Facial plast Surg 2013; 29(01): 032-039
DOI: 10.1055/s-0033-1333836
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Algorithmic Approach to Lower Lid Blepharoplasty

Ryan M. Collar1, Sofia Lyford-Pike1, Patrick Byrne1
  • 1Department of Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Publication History

Publication Date:
20 February 2013 (online)


The debate continues around transconjunctival versus transcutaneous approaches. Despite the perceived safety of the former, many experienced surgeons continue to advocate the latter. This review aims to present a balanced view of each approach. It will first address the anatomic basis of lower lid aging and then organize recent literature and associated discussion into the transconjunctival and transcutaneous approaches. The integrated algorithm employed by the senior author will be presented. Finally this review will describe less mainstream suture techniques for lower lid rejuvenation and lower lid blepharoplasty complications with a focus upon lower lid malposition.