Semin Plast Surg 2021; 35(02): 072-077
DOI: 10.1055/s-0041-1727281
Review Article

Eyelid Malposition after Blepharoplasty: An Ounce of Prevention

Katherine J. Williams
1   Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
,
Richard C. Allen
1   Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
2   Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
› Author Affiliations
Funding None.

Abstract

Upper and lower eyelid blepharoplasty are common procedures performed to provide a more youthful and rejuvenated appearance. However, this seemingly straightforward procedure may result in lid malpositions, frustrating the patient and surgeon alike, which ultimately require further treatment. We review preoperative assessment pearls to avoid these lid malpositions, as well as options for treating any postoperative complications related to lid position. Many of the techniques discussed in this article, in addition to many other oculoplastic procedures, are available to view in Dr. Richard C. Allen's operative video library at: http://webeye.ophth.uiowa.edu/eyeforum/video/plastics/.



Publication History

Article published online:
08 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Hassanpour SE, Khajouei Kermani H. Brow ptosis after upper blepharoplasty: findings in 70 patients. World J Plast Surg 2016; 5 (01) 58-61
  • 2 Prado RB, Silva-Junior DE, Padovani CR, Schellini SA. Assessment of eyebrow position before and after upper eyelid blepharoplasty. Orbit 2012; 31 (04) 222-226
  • 3 Millay DJ, Larrabee Jr WF. Ptosis and blepharoplasty surgery. Arch Otolaryngol Head Neck Surg 1989; 115 (02) 198-201
  • 4 Wolfort FG, Poblete JV. Ptosis after blepharoplasty. Ann Plast Surg 1995; 34 (03) 264-266 , discussion 266–267
  • 5 Pham TT, Perry JD. Floppy eyelid syndrome. Curr Opin Ophthalmol 2007; 18 (05) 430-433
  • 6 Lee CC, Lai HT, Kuo YR, Lee SS, Lai CS. Floppy eyelid syndrome: an unfamiliar entity for plastic surgeons. Ann Plast Surg 2018; 80 (2S): (Suppl. 01) S40-S47
  • 7 Massry GG. Prevalence of lacrimal gland prolapse in the functional blepharoplasty population. Ophthal Plast Reconstr Surg 2011; 27 (06) 410-413
  • 8 Beer GM, Kompatscher P. A new technique for the treatment of lacrimal gland prolapse in blepharoplasty. Aesthetic Plast Surg 1994; 18 (01) 65-69
  • 9 Friedhofer H, Orel M, Saito FL, Alves HR, Ferreira MC. Lacrimal gland prolapse: management during aesthetic blepharoplasty: review of the literature and case reports. Aesthetic Plast Surg 2009; 33 (04) 647-653
  • 10 Oestreicher J, Mehta S. Complications of blepharoplasty: prevention and management. Plast Surg Int 2012; 2012: 252368
  • 11 Yang P, Ko AC, Kikkawa DO, Korn BS. Upper eyelid blepharoplasty: evaluation, treatment, and complication minimization. Semin Plast Surg 2017; 31 (01) 51-57
  • 12 Shorr N, Goldberg RA, McCann JD, Hoenig JA, Li TG. Upper eyelid skin grafting: an effective treatment for lagophthalmos following blepharoplasty. Plast Reconstr Surg 2003; 112 (05) 1444-1448
  • 13 Hahn S, Holds JB, Couch SM. Upper lid blepharoplasty. Facial Plast Surg Clin North Am 2016; 24 (02) 119-127
  • 14 Czyz CN, Lam VB, Foster JA. Management of complications of upper eyelid blepharoplasty. In: Massry GG, Murphy MR, Azizzadeh B. eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 109-123
  • 15 Cho IC. Revision upper blepharoplasty. Semin Plast Surg 2015; 29 (03) 201-208
  • 16 Stanciu NA, Nakra T. Revision blepharoplasty. Clin Plast Surg 2013; 40 (01) 179-189
  • 17 Stanciu N, Nakra T. Revision blepharoplasty. In: Massry G. Azizzadeh. eds. Brow and Upper Eyelid Surgery: Multispecialty Approach [e-book]. Saunders; 2012: 179
  • 18 Mendelson BC, Luo D. Secondary upper lid blepharoplasty: a clinical series using the tarsal fixation technique. Plast Reconstr Surg 2015; 135 (03) 508e-516e
  • 19 Lew H, Goldberg RA. Maximizing symmetry in upper blepharoplasty: the role of microptosis surgery. Plast Reconstr Surg 2016; 137 (02) 296e-304e
  • 20 Mohammed MF. Impact of orbicularis oculi muscle strip excision during upper lid blepharoplasty on tear film break up time and postoperative dry eye symptoms. Azhar Med J 2018; 47 (03) 539-550
  • 21 Lelli Jr GJ, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg 2010; 125 (03) 1007-1017
  • 22 Bassichis BA. Cosmetic upper lid blepharoplasty. J Otolaryngol Head Neck Surg 2007; 18: 203-208
  • 23 Burkat CN. Fat preservation and other tips for upper blepharoplasty. In: Hartstein ME, Massry GG, Holds JB. eds. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. New York, NY: Springer; 2008: 84-88
  • 24 Massry GG. Nasal fat preservation in upper eyelid blepharoplasty. Ophthal Plast Reconstr Surg 2011; 27 (05) 352-355
  • 25 Morax S, Touitou V. Complications of blepharoplasty. Orbit 2006; 25 (04) 303-318
