The transconjunctival approach is commonly performed in lower lid blepharoplasty so as not to violate the orbicularis oculi muscle integrity and avoid additional scars. This technique does not, however, permit easy access to the lateral fat pad (LFP). As upper and lower blepharoplasty are frequently combined in our clinical practice, the removal of LFP via upper blepharoplasty is a surgical approach that we found most applicable with good outcomes.
A prospective review of 47 consecutive bilateral combined upper and lower blepharoplasty cases using a single access technique was conducted; patient outcomes and the occurrence of any complications were recorded, in addition to preoperative and postoperative measurements between standardized anatomical landmarks.
Forty-seven patients were included in our study. Postoperative measurements showed a decrease of both lateral cantus to inferior orbital border distance and horizontal width of LFP. Good esthetic outcomes and patient satisfaction with surgical results were achieved in the majority of patients.
The single access upper blepharoplasty and lower lid LFP removal technique can improve esthetic outcomes in lower blepharoplasty. The advantages are many; a low risk of missing the lateral pad, ease of achieving a uniform contour of lower eyelid; short lower transconjunctival incision, minimizing complications associated with an intra-conjunctival scar. This technique, based on cadaveric anatomical studies, has been found to be safe and is of great utility to those patients requiring upper and lower lid blepharoplasties.
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- What causes eyelid bags? Analysis of 114 consecutive patients.Plast Reconstr Surg. 2005; 115: 1395-1402https://doi.org/10.1097/01.PRS.0000157016.49072.61
- Transconjunctival blepharoplasty for upper and lower eyelids.Plast Reconstr Surg. 2009; 125: 384-392https://doi.org/10.1097/PRS.0b013e3181c2a534
- The five-step lower blepharoplasty: blending the eyelid-cheek junction.Plast Reconstr Surg. 2011; 128: 775-783https://doi.org/10.1097/PRS.0b013e3182121618
- Treatment of the lower eyelid with the CO2 laser: transconjunctival or transcutaneous approach?.Orbit. 2007; 26: 23-28https://doi.org/10.1080/01676830600974993
- Advances in cosmetic oculoplastic surgery.Curr Opin Ophthalmol. 2002; 13 (1): 324-330https://doi.org/10.1097/00055735-200210000-00006
- Atlas of Aesthetic Eyelid and Periocular Surgery.Saunders, Philadelphia2004
- Anatomic variations of the infraorbital fat compartment.J Plast Reconstr Aesthet Surg. 2006; 59: 376-379https://doi.org/10.1016/j.bjps.2005.11.001
- Aesthetic blepharoplasties, complications and treatment.Ann Chir Plast Esthet. 2004; 49 (1): 569-585https://doi.org/10.1016/j.anplas.2004.10.004
- Refinements in upper blepharoplasty: the five-step technique.Plast Reconstr Surg. 2018; 141: 1144-1146https://doi.org/10.1097/PRS.0000000000004439
- The effect of upper eyelid blepharoplasty on eyebrow position.J Plastic, Reconstruct Aesthetic Surg. 2014; 67: 1242-1247https://doi.org/10.1016/j.bjps.2014.05.022
- Resecting orbicularis oculi muscle in upper eyelid blepharoplasty – a review of the literature.J Plastic, Reconstruct Aesthetic Surg. 2009; 63: 787-792https://doi.org/10.1016/j.bjps.2009.02.069
- Plastic Surgery – Aesthetic.3rd Ed. Elsevier Saunders, London2013
- Lower blepharoplasty transconjuntival fat repositioning.Facial Plast Surg Clin North Am. 2005 Nov; 13; (vi): 553-559https://doi.org/10.1016/j.fsc.2005.06.006
- Tarsal strip for postsurgical cicatricial ectropion repair.Actas Dermosifiliogr. 2021; 112: 269-270https://doi.org/10.1016/j.ad.2019.12.007
- The fourth option: a novel approach to lower-lid blepharoplasty.Aesthetic Plast Surg. 1991; 15: 293-296https://doi.org/10.1007/BF02273875
- The conjunctival approach to the orbital floor and maxilla in congenital malformation and trauma.J Maxillo-Facial Surg. 1973; 1: 3-8https://doi.org/10.1016/s0301-0503(73)80005-0
- Transconjunctival lower eye lid blepharoplasty—technique and complications.Ophtalmology. 1989; 96: 1027-1032https://doi.org/10.1016/s0161-6420(89)32787-4
- Lower lid blepharoplasty—the transconjunctival approach: extended indications.Aesth Plast Surg. 1998; 22: 1-8https://doi.org/10.1007/s002669900156
- Use of a muscle flap in lower blepharoplasty.Plast Reconstr Surg. 1997; 63 (PMID419213): 359-363
Published online: August 22, 2022
Accepted: August 16, 2022
Received: August 31, 2021
Meeting presentation: 69° SICPRE National Congress, 23–25 September 2021.
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.