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Clin Plast Surg 2022 Apr;49(2):213-220

235 Plain Street, Suite 502, Providence, RI 02905, USA. Electronic address:

Periorbital changes in men occur similarly to in women and may result in a need for correction through blepharoplasty. Lower lid techniques vary, but the authors prefer a transconjunctival approach that may extend into a retroseptal approach in men. Using this approach, excess fat can be excised and even redraped with orbitomalar retaining ligament release. Read More

Ann Ital Chir 2022 Jan 10;11. Epub 2022 Jan 10.

Aim: The main focus of this paper was to describe our experience in the management of primary lesions involving the orbit, analyzing signs and symptoms and illustrating surgical management.

Material Of Study: We describe our experience managing 62 consecutive patients diagnosed with orbital tumors confined to the orbital content (not involving skin or bone, with no intracranial invasion) and treated between January 2013 and December 2016. Demographic characteristics, symptoms, clinical findings, histological types and approaches have been recorded. Read More

J Plast Reconstr Aesthet Surg 2022 Feb 28. Epub 2022 Feb 28.

Instituto de Microcirugía Ocular, IMO, oculoplastic surgery department, Barcelona, Spain.

Lower eyelid retraction occurring as a complication of lower eyelid blepharoplasty may give rise to symptoms of exposure keratitis as well as cosmetic considerations. This retrospective longitudinal study describes our clinical experience with 74 patients with bilateral lower eyelid retraction postblepharoplasty (148 eyes) undergoing a transconjunctival subperiosteal midface lift with the implantation of a hard palate spacer graft over the period 2002 to 2019. All patients had a forced-up traction test result of less than or equal to 2 mm, indicating a significant fibrosis of the middle lamellae. Read More

J Plast Reconstr Aesthet Surg 2022 03 28;75(3):1230-1238. Epub 2021 Nov 28.

Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Aesthetic Medicine, Chang Gung Clinic, Taipei, Taiwan; Graduate Institute of Biochemical and Biomedical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Background: Many Oriental eyes feature single eyelid fold and ptotic eyelid. Performing the double eyelid blepharoplasty (DEB) in a minimally invasive manner with simultaneous blepharoptosis correction (BPC) is important to achieve an aesthetic pleasing outcome.

Objective: To demonstrate an effective mini-invasive transcutaneous and transconjunctival dual approach technique for simultaneous DEB and BPC. Read More

Ophthalmic Plast Reconstr Surg 2022 Jan-Feb 01;38(1):87-89

Eyesthetica, Private Practice, Los Angeles, California, U.S.A.

Purpose: To describe a novel surgical technique for implanting eyelid weights via a sutureless transconjunctival approach. In comparison to the traditional supratarsal crease approach, this technique does not involve any external incisions or suture placement. The procedure can reduce surgical time and complications associated with the traditional external approach. Read More

Ear Nose Throat J 2022 Feb 23;101(2_suppl):43S-49S. Epub 2021 Sep 23.

Department of Ophthalmology, 12312Drexel University College of Medicine, Philadelphia, PA, USA.

Objective: To test the applicability of a fresh tissue model for teaching facial plastic techniques and approaches to the eyelids and orbit.

Design: Observational animal experiments.

Subjects: Ten prepubescent sheep heads harvested following humane euthanasia at the completion of unrelated live animal research. Read More

J Craniofac Surg 2022 Mar-Apr 01;33(2):628-631

Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Beijing, China.

Abstract: The predominant method for transconjunctival orbital fat transposition is by conducting 1 or several temporary externalized sutures. A new method that could internally and more securely fixate the fat to the periosteum remains desirable. This manuscript introduces a technique that utilizes a titanium ring to guide transconjunctival orbital fat fixation for lower blepharoplasty. Read More

J Craniofac Surg 2021 Sep;32(6):2024-2028

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

Abstract: Fat repositioning is an effective way to treat tear trough deformity (TTD) in Asians. Recent techniques mainly focused on the fixation technique, whereas how to precisely shape and individually quantify the fat pedicle has been ignored. This article introduced an individualized, targeted, and tension-free technique to fabricate a fan-shaped thin septum fat pedicle for repositioning. Read More

Aesthet Surg J 2021 07;41(8):NP1021-NP1023

The University of Illinois Medical Center in Chicago, IL, USA.

