Lower blepharoplasty; advanced techniques and adjunctive procedures

Abstract

ABSTRACT Introduction There are two main techniques of lower blepharoplasty: transcutaneous and transconjunctival approaches. Most patients seeking lower eyelid rejuvenation have concomitant involutional changes in the lower eyelid and midface, which would better be addressed concurrently with the lower blepharoplasty procedure to yield better aesthetic and functional outcomes. Areas covered This study aims to review common aging-related changes in the lower eyelid as well as important preoperative considerations, surgical techniques, and various modifications of lower blepharoplasty. A literature search was performed in the PubMed database of English-language journals without restriction on the publication date using selected keywords. The relevant articles were selected by reviewing the titles and abstracts. Expert opinion The lower eyelid and midface should be perceived as a continuum. Currently the fat preservation approach is the mainstream in lower blepharoplasty to prevent postoperative skeletonization of the eye. Fat transposition, via either pedicled fat flaps or free fat grafts, is used to efface tear trough deformity and the eyelid-cheek junction as a primary aim inaesthetic lower eyelid surgeries. Lower blepharoplasty can also be combined with adjuvant procedures to address festoon and droopy midface in selected individuals.