Blepharoplasty lateral internal suspension suture: BLISS technique

The lower blepharoplasty procedure has had numerous surgical variations described and remains a challenge to those performing the operation. Disappointments with the technique revolve around complications such as lateral third scleral show, hollow sunken eyelids, rounding of the eye and overall long-term, tired, drawn appearance of the lower lids. Multiple adjuncts to the blepharoplasty procedure have been described. These vary in their difficulty of execution and associated complications. The concept of internal muscle suspension has been accepted as a successful adjunct by many authors but often the technique chosen has been a complicated one, adding time and complexity to the procedure.