The management of eyelid laxity during lower eyelid blepharoplasty

Lower eyelid and lateral canthal angle malposition or frank ectropion are the most common complications of lower eyelid blepharoplasty. Although these complications may result from excessive skin excision, from surgical imbrication of the orbital septum or lower eyelid retractors, or from scar formation within the eyelid, failure to correct preexisting lower eyelid laxity is the most common cause. Recently published data have established laxity at the lateral canthus as the primary cause of involutional lower eyelid laxity. We review the pathophysiology of lower eyelid laxity and present an anatomic approach for the correction of lower eyelid laxity during blepharoplasty.