Lower Eyelid Rejuvenation with Skin/Skin-Muscle/Fat Repositioning Techniques

Abstract

A preoperative examination of the cosmetic patient considering lower eyelid blepharoplasty is essential. The preoperative examination allows the patient to express his or her concerns and desires and allows the physician to establish a healthy physician-patient relationship, which is vital in the treatment of the patient. The preoperative examination also allows the physician to explain the surgery and possible complications. As opposed to the aging patient with severe dermatochalasis and orbital fat prolapse, the cosmetic patient considering lower eyelid blepharoplasty often has specific areas of the eyelids to address. It is important for the surgeon to identify these areas and understand exactly what the patient wishes to accomplish with the surgery. One patient may wish to diminish the prominence of the central and lateral fat pads, whereas another may wish to reduce redundant lower eyelid skin. It is often helpful to have the cosmetic patient hold a hand mirror and point out to the surgeon exactly the areas of concern. Both anterior and posterior approaches to the lower eyelid exist. The anterior approach to lower eyelid blepharoplasty is made through an infraciliary skin incision, and most patients require excision of excess skin, orbicularis oculi muscle, and fat. In these patients, a skin-muscle flap is removed. If only loose and redundant skin is present, a skin flap with resection of the redundant skin is performed. If only excess fat needs to be removed, a skin-muscle flap is raised, excess fat is removed, and little or no excess skin or muscle is removed.