid is a common yet frequently undertreated aspect of periorbital aging in East Asians. This study aimed to investigate the roles of the orbicularis oculi muscle (OOM), retro-orbicularis oculi fat (ROOF), orbicularis retaining ligament (ORL), and lateral orbital thickening (LOT) in the pathogenesis and to evaluate the novel OOM-ORL-ROOF composite suspension (ORRCS) technique.
methodsAnatomical analyses were conducted on 6 cadaveric heads and 18 plastinated specimens. Clinical outcomes of the ORRCS procedure were retrospectively reviewed in 85 East Asian patients with lateral dermatochalasis (LDC grade ≥1). Assessments included LDC grade, lateral canthal tilt, brow position, complications, and patient satisfaction preoperatively and at 6 and 12 months postoperatively.
resultsAnatomically, the age-related descent of the continuous OOM-ORL-ROOF composite is primarily due to the attenuation of its deep retaining structures, the ORL-LOT retaining complex. Clinically, ORRCS significantly improved the mean LDC grade from 2.24±0.77 to 0.40±0.49 (p<0.001) and increased lateral canthal tilt by ~5° (from 3.0° ± 1.13° to 8.0° ± 1.25°). Brow position remained stable ( p >0.05). Scars were inconspicuous, with no major complications and high patient satisfaction (4.7/5).
conclusionsLateral hooding primarily results from the descent of the OOM-ORL-ROOF composite unit due to the attenuation of the deep ORL-LOT retaining complex. The ORRCS technique corrects this deformity by re-suspending the complex to the robust LOT, providing a promising anatomy-guided deep-plane approach with favorable early outcomes in this cohort while restoring a natural contour and preserving brow dynamics. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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