  • 26 Steinsapir KD, Kim YD. Pathology of “post-upper blepharoplasty syndrome”: implications for upper eyelid reconstruction. Clin Ophthalmol 2019; 13: 2035-2042
  • 27 Steinsapir K. Eyelid crease asymmetry. In: Hartstein ME, Burkat CN, Ramesh S, Holds JB. eds. Avoiding and Managing Complications in Cosmetic Oculofacial Surgery. Cham: Springer; 2020: 61-73
  • 28 Branham GH. Lower eyelid blepharoplasty. Facial Plast Surg Clin North Am 2016; 24 (02) 129-138
  • 29 Murri M, Hamill EB, Hauck MJ, Marx DP. An update on lower lid blepharoplasty. Semin Plast Surg 2017; 31 (01) 46-50
  • 30 McCord CD. Commentary on: New insights into physical findings associated with postblepharoplasty lower eyelid retraction. Aesthet Surg J 2014; 34 (07) 1005-1007
  • 31 Pessa JE, Desvigne LD, Lambros VS, Nimerick J, Sugunan B, Zadoo VP. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesthetic Plast Surg 1999; 23 (05) 337-342
  • 32 Fezza JP, Massry G. Lower eyelid length. Plast Reconstr Surg 2015; 136 (02) 152e-159e
  • 33 Taban MR. Lower eyelid retraction surgery without internal spacer graft. Aesthet Surg J 2017; 37 (02) 133-136
  • 34 Pepper JP, Baker SR. Transcutaneous lower blepharoplasty with fat transposition. Clin Plast Surg 2015; 42 (01) 57-62
  • 35 McKelvie J, Papchenko T, Carroll S, Ng SG. Cicatricial ectropion surgery: a prospective study of long-term symptom control, patient satisfaction and anatomical success. Clin Exp Ophthalmol 2018; 46 (09) 1002-1007
  • 36 O'Donnell BA. Eyelid retractor surgery as an adjunct to cicatricial ectropion repair. Clin Exp Ophthalmol 2000; 28 (04) 293-297
  • 37 Manku K, Leong JK, Ghabrial R. Cicatricial ectropion: repair with myocutaneous flaps and canthopexy. Clin Exp Ophthalmol 2006; 34 (07) 677-681
  • 38 Chung JE, Yen MT. Midface lifting as an adjunct procedure in ectropion repair. Ann Plast Surg 2007; 59 (06) 635-640
  • 39 Liebau J, Schulz A, Arens A, Tilkorn H, Schwipper V. Management of lower lid ectropion. Dermatol Surg 2006; 32 (08) 1050-1056 , discussion 1056–1057
  • 40 Choi B, Yang S, Park J, Lee H, Baek S. Effectiveness and satisfaction degree of transconjunctival-approach lower blepharoplasty combined with pinch skin excision technique. J Craniofac Surg 2020; 31 (03) 766-768
  • 41 Hidalgo DA. An integrated approach to lower blepharoplasty. Plast Reconstr Surg 2011; 127 (01) 386-395
  • 42 Bravo FG, Kufeke M, Pascual D. Incidence of lower eyelid asymmetry: an anthropometric analysis of 204 patients. Aesthet Surg J 2013; 33 (06) 783-788
  • 43 Putterman AM. Eyelid finger manipulation in the treatment of overcorrected blepharoptosis and postblepharoplasty ectropion-retraction. Plast Reconstr Surg 2015; 135 (06) 1073e-1074e
  • 44 Schwarcz R, Fezza JP, Jacono A, Massry GG. Stop blaming the septum. Ophthal Plast Reconstr Surg 2016; 32 (01) 49-52
  • 45 Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016; 137 (01) 196e-213e
  • 46 Patel BC, Patipa M, Anderson RL, McLeish W. Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip. Plast Reconstr Surg 1997; 99 (05) 1251-1260
  • 47 Patel MP, Shapiro MD, Spinelli HM. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach. Plast Reconstr Surg 2005; 115 (07) 2105-2114 , discussion 2115–2117
  • 48 Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000; 106 (02) 438-453 , discussion 454–459
  • 49 de Araujo FV, Faiwichow L, Vasconcellos C. et al. Electroneuromyographic study of orbicularis oculi muscle for evaluation of denervation after a transcutaneous inferior blepharoplasty with musculocutaneous flap. Eur J Plast Surg 2017; 40: 11-16
  • 50 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
  • 51 Grant JR, Laferriere KA. Periocular rejuvenation: lower eyelid blepharoplasty with fat repositioning and the suborbicularis oculi fat. Facial Plast Surg Clin North Am 2010; 18 (03) 399-409
  • 52 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
  • 53 Freeman MS. Rejuvenation of the midface. Facial Plast Surg 2003; 19 (02) 223-236
  • 54 Tan P, Kwong TQ, Malhotra R. Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review. Br J Ophthalmol 2018; 102 (06) 725-735
  • 55 Barrera JE, Most SP. Management of the lower lid in male blepharoplasty. Facial Plast Surg Clin North Am 2008; 16 (03) 313-316 , vi
  • 56 Homer N, Nakra T, Somogyi M. Lateral canthal complications. In: Hartstein ME, Burkat CN, Ramesh S, Holds JB. eds. Avoiding and Managing Complications in Cosmetic Oculofacial Surgery. Cham: Springer; 2020: 155-156
  • 57 Massry GG. Managing the lateral canthus in the aesthetic patient. In: Massry GG, Murphy MR, Azizzadeh B. eds. Master Techniques in Blepharoplasty and Periorbital Rejuvenation. New York, NY: Springer; 2011: 185-197
  • 58 McCord CD, Miotto GC. Dynamic diagnosis of “fishmouthing” syndrome, an overlooked complication of blepharoplasty. Aesthet Surg J 2013; 33 (04) 497-504