Lower Eyelid Skin Research Articles

Tarsal strip procedure and plication sutures combined with lower blepharoplasty

Acquired ectropion may result from both horizontal lower eyelid laxity and attenuation of the lateral canthal tendon. The tarsal strip procedure ensures a normal horizontal length of the lower eyelid and also corrects the attenuated lateral canthal tendon. Lateral plication sutures, which unite the temporal lower lid orbicularis muscle to periosteum of the lateral orbital rim, can also be used to suspend lower eyelid skin. This article describes the technique of combining the tarsal strip and plication suture procedure with a lower eyelid blepharoplasty.

The fourth option: A novel approach to lower-lid blepharoplasty

Three basic surgical techniques exist for lower-lid blepharoplasty: (1) the skin flap, (2) the transconjunctival approach, and (3) the skin-muscle flap. Each addresses the problems of excessive skin, muscle, and infraorbital fat either alone or in combination. None of these procedures will correct fine wrinkles. In fact, in some patients the lower-lid wrinkling appears far worse after fat removal. We describe a "fourth option" to lower-lid blepharoplasty which corrects the problem of fine wrinkling, periorbital fat herniation, and mild skin excess. For these patients, we remove the fat through a transconjunctival approach and peel the lower lid using full-strength Baker's phenol solution. To date, we have performed this procedure in 17 patients with excellent results. There have been no complications. Our longest followup is 30 months. This procedure is indicated for patients with both excess infraorbital fat and lower-lid skin with associated fine wrinkling. Only the experienced surgeon should attempt this procedure. Caution should be exercised with patients who have previously undergone blepharoplasty as severe ectropion has been reported with chemical peel around the eyelids. Lower-lid chemical peel after a modified skin-muscle flap has been described, but we believe that peeling after a transconjunctival approach is safer. We feel that with more knowledge and experience using the "fourth option" of lower-lid blepharoplasty, it will become the procedure of choice for select patients.

The Transconjunctival Approach to the Orbital Floor and Orbital Fat A Prospective Study

The transconjunctival approach to the inferior orbit and orbital fat offers the potential advantage of avoidance of scar creation in the lower eyelid skin and anterior lamellae. Complications of this approach, including conjunctival fornix shortening and eyelid margin malposition, have been occasionally reported. We prospectively observed 25 patients undergoing transconjunctival blepharoplasty and orbital floor surgery. Fornix depth, eyelid margin position, and the presence or absence of eyelid retraction were measured preoperatively and at each postoperative visit. No significant permanent change in these parameters was observed. Temporary entropion was observed in two patients; this resolved with conservative treatment. On self-limited suture granuloma was observed. In a subgroup of six patients, the conjunctival incision was closed on one side and left unclosed on the other. No adverse healing was noted on the unclosed side. We conclude that the transconjunctival approach is associated with a low incidence of complications, and that it does not significantly alter the fornix depth or eyelid margin position. A skin incision is avoided. The inferior orbital septum is not violated, greatly reducing the risk of development of lower eyelid retraction.

Lower eyelid examination following blepharoplasty in the monkey.

To determine the validity and reliability of the physical examination in evaluating abnormalities of the lower eyelid following blepharoplasty, a model using monkeys was developed. One plastic surgeon performed a variety of blepharoplasties, including extensive resection of lower lid skin and/or muscle, and/or the creation of scarring in the orbital septum. Three months postoperatively, a second plastic surgeon and an ophthalmologist examined these monkeys' lower eyelids. Although there was substantial agreement between the observers as to the degree of scleral show and which eye was "worse" in each monkey, the examiners were correct in just 7 of 24 attempts to identify the exact operative procedure that had been performed. This study demonstrates that it is difficult to identify the cause of abnormalities in appearance and position of the lower lid after blepharoplasty. Orbital septal scarring can cause the same degree of scleral show as excessive skin resection. Muscle resection contributed little to lower lid position.

Conservative surgery in orbital teratoma

A case of orbital teratoma is presented. The clinical, X-ray, CT scan, echographic and histopathologic features are discussed. The tumor was excised in toto through a lower eyelid skin approach with preservation of the eye ball and optic nerve. There was no recurrence at one year follow-up.

Syringoma: Removal by Electrodesiccation and Curettage

Syringomas are benign adnexal tumors often located on the lower eyelid skin. Patients usually request removal for aesthetic reasons. Electrodesiccation and curettage of these lesions provides local control while preserving uninvolved eyelid skin.

Simultaneous Treatment of Lower Eyelid Dermatochalasis and Abnormal-Appearing Skin

Abnormal, thin, crinkly, or pigmented nasal lower eyelid skin is sometimes associated with dermatochalasis (excessive skin). In these cases, excision of temporal lower eyelid skin by conventional cosmetic blepharoplasty draws and diffuses this abnormal skin temporally and worsens the appearance of the lower eyelid skin. A new procedure in which excessive abnormal skin is excised nasally rather than temporally draws and diffuses the more normal temporal skin nasally and improves the appearance of the lower eyelid skin. This approach simultaneously resolved dermatochalasis and abnormal-appearing lower eyelid skin in six eyelids of three patients without complications.