Search Our Scientific Publications & Authors

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 Feb 3. Epub 2021 Feb 3.

The Third Affiliated Hospital, Southern Medical University.

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

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

Methods: 226 patients underwent this procedure. Read More

J Craniofac Surg 2021 Jan 20. Epub 2021 Jan 20.

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

Semin Plast Surg 2017 Feb;31(1):46-50

Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.

Aging changes to the lower eyelids and midface include pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition with a lower eyelid blepharoplasty. Either a transcutaneous or transconjunctival approach may be used, though recent trends have favored the transconjunctival technique if procedures require more than simple skin excision. Read More

Aesthetic Plast Surg 2017 Jun 8;41(3):568-572. Epub 2017 Feb 8.

Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, 15 Changle Road, Xi'an, 710000, Shanxi Province, China.

Background: Compared to the traditional transcutaneous approach, a safe and effective lower eyelid blepharoplasty has been recognized. In 2007, Sadove first reported a series of patients treated with transconjunctival septal suturing, but the inferior orbitopalpebral sulcus was not totally improved.

Purpose: Orbital septal fat release and preservation through the transconjunctival approach was used to treat 20 young patients with bulging bags and inferior orbitopalpebral sulcus. Read More

Plast Reconstr Surg 2017 Jan;139(1):139e-150e

Cleveland, Ohio; and Cairo, Egypt.

Learning Objectives: After studying this article, the participant should be able to: 1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance. 2. Read More

Atlas Oral Maxillofac Surg Clin North Am 2016 Sep 23;24(2):147-51. Epub 2016 Jun 23.

Department of Oral and Maxillofacial Surgery, Case Western Reserve University, 2124 Cornell Road, Room DOA 53A, Cleveland, OH 44106, USA.

There is no secret to achieving successful results with lower belpharoplasties; as is the case with any surgical procedure, proper patient evaluation and development of a comprehensive, anatomic-based treatment plan are prerequisites for success. For situations in which a patient has little lid laxity and pseudoherniated periorbital fat, transconjunctival lower blepharoplasty is the treatment of choice. Transconjunctival lower blepharoplasty enables the surgeon to reposition fat, effectively blending the lid-cheek junction and filling the tear trough deformity. Read More

Plast Reconstr Surg 2016 Jan;137(1):196e-213e

Los Angeles, Calif. From the Division of Oculoplastic Surgery, Department of Ophthalmology, Keck School of Medicine of the University of Southern California; and the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles.

Blepharoplasty remains one of the most common aesthetic procedures performed today. Its popularity stems partly from the ability to consistently make significant improvements in facial aesthetics with a relatively short operation that carries an acceptable risk profile. In this article, the authors attempt to simplify the approach to both upper and lower lid blepharoplasty and provide an algorithm based on the individual findings for any given patient. Read More

Aesthetic Plast Surg 2016 Feb 4;40(1):13-8. Epub 2015 Nov 4.

Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, 11th and 12th Floors, New York, NY, 10021, USA.

Background: The objective of this study was to determine the effects of lower eyelid transconjunctival blepharoplasty (TCB) on lower eyelid position.

Methods: Transconjunctival blepharoplasty was performed alone in 15 lower eyelids without simultaneous canthoplasty or upper eyelid procedure. In this study, blepharoplasty was performed by the transconjunctival approach without removal of skin. Read More

JAMA Facial Plast Surg 2015 Sep-Oct;17(5):374-81

TOC Eye and Face, Austin, Texas.

Importance: Cosmetic rejuvenation of the lower eyelid-midface complex has evolved as our understanding of 3-dimensional midfacial aging and anatomy has become more sophisticated. Treating the lower eyelid and the midface as a single aesthetic unit leads to a more effective and natural-appearing rejuvenation.

Observations: This is a review of midfacial anatomy and a 5-step approach to lower blepharoplasty and midface rejuvenation: (1) midfacial autologous fat transfer, (2) canthoplasty, (3) transconjunctival orbicularis-retaining ligament release and orbital fat manipulation, (4) transcutaneous midface-superficial muscular aponeurotic system elevation and orbicularis contouring, and (5) skin treatment. Read More

Ophthalmic Plast Reconstr Surg 2016 May-Jun;32(3):191-4

*Facial Plastic and Reconstructive Surgery, Head and Neck Associates, Havertown, Pennsylvania; †Eye Plastic, Orbital and Facial Cosmetic Surgery Service, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; ‡Clinical Professor of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; and §Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, Beverly Hills, California, U.S.A.

Purpose: This study quantifies the incision location in transconjunctival lower eyelid blepharoplasty to optimize postspetal (direct) access to the eyelid/orbital fat.

Methods: A retrospective chart review of patients undergoing transconjunctival blepharoplasty by one surgeon (GGM) from January 2013 to January 2014 was performed. Simultaneous globe retropulsion and lower eyelid inferior displacement was used to balloon the conjunctiva forward to maximally visualize the transconjunctival surface anatomical landmarks of importance. Read More

Clin Plast Surg 2015 Jan;42(1):95-101

Texas Oculoplastic Consultants, 3705 Medical Parkway, Suite 120, Austin, TX 78705, USA. Electronic address:

The transeyelid approach to midface lift is an elegant approach for mild descent of malar soft tissue. The subciliary approach is the most commonly used and technically less challenging for surgeons experienced in facelift techniques. This technique in midface rejuvenation also has the advantage of ease of combining with other periocular and mid and upper face rejuvenation, such as blepharoplasty and forehead lift. Read More

Clin Plast Surg 2015 01;42(1):51-6

Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA.

The transconjunctival approach to lower lid blepharoplasty provides access for both fat resection and transposition to soften tear trough deformities and correct infraorbital fat herniation. Overall, there is a paradigm shift that has focused more on enhancing lower lid-cheek shape and contour and preserving orbital volume Read More