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Updated: Jan 7, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Composite Flaps in Subciliary Lower Blepharoplasty: Technique and Postoperative Results Compared to Traditional
Craig Cameron Brawley, Andrew T Timberlake1, Benjamin Paul1
1Manhattan Facial Surgical Suites, PLLC, New York City, NY.
Introduction:
Lower eyelid blepharoplasty is performed via transconjunctival and subciliary approaches. In the subciliary approach, we have compared 2 methods: biplanar flaps versus a composite flap, with the goal of improved short-term recovery.
Materials And Methods:
Preoperative and 6-day postoperative 2-dimensional patient photographs were reviewed from each patient assigned to 1 of the 2 groups. Two blinded surgeons who neither performed the procedure nor were aware of the technique used reviewed the postoperative pictures from each patient and scored the results based on the Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) Questionnaire.
Results:
Forty-one patients (82 eyes) underwent subciliary lower blepharoplasty in the stated time frame. The primary outcome of the modified SPREE survey showed that patients who underwent the composite technique had an average edema score of 1.06 (from a 1-4 increasing severity scale) compared to 1.52 scored on patients with the biplanar technique ( P < 0.00228). For ecchymosis, patients who underwent the composite technique had an average score of 0.25 (from a 0-3 increasing severity scale) compared to 0.60 scored on patients with the biplanar technique ( P < 0.04444).
Conclusions:
Composite flaps were shown to have a statistically significant decreased Modified SPREE score compared to biplanar flaps.
