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Facial Plast Surg 2021; 37(02): 198-204
DOI: 10.1055/s-0041-1724112
Original Article

An Update on Subciliary Lower Eyelid Blepharoplasty

Ozcan Cakmak
1   Department of Facial Plastic Surgery, Faceistanbul, Istanbul, Turkey
,
Ismet Emrah Emre
2   Department of Otorhinolaryngology, Acibadem University, Halkali Merkez Mahallesi Turgut Ozal Bulvari, Istanbul, Turkey
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Abstract

The subciliary lower eyelid blepharoplasty has evolved considerably to create a more harmonious natural appearance with a fuller and unoperated look and also to minimize the complications. While lower eyelid malposition was very common in the past, now this complication is significantly reduced by attention to preoperative evaluation, meticulous surgical planning, precise surgical technique, and postoperative care. Various prophylactic maneuvers maintaining/strengthening lower lid support can be utilized to prevent lower lid malposition including preservation of the pretarsal orbicularis oculi muscle, conservative resection of skin and muscle, and suspension of the orbicularis oculi muscle and/or tarsus to the periosteum of the lateral orbital rim. The release of the orbicularis retaining ligament and surgical transposition of orbital fat over the rim rather than excision allows for smoothing of the lid-cheek junction, filling the tear trough deformity, and reducing the appearance of bulging fat in the lower eyelid. In this article the reader will find a comprehensive approach for achieving a smooth contour with gradual blending at the lower eyelid–cheek junction while maintaining/restoring normal lower lid support. A descriptive outline of postoperative care is also provided to help in optimal healing for the patient.

Keywords

lower eyelid blepharoplasty - subciliary approach - septal reset - lateral canthopexy - orbicularis muscle suspension


