Eyelid rejuvenation: a marriage of old and new

Lower lid anatomy and the subtleties of this region have been studied extensively in the past. The variations that are found in the lower eyelid can lead to complications if the surgeon does not have a complete understanding. Lower lid blepharoplasty techniques have progressed over the past from simple skin excisions to midface and lower eyelid repositioning. With these modifications, our understanding of the anatomy and the function of the lower eyelid improve. This review highlights the findings of lower eyelid anatomy and rejuvenating techniques reported over the past year.

Over this past year anatomic studies have been performed focusing on the aging eye and midface in both Asians and non-Asians. Controversial work has been presented using an injectable (phosphatidylcholine) to ablate fat in the lower eyelids. A myriad of articles have discussed various options for combined midface and lower eyelid rejuvenation. The age-old argument of transconjunctival vs skin muscle techniques has been presented. More recent debates over fat volumetric preservation continue. Finally, a highlight of this year was a retrospective study looking at a conservative approach to blepharoplasty.

This has been a year of confirmation of old techniques and anatomic findings and a year of increasing complexity in midface lower eyelid rejuvenation. What is clear is that no one technique is ideal for every patient. A basic understanding of lower eyelid anatomy, preoperative evaluation, and a grasp of the multiple techniques will allow us to formulate a treatment algorithm that can be safe and effective for our patients.