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An integrated approach to lower blepharoplasty.

David A Hidalgo1

  • 1New York, N.Y. From the Division of Plastic Surgery, Weill-Cornell University Medical College.

Plastic and Reconstructive Surgery
|January 5, 2011
PubMed
Summary

This study shows that a tailored lower blepharoplasty technique, preserving the orbicularis muscle and using fat transposition with skin flaps and TCA peels, effectively corrects tear troughs and wrinkles with low complication rates.

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Area of Science:

  • Oculoplastic surgery
  • Facial plastic surgery
  • Cosmetic surgery

Background:

  • Traditional lower blepharoplasty methods have limitations.
  • Newer techniques focus on fat preservation and blending the lid-cheek junction.
  • Avoiding orbicularis muscle incision and utilizing lateral canthal tightening are favored.

Purpose of the Study:

  • To investigate a transconjunctival approach for fat resection and transposition.
  • To evaluate a skin flap technique for excision and simultaneous resurfacing with trichloroacetic acid (TCA).
  • To assess the efficacy and safety of preserving orbicularis muscle innervation.

Main Methods:

  • A retrospective study of 248 lower blepharoplasty patients over 4 years.
  • Component procedures were tailored to individual patient anatomy.
  • Techniques included fat excision/transposition, skin excision, TCA peels, temporary tarsorrhaphy, and lateral canthopexy.

Main Results:

  • High rates of fat excision (91%) and transposition (61%).
  • Skin excision (63%) and TCA peels (62%) were frequently performed.
  • Low complication (3) and revision (6) rates observed with an average follow-up of 5.5 months.

Conclusions:

  • A component-based lower blepharoplasty sparing the orbicularis muscle is effective.
  • Fat transposition successfully corrects tear trough deformities.
  • Skin flap with TCA peel safely addresses rhytides, and lateral canthal support improves eyelid tone.