Publication History

Article published online:
25 February 2021

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  • References

  • 1 Codner MA, Wolfli JN, Anzarut A. Primary transcutaneous lower blepharoplasty with routine lateral canthal support: a comprehensive 10-year review. Plast Reconstr Surg 2008; 121 (01) 241-250
    CrossrefPubMedGoogle Scholar
  • 2 Maffi TR, Chang S, Friedland JA. Traditional lower blepharoplasty: is additional support necessary? A 30-year review. Plast Reconstr Surg 2011; 128 (01) 265-273
    CrossrefPubMedGoogle Scholar
  • 3 Shadfar S, Perkins SW. Transcutaneous skin-muscle flap suspension lower-eyelid blepharoplasty. JAMA Facial Plast Surg 2015; 17 (06) 459-461
    CrossrefPubMedGoogle Scholar
  • 4 Jacobs SW. Prophylactic lateral canthopexy in lower blepharoplasties. Arch Facial Plast Surg 2003; 5 (03) 267-271
    CrossrefPubMedGoogle Scholar
  • 5 Korn BS, Kikkawa DO, Cohen SR. Transcutaneous lower eyelid blepharoplasty with orbitomalar suspension: retrospective review of 212 consecutive cases. Plast Reconstr Surg 2010; 125 (01) 315-323
    CrossrefPubMedGoogle Scholar
  • 6 Drolet BC, Sullivan PK. Evidence-based medicine: blepharoplasty. Plast Reconstr Surg 2014; 133 (05) 1195-1205
    CrossrefPubMedGoogle Scholar
  • 7 Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg 2004; 113 (07) 2124-2141 , discussion 2142–2144
    CrossrefPubMedGoogle Scholar
  • 8 Carraway JH, Mellow CG. The prevention and treatment of lower lid ectropion following blepharoplasty. Plast Reconstr Surg 1990; 85 (06) 971-981
    CrossrefPubMedGoogle Scholar
  • 9 Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000; 106 (02) 438-453 , discussion 454–459
    CrossrefPubMedGoogle Scholar
  • 10 Kamer FM, Mikaelian AJ. Preexcision blepharoplasty. Arch Otolaryngol Head Neck Surg 1991; 117 (09) 995-999 , discussion 1000
    CrossrefPubMedGoogle Scholar
  • 11 Jindal K, Sarcia M, Codner MA. Functional considerations in aesthetic eyelid surgery. Plast Reconstr Surg 2014; 134 (06) 1154-1170
    CrossrefPubMedGoogle Scholar
  • 12 Ramirez O, Santamarina R. Spatial orientation of motor innervation to the lower orbicularis oculi muscle. Aesthet Surg J 2000; 20 (02) 107-113
    CrossrefPubMedGoogle Scholar
  • 13 Stuzin JM, Baker TJ, Baker TM. Discussion: expanded applications for the transconjunctival lower lid blepharoplasty. Plast Reconstr Surg 1999; 103 (03) 1044-1045
    CrossrefPubMedGoogle Scholar
  • 14 DiFrancesco LM, Anjema CM, Codner MA, McCord CD, English J. Evaluation of conventional subciliary incision used in blepharoplasty: preoperative and postoperative videography and electromyography findings. Plast Reconstr Surg 2005; 116 (02) 632-639
    CrossrefPubMedGoogle Scholar
  • 15 Hwang K, Lee DK, Lee EJ, Chung IH, Lee SI. Innervation of the lower eyelid in relation to blepharoplasty and midface lift: clinical observation and cadaveric study. Ann Plast Surg 2001; 47 (01) 1-5 , discussion 5–7
    CrossrefPubMedGoogle Scholar
  • 16 McCord D, Codner A. Current concepts of eyelid function, innervation, and biomechanics. In: McCord D, Codner A. eds. Eyelid and Periorbital Surgery. St. Louis, MO: Quality Medical Publishing, Inc.; 2008: 61-80
    Google Scholar
  • 17 McCord D, Codner A. Lower lid blepharoplasty. In: McCord D, Codner A. eds. Eyelid and Periorbital Surgery. St. Louis, MO: Quality Medical Publishing, Inc.; 2008: 259-306
    Google Scholar
  • 18 Wong CH, Mendelson B. Extended transconjunctival lower eyelid blepharoplasty with release of the tear trough ligament and fat redistribution. Plast Reconstr Surg 2017; 140 (02) 273-282
    CrossrefPubMedGoogle Scholar
  • 19 Muzaffar AR, Mendelson BC, Adams Jr WP. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg 2002; 110 (03) 873-884 , discussion 897–911
    CrossrefPubMedGoogle Scholar
  • 20 Wong CH, Hsieh MKH, Mendelson B. The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg 2012; 129 (06) 1392-1402
    CrossrefPubMedGoogle Scholar
  • 21 McCord Jr CD, Codner MA, Hester TR. Redraping the inferior orbicularis arc. Plast Reconstr Surg 1998; 102 (07) 2471-2479
    CrossrefPubMedGoogle Scholar
  • 22 Zoumalan CI, Lattman J, Zoumalan RA, Rosenberg DB. Orbicularis suspension flap and its effect on lower eyelid position: a digital image analysis. Arch Facial Plast Surg 2010; 12 (01) 24-29
    CrossrefPubMedGoogle Scholar
  • 23 Honrado CP, Pastorek NJ. Long-term results of lower-lid suspension blepharoplasty: a 30-year experience. Arch Facial Plast Surg 2004; 6 (03) 150-154
    CrossrefPubMedGoogle Scholar
  • 24 Massry GG. Managing the lateral canthus in the aesthetic patient. In: Massry GG, Murphy M, Azizzadeh B. eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 185-197
    CrossrefGoogle Scholar
  • 25 Fagien S. Algorithm for canthoplasty: the lateral retinacular suspension: a simplified suture canthopexy. Plast Reconstr Surg 1999; 103 (07) 2042-2053 , discussion 2054–2058
    CrossrefPubMedGoogle Scholar
  • 26 Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016; 137 (01) 196e-213e
    CrossrefPubMedGoogle Scholar
  • 27 Taban M, Lee S, Hoenig JA, Mancini R, Goldberg RA, Douglas RS. Postoperative wound modulation in aesthetic eyelid and periorbital surgery. In: Massry GG, Murphy M, Azizzadeh B. eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 307-312
    CrossrefGoogle Scholar
  • 28 Pacella SJ, Codner MA. Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show. Plast Reconstr Surg 2010; 125 (02) 709-718
    CrossrefPubMedGoogle Scholar
  • 29 Stutman RL, Codner MA. Tear trough deformity: review of anatomy and treatment options. Aesthet Surg J 2012; 32 (04) 426-440
    CrossrefPubMedGoogle Scholar
  • 30 Goldberg RA. Transconjunctival orbital fat repositioning: transposition of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 2000; 105 (02) 743-748 , discussion 749–751
    CrossrefPubMedGoogle Scholar
  • 31 Barton Jr FE, Ha R, Awada M. Fat extrusion and septal reset in patients with the tear trough triad: a critical appraisal. Plast Reconstr Surg 2004; 113 (07) 2115-2121 , discussion 2122–2123
    CrossrefPubMedGoogle Scholar
  • 32 Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning: a retrospective comparison of transposing fat to the subperiosteal vs supraperiosteal planes. JAMA Facial Plast Surg 2013; 15 (03) 176-181
    CrossrefPubMedGoogle Scholar
  • 33 Wong CH, Mendelson B. Facial soft-tissue spaces and retaining ligaments of the midcheek: defining the premaxillary space. Plast Reconstr Surg 2013; 132 (01) 49-56
    CrossrefPubMedGoogle Scholar
  • 34 Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 1995; 96 (02) 354-362
    CrossrefPubMedGoogle Scholar
  • 35 Eder H. Importance of fat conservation in lower blepharoplasty. Aesthetic Plast Surg 1997; 21 (03) 168-174
    CrossrefPubMedGoogle Scholar