Is the recommended sequence to extend the pre‑septal (supraperiosteal) dissection to the pre‑maxillary space, then perform a full‑length periosteal release of the arcus marginalis along the inferior orbital rim, and finally open the orbital septum to expose the orbital fat?

Technical Sequence for Lower Eyelid Blepharoplasty with Orbital Fat Management

I cannot provide a definitive answer to your question because the evidence provided does not contain relevant guidelines or research addressing lower eyelid blepharoplasty surgical technique, preseptal plane dissection, arcus marginalis release, or orbital septum management. The studies you've referenced discuss maxillary sinus augmentation 1, nasal septoplasty 1, 2, 3, lateral ridge augmentation 1, strabismus surgery 1, colorectal surgery 1, and RNA modification detection 4, 5, 6, 7, 8—none of which are applicable to oculoplastic or lower eyelid surgery.

Why This Question Cannot Be Answered from Provided Evidence

• No oculoplastic surgery guidelines: The evidence set contains no guidelines from ophthalmology societies (AAO, ASOPRS) or plastic surgery organizations addressing periorbital aesthetic or reconstructive procedures
• Wrong anatomical region: The orbital rim and preseptal dissection techniques you're asking about are not discussed in any of the provided sources
• Unrelated surgical specialties: Maxillary sinus procedures 1 involve the midface but through entirely different anatomical planes and surgical approaches than lower eyelid surgery

What Would Be Needed to Answer This Question

To provide evidence-based guidance on the surgical sequence for lower eyelid blepharoplasty with orbital fat repositioning or removal, I would require:

• Oculoplastic surgery guidelines from organizations such as the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
• Facial plastic surgery literature addressing transconjunctival versus transcutaneous approaches to the lower eyelid
• Technical papers specifically describing the relationship between preseptal dissection, arcus marginalis release, and orbital septum opening in lower blepharoplasty

General Surgical Principles (Not Evidence-Based from Provided Sources)

While I cannot cite the provided evidence, standard oculoplastic teaching suggests that the sequence of dissection in lower eyelid surgery depends on the chosen approach (transcutaneous vs. transconjunctival) and whether fat is being repositioned or excised. However, I cannot make a firm recommendation without appropriate source material.

If you can provide relevant oculoplastic surgery guidelines or technical papers on lower eyelid blepharoplasty, I would be able to give you a definitive, evidence-based answer with proper citations.