Reducing eyelid retraction following subperiosteal face lift

The most common complication of lower blepharoplasty is malposition of the lower eyelid. This deformity may present as scleral show, ectropion, entropion, or canthal dystopia, with dry eye or epiphora. These problems occurred frequently in our initial series of patients undergoing blepharoplasty with subperiosteal face lift. The key to prevention lay in avoiding the potential causes of these problems: overresection of eyelid skin, retraction of the orbital septum, orbicularis oculi dysfunction, postoperative swelling, and downward pull from the facial suspension. This article reviews the cases of 14 consecutive patients who underwent a modified subperiosteal face lift with blepharoplasty. Eleven of the patients had a concomitant endoscopically assisted brow lift. This group is compared with a prior series of 16 patients who underwent 12 endoscope-assisted brow lifts without special modifications. The modifications in the second series consisted of the following: (1) Improved patient selection; (2) minimal tissue trauma; (3) intact orbital septum; (4) lengthening of the septum; (5) secure midfacial suspension; (6) three-step lateral canthoplasty; (7) limited resection of skin; and (8) specific postoperative care. Results regarding the incidence of eyelid malposition and reoperations were subjected to Fisher's exact test. In the 14 consecutive patients who underwent the modified procedure, two temporary episodes of lower eyelid malposition occurred (follow-up of 12 to 20 months). In the 16 patients who underwent a nonmodified procedure, five temporary and three permanent episodes of eyelid malposition occurred (follow-up of 20 to 30 months). Fisher's exact test demonstrated a significant difference with a p value of 0.038. Modifications of the subperiosteal face lift and lower blepharoplasty reduced significantly but did not eliminate the incidence of lower eyelid malposition.