Techniques in blepharoplasty

The technique for upper lid blepharoplasty is presented, which emphasizes the creation of a concave, high supratarsal fold by removal of existing preaponeurotic fat pads, excision of a strip of preseptal orbicularis fibers, and portion of the orbital septum. In additon, the skin edges are fixated to the levator aponeurosis just above the tarsus. With this technique, a pleasing result can be obtained, minimizing the amount of skin that is required to excised and introducing a safety factor in the prevention of postoperative lagophthalmos. A skin technique for lower led blepharoplasty is presented which reduces a tendency for "dog-ear" formation with skin closure and minimizes chances of postoperative ectropion. The technique consists of triangulation of the excision of skin from the lower lid to insure an equal-sided wound edge for precise closure and anchoring the lower lid skin flap to the lateral orbital rim. Although the above techniques introduce a safety factor reducing the problem of lagophthalmos in the upper lid and ectropion in the lower lid, they should be considered an "advanced technique" by the occasional blepharoplasty surgeon.