Aesthet Surg J 2021 07;41(8):NP1014-NP1020

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Background: The transconjunctival technique is an effective approach to mild to moderate blepharoptosis repair that does not involve skin incision. However, accurate surgical manipulation of this method is greatly restricted by poor intraoperative evaluation.

Objectives: The aim of this study was to introduce a modified transconjunctival approach with flexible intraoperative adjustments in order to achieve more accurate ptosis correction. Read More

Facial Plast Surg 2021 Apr 3;37(2):149-159. Epub 2021 Mar 3.

PLLC-Otolaryngology Division, Rochester, New York.

Facial aging in the midface has been described to encompass both soft tissue descent and volumetric change. Currently, there is no established and widely accepted grading system for midfacial ptosis. We propose a simplified grading system for midfacial ptosis ranging from mild to severe in terms of Grades I through III. Read More

Aesthet Surg J 2021 07;41(8):893-902

The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.

Background: Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags.

Objectives: The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method.

Methods: A total 226 patients underwent this procedure. Read More

J Craniofac Surg 2021 May;32(3):1087-1089

Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, Lanzhou, China.

Purpose: There are multiple approaches described to access the zygomaticomaxillary complex (ZMC) fractures: lateral eyebrow, upper blepharoplasty, coronal, subciliary, subtarsal, infraorbital, transconjunctival, and transoral. All these approaches have their advantages, disadvantages, and indications according to location of fracture, degree of displacement, and surgeon's experience with a specific technique. However, there is not a good approach for treating the zygomatic arch or body fracture. Read More

Indian J Ophthalmol 2020 Oct;68(10):2075-2083

Research Associate, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA.

Of the two common techniques of lower blepharoplasty, the transconjunctival approach is limited to young patients with prominent herniation of lower fat pad without skin excess and the transcutaneous approach to patients requiring skin excision. However, the current trends not only highlight the traditional sculpting of the three orbital fat pads in lower lid blepharoplasty but also additional relocation of the intraorbital fats for correcting the inferior orbital hollowing. The purpose of this review is to analyze the published literature on common types, techniques, indications, and outcomes of the multiple surgical variants of lower lid blepharoplasty often aimed at treating the redundant skin, steatoblepharon, tear trough deformity, lid laxity, and dermatochalasis, thereby to correct the negative vector and inferior orbital hollowing along with effacement of the lid cheek junction. Read More

Asia Pac J Ophthalmol (Phila) 2020 Sep-Oct;9(5):461-469

Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

Purpose: The aim of this study was to summarize the literature from 2012 to 2018 on 4 common cosmetic periocular operative procedures including epicanthoplasty, lateral canthoplasty, and upper and lower blepharoplasty.

Design: Systematic review of epicanthoplasty, lateral canthoplasty, upper and lower blepharoplasty in the period of 6 years.

Methods: A systematic MEDLINE search by 2 independent reviewers was performed on PubMed using the search terms (blepharoplasty) OR double eyelid) OR lateral canthopexy) OR fat repositioning) OR epicanthoplasty) OR love band) AND (From January 2012 to January 2018). Read More

J Craniofac Surg 2020 Oct;31(7):2003-2006

Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Purpose: To introduce an easy and effective approach for internal fixation of repositioned fat pedicles in transconjunctival lower eyelid blepharoplasty.

Methods: Thirty-six consecutive patients underwent fat repositioning transconjunctival lower blepharoplasty from August 2016 to January 2018. After release of the orbicularis oculi muscle and exposure of the intraorbital fat pedicles, a supraperiosteal pocket was dissected. Read More

J Craniofac Surg 2020 May/Jun;31(3):766-768

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

The purpose of this study was to evaluate and compare the effectiveness and satisfaction of transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique between young patients (younger than 60 years of age) and elderly patients (older than 60 years of age) in Korea. The medical records of 69 patients who underwent transconjunctival-approach lower blepharoplasty combined with a pinch skin excision technique from January 2003 to February 2018 were reviewed. Success rate postoperative complications, and degree of satisfaction with the surgical technique were evaluated and statistically compared between the 2 different age groups. Read More

Ann Plast Surg 2019 10;83(4S Suppl 1):S70-S73

From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.

