Lower blepharoplasty techniques should be tailored to individual anatomical problems

Limitations associated with traditional skin-muscle flaps and transconjunctival fat resection have led to newer concepts in lower blepharoplasty that emphasize fat preservation, blending of the lid-cheek junction, simplified skin excision, and less morbid resurfacing techniques. This study provides a good review of these various techniques and investigates a transconjunctival approach to resect and transpose fat combined with a skin flap technique that permits skin excision and simultaneous resurfacing with 30% trichloroacetic acid. The orbicularis is not violated and lateral canthal support is used as necessary.

Investigators reviewed data from 248 patients who underwent lower blepharoplasty over a four-year period. The technique consisted of component procedures that varied based on individual anatomy. Fat excision was performed in 91 percent of patients, fat transposition in 61 percent, skin excision in 63 percent, trichloroacetic acid peels in 62 percent, temporary tarsorrhaphy in 31 percent, and lateral canthopexy in 18 percent. At an average follow-up of 5.5 months, there were only three complications and six revisions.

The authors conclude that lower blepharoplasty integrating component techniques tailored to individual anatomical problems and sparing the orbicularis muscle is effective and associated with few complications and revisions. Fat transposition achieves effacement of the tear trough deformity. A skin flap approach effectively treats rhytides and is safe for simultaneous resurfacing with a mild peeling agent. Selective use of lateral canthal support improves lower eyelid tone and prevents malposition problems.