Transconjunctival Lower Blepharoplasty for Chinese Patients Combined With a Subciliary Incision for Skin Removal

Abstract

With socioeconomic standards and life spans increasing, lower blepharoplasty is becoming one of the most popularly performed rejuvenation operations in China. Classic lower blepharoplasty includes transconjunctival and transcutaneous procedures. These procedures have been the primary solution to the common problem of palpebral bags. However, many plastic surgeons have ignored the shortcomings of the postoperative results for these surgical techniques. The lower blepharoplasty is fraught with both functional and aesthetic complications such as eyelid malpositioning, dry eye, ocular irritation, blurred vision, tearing, and poor aesthetic outcome [1, 2]. A less than excellent surgical appearance after lower blepharoplasty has resulted from a faulty operative design. Before the operation, the plastic surgeon must perform a comprehensive analysis of the patient and choose the proper rejuvenation procedure to obtain a satisfactory aesthetic result. The traditional (transcutaneous) approach to lower eyelid blepharoplasty involves excision of varied amounts of skin, muscle, and fat. This subtractive form of surgery typically is performed through a cutaneous subciliary incision with violation of several tissue planes (orbicularis muscle and orbital septum), which potentially promotes postoperative complications such as lower eyelid retraction or ectropion. The advantages of the transconjunctival procedure include the integrity and innervation of the orbicularis oculi muscle being maintained. The probability of postoperative lower eyelid retraction or ectropion is decreased [3, 4]. In contrast, excess skin and muscle and periorbital rhytides cannot be treated with transconjunctival surgery. In recent years, we have used lower lid blepharoplasty, a bilamellar surgery that addresses lower eyelid fat through a transconjunctival incision and excess skin through a subciliary skin flap alone. From January 2006 to June 2008, 80 lids in 40 patients were subjected to this operation. Most of the patients were women, and the average patient age was 53.5 years. The primary indications for the procedure are as follows: