Comprehensive Lower Eyelid Rejuvenation

ABSTRACT

Historically, lower eyelid blepharoplasty has been a challenging surgery fraught with many potential complications, ranging from ocular irritation to full-blown lower eyelid malposition and a poor cosmetic outcome. The prevention of these complications requires a detailed knowledge of lower eyelid anatomy and a focused examination of the factors that may predispose to poor outcome. A thorough preoperative evaluation of lower eyelid skin, muscle, tone, laxity, fat prominence, tear trough deformity, and eyelid vector are critical for surgical planning. When these factors are analyzed appropriately, a natural and aesthetically pleasing outcome is more likely to occur. I have found that performing lower eyelid blepharoplasty in a bilamellar fashion (transconjunctivally to address fat prominence and transcutaneously for skin excision only), along with integrating contemporary concepts of volume preservation/augmentation, canthal eyelid support, and eyelid vector analysis, has been an integral part of successful surgery. In addition, this approach has significantly increased my confidence in attaining more consistent and reproducible results.

KEYWORDS

Transconjunctival lower lid blepharoplasty - tear trough deformity - canthopexy - eyelid fat grafting - eyelid vector

REFERENCES

• 1 Neuhaus R, Baylis H. Complications of lower eyelid blepharoplasty. In: Putterman AM Cosmetic Oculoplastic Surgery. New York, NY; Grund Stratton 1982
• 2 McGraw B L, Adamson P A. Postblepharoplasty ectropion. Prevention and management.  Arch Otolaryngol Head Neck Surg. 1991;  117 852-856
• 3 Taban M, Douglas R, Li T et al.. Efficacy of “thick” acellular human dermis (alloderm) for lower eyelid retraction.  Arch Facial Plast Surg. 2005;  7 38-44
• 4 Reidy J P. Swellings of eyelids.  Br J Plast Surg. 1960;  13 256-267
• 5 Marshak H, Dresner S. Transconjunctival lower blepahroplasty. In: Azizzadeh B, Murphy M, Johnson C Master Techniques in Facial Rejuvenation. Philadelphia, PA; Saunders Elsevier 2007: 89-98
• 6 Fagien S. Algorithm for canthoplasty: the lateral retinacular suspension: a simplified suture canthopexy.  Plast Reconstr Surg. 1999;  103 2042-2053 discussion 2054-2058
• 7 Knize D M. The superficial lateral canthal tendon: anatomic study and clinical application to lateral canthopexy.  Plast Reconstr Surg. 2002;  109 1149-1157 discussion 1158-1163
• 8 Schiller J D, Bosniak S. Blepharoplasty: conventional and incisional laser techniques. In: Mauriello, JA Unfavorable Results of Eyelid and Lacrimal Surgery. Boston, MA; Butterworth-Heinemann 2000: 3-10
• 9 Baylis H I, Long J A, Groth M J. Transconjunctival lower eyelid blepharoplasty. Technique and complications.  Ophthalmology. 1989;  96 1027-1032
• 10 Mullins J B, Holds J B, Branham G H, Thomas J R. Complications of the transconjunctival approach. A review of 400 cases.  Arch Otolaryngol Head Neck Surg. 1997;  123 385-388
• 11 Hamra S T. The role of orbital fat preservation in facial aesthetic surgery. A new concept.  Clin Plast Surg. 1996;  23 17-28
• 12 Nassif P S. Lower blepharoplasty: transconjunctival fat repositioning.  Facial Plast Surg Clin North Am. 2005;  13 553-559, vi
• 13 Goldberg R A. Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket.  Plast Reconstr Surg. 2000;  105 743-748 discussion 749-751
• 14 Hamra S T. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation.  Plast Reconstr Surg. 2004;  113 2124-2141 discussion 2142-2144
• 15 Coleman S R. Structural lipoaugmentation. In: Narins RS Safe Liposuction and Fat Transfer. New York, NY; Marcel Dekker 2003: 409-423
• 16 Lam S M, Glasgold M J, Glasgold R A. Complimentary fat grafting. Chapter 1: Aesthetic and aging: a new paradigm. First edition. Philadelphia, PA; Lippincott Williams & Wilkins 2007: 1-11
• 17 Massry G G. Transconjunctival approach to lower-lid blepharoplasty. In: Shiffman MA, Mirrafati SJ, Lam SM Simplified Facial Rejuvenation. New York, NY; Springer 2008: 471-474
• 18 Anderson R L, Gordy D D. The tarsal strip procedure.  Arch Ophthalmol. 1979;  97 2192-2196