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Surgical Correction for Pediatric Epiblepharon and Trichiasis

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

The shade procedure: for lower lid deformities.

John A Persing¹, Bianca Knoll, Joseph Shin

¹New Haven, Conn. From the Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine.

Plastic and Reconstructive Surgery

|March 20, 2008

Summary

The shade procedure repositions lower eyelid fat to improve contour deformities, offering a solution for patients experiencing fat herniation and midface depression. This technique enhances periorbital aesthetics and globe prominence.

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Area of Science:

Oculoplastic surgery
Facial plastic surgery
Reconstructive surgery

Background:

Traditional lower lid blepharoplasty involving fat resection can lead to undesirable aesthetic outcomes like periorbital depression.
The shade procedure was developed to mitigate these complications and improve aesthetic results.

Purpose of the Study:

To evaluate the efficacy and safety of the shade procedure for lower lid fat herniation.
To assess the shade procedure's ability to correct periorbital contour deformities.

Main Methods:

The shade procedure involves repositioning herniated orbital fat as an apron over the orbital rim.
Key techniques include limited dissection, fat apron fixation, and elevation of midface structures.
Sixty-five patients underwent the procedure over 11 years, combined with other facial surgeries.

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Main Results:

The study reported no instances of hematoma, facial nerve palsy, or skin slough.
Two patients (3%) experienced postoperative ectropion requiring revision.
Independent raters rated operative results as improved in all cases.

Conclusions:

The shade procedure is a viable option for lower lid blepharoplasty, particularly for patients with fat herniation and associated midface depression.
It effectively addresses contour abnormalities, improving aesthetic outcomes.