Background: Prominent tear trough deformity and midfacial depression are the first priority in periorbital rejuvenation. To achieve harmonious lower eyelid improvement, we developed a novel approach to reposition infraorbital fat using intraoral anchoring in transconjunctival lower eyelid blepharoplasty.

Methods: Fourteen patients were included. Read More

Can J Ophthalmol 2019 02 30;54(1):98-101. Epub 2018 Apr 30.

Royal Shrewsbury Hospital, Shrewsbury, United Kingdom.. Electronic address:

Objective: To describe a modification of trans-conjunctival, lower eyelid retractor advancement to correct tarsal ectropion.

Design: A retrospective case review.

Participants: Consecutive patients with lower eyelid tarsal ectropion. Read More

Aesthetic Plast Surg 2019 06 7;43(3):680-685. Epub 2019 Feb 7.

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.

Background: Over the years, many techniques have been described to correct tear trough deformity (TTD). Fat-repositioning lower blepharoplasty via a transconjunctival approach is increasingly applied due to its satisfactory rejuvenating effect. However, those methods have disadvantages such as a complicated surgical approach, residual scar, and long recovery time. Read More

Korean J Ophthalmol 2018 Oct;32(5):344-352

Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Purpose: The lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty.

Methods: A total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. Read More

Aesthet Surg J 2018 Jun;38(7):707-713

Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.

Background: Numerous techniques have been used for lower blepharoplasty. The techniques can be classified into four principles: excision of excess fat, septal reset, orbital fat repositioning, and reinforcement of the attenuated orbital septum.

Objectives: We modified the conventional approach of septal reinforcement to utilize an inverted T-shaped plication with preservation of the orbital fat, repositioning the septum below the arcus marginalis to refine tear-trough deformity. Read More

Aesthet Surg J 2018 Sep;38(10):1052-1061

University of New South Wales Medical School and the University of Notre Dame Medical School, Wagga Wagga, Australia.

Background: Aesthetic rehabilitation of thyroid orbitopathy includes orbital decompression, correction of eyelid retraction, and aesthetic blepharoplasty, performed traditionally in separate stages.

Objectives: To report the results of orbital decompression surgery associated with aesthetic eyelid surgery in one stage for aesthetic rehabilitation of patients affected by thyroid eye disease.

Methods: Retrospective, multicentric study including 40 consecutive patients, who underwent orbital decompression surgery associated with aesthetic eyelid surgery in two centers: Genova (group 1) + Buenos Aires (group 2). Read More

Arch Craniofac Surg 2016 Dec 23;17(4):206-210. Epub 2016 Dec 23.

Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea.

Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. Read More

Plast Reconstr Surg 2017 Aug;140(2):273-282

Singapore; and Toorak, Victoria, Australia.

Background: The transconjunctival lower eyelid blepharoplasty is advantageous for its quick recovery and low complication rates. Conventional techniques rely on fat removal to contour the lower eyelid. This article describes the authors' extended transconjunctival lower eyelid blepharoplasty technique that takes dissection beyond the orbital rim to address aging changes on the midcheek. Read More

Orbit 2017 Oct 5;36(5):256-263. Epub 2017 Jul 5.

c Colmenero Clinic , Madrid , Spain.

This article describes our surgical technique for subperiosteal midface elevation in patients with paralytic lower eyelid malposition or cicatricial inferior eyelid retraction. Nineteen patients with paralytic lower eyelid malposition and 15 patients with cicatricial inferior eyelid retraction underwent a subperiosteal midface lift (n = 34). The procedure was performed under local anesthesia through three nonvisible incisions. Read More

J Craniofac Surg 2017 May;28(3):831-832

*Department of Ophthalmology, Medical Faculty, Yüzüncü Yil University, Van †Department of Ophthalmology, Medical Faculty, Gazi University, Ankara, Turkey.

The authors describe a 5-month-old male infant with Wiedemann-Rautenstrauch syndrome, which is an extremely rare condition. He had tarsal kink in upper eyelids in both eyes. The authors treated bilateral tarsal kink with an everting suture via a transconjunctival approach under local anesthesia. Read More