Abstract
Baggy lower eyelids result from herniated orbital fat, excess skin, hypertrophic or lax orbicularis sometimes associated with lower lid laxity resulting from degeneration of the lateral canthal tendon with age. Two main approaches are used: skin-muscle flap or the transconjunctival approach in younger patients who have herniated orbital fat with minimal or not excessive lower eyelid skin. Preoperative evaluation of the patient is extremely important in lower lid blepharoplasty before any surgical procedure: excessive skin, herniated orbital fat, retraction and laxity must be evaluated. In our practice, a lateral canthoplasty is often performed in case of horizontal lower laxity in order to avoid round eye, scleral show or lower lid ectropion. In some patients, subperiosteal elevation of malar soft tissue is associated with lower blepharoplasty via subciliary incision.
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