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DOI: 10.1055/s-0037-1598632
An Update on Lower Lid Blepharoplasty
Publication History
Publication Date:
28 February 2017 (online)
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Abstract
Aging changes to the lower eyelids and midface include pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition with a lower eyelid blepharoplasty. Either a transcutaneous or transconjunctival approach may be used, though recent trends have favored the transconjunctival technique if procedures require more than simple skin excision. In manipulating the inferior orbital fat pads, a surgeon has many options including excision, repositioning, or augmentation with synthetic dermal filler, autologous fat grafts, or acellular dermal allografts. The authors review and detail indications, preoperative evaluation, techniques, and complications of lower lid blepharoplasty.
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References
- 1 Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 1995; 96 (2) 354-362
- 2 The American Society for Aesthetic Plastic Surgery. Cosmetic surgery national databank statistics. Aesthet Surg J [serial online]. Available at: http://www.surgery.org/sites/default/files/ASAPS-Stats2015.pdf . Accessed January 3, 2017
- 3 Naik MN, Honavar SG, Das S, Desai S, Dhepe N. Blepharoplasty: an overview. J Cutan Aesthet Surg 2009; 2 (1) 6-11
- 4 Davison SP, Irio M, Oh C. Transconjunctival lower lid blepharoplasty with and without fat repositioning. Clin Plast Surg 2015; 42 (1) 51-56
- 5 Pepper JP, Baker SR. Transcutaneous lower blepharoplasty with fat transposition. Clin Plast Surg 2015; 42 (1) 57-62
- 6 Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016; 137 (1) 196e-213e
- 7 Smith CB, Waite PD. Lower transcutaneous blepharoplasty. Atlas Oral Maxillofac Surg Clin North Am 2016; 24 (2) 135-145
- 8 Jindal K, Sarcia M, Codner MA. Functional considerations in aesthetic eyelid surgery. Plast Reconstr Surg 2014; 134 (6) 1154-1170
- 9 Moss SE, Klein R, Klein BE. Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol 2000; 118 (9) 1264-1268
- 10 Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plast Surg 2013; 15 (1) 39-46
- 11 McKinney P, Byun M. The value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg 1999; 104 (2) 566-569 , discussion 570–573
- 12 Altinors DD, Akça S, Akova YA , et al. Smoking associated with damage to the lipid layer of the ocular surface. Am J Ophthalmol 2006; 141 (6) 1016-1021
- 13 Tan KS, Oh S-R, Priel A , et al. Surgical anatomy of the forehead, eyelids, and midface for the aesthetic surgeon. In: Massry GG, Murphy MR, Azizzadeh B, , eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York: Springer; 2011: 11-24
- 14 Castanares S. Blepharoplasty for herniated intraorbital fat; anatomical basis for a new approach. Plast Reconstr Surg (1946) 1951; 8 (1) 46-58
- 15 McCollough EG, English JL. Blepharoplasty. Avoiding plastic eyelids. Arch Otolaryngol Head Neck Surg 1988; 114 (6) 645-648
- 16 Garcia RE, McCollough EG. Transcutaneous lower eyelid blepharoplasty with fat excision: a shift-resisting paradigm. Arch Facial Plast Surg 2006; 8 (6) 374-380
- 17 Beare R. Surgical treatment of senile changes in the eyelids: the McIndoe-Beare technique. In: Smith B, , ed. Proceedings of the 2nd International Symposium on Plastic and Reconstructive Surgery of the Eye and Adnexa. St. Louis, MO: Mosby; 1967: 362-366
- 18 Massiha H. Combined skin and skin-muscle flap technique in lower blepharoplasty: a 10-year experience. Ann Plast Surg 1990; 25 (6) 467-476
- 19 Pack S, Quereshy FA, Altay MA, Baur DA. Transconjunctival lower blepharoplasty. Atlas Oral Maxillofac Surg Clin North Am 2016; 24 (2) 147-151
- 20 Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg 1999; 103 (3) 1041-1043 , discussion 1044–1045
- 21 Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty. Technique and complications. Ophthalmology 1989; 96 (7) 1027-1032
- 22 Undavia S, Briceño CA, Massry GG. Quantified incision placement for postseptal approach transconjunctival blepharoplasty. Ophthal Plast Reconstr Surg 2016; 32 (3) 191-194
- 23 Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg 2004; 113 (7) 2124-2141 , discussion 2142–2144
- 24 Netscher DT, Patrinely JR, Peltier M, Polsen C, Thornby J. Transconjunctival versus transcutaneous lower eyelid blepharoplasty: a prospective study. Plast Reconstr Surg 1995; 96 (5) 1053-1060
- 25 Goldberg RA, Edelstein C, Shorr N. Fat repositioning in lower blepharoplasty to maintain infraorbital rim contour. Facial Plast Surg 1999; 15 (3) 225-229
- 26 Loeb R. Fat pad sliding and fat grafting for leveling lid depressions. Clin Plast Surg 1981; 8 (4) 757-776
- 27 Goldberg RA, Edelstein C, Balch K, Shorr N. Fat repositioning in lower eyelid blepharoplasty. Semin Ophthalmol 1998; 13 (3) 103-106
- 28 Goldberg RA. Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 2000; 105 (2) 743-748 , discussion 749–751
- 29 Mohadjer Y, Holds JB. Cosmetic lower eyelid blepharoplasty with fat repositioning via intra-SOOF dissection: surgical technique and initial outcomes. Ophthal Plast Reconstr Surg 2006; 22 (6) 409-413
- 30 Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning: a retrospective comparison of transposing fat to the subperiosteal vs supraperiosteal planes. JAMA Facial Plast Surg 2013; 15 (3) 176-181
- 31 McCord CD, Boswell CB, Hester TR. Lateral canthal anchoring. Plast Reconstr Surg 2003; 112 (1) 222-237 , discussion 238–239
- 32 Jelks GW, Glat PM, Jelks EB, Longaker MT. The inferior retinacular lateral canthoplasty: a new technique. Plast Reconstr Surg 1997; 100 (5) 1262-1270 , discussion 1271–1275
- 33 Lelli Jr GJ, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg 2010; 125 (3) 1007-1017
- 34 Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000; 106 (2) 438-453 , discussion 454–459
- 35 Carraway JH, Mellow CG. The prevention and treatment of lower lid ectropion following blepharoplasty. Plast Reconstr Surg 1990; 85 (6) 971-981
- 36 Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg 1999; 25 (3) 224-232