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 Jan 24. Epub 2018 Jan 24.

Dr Devoto is an oculoplastic surgeon in private practice in Buenos Aires, Argentina.

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, multi centric 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 From the W Aesthetic Plastic Surgery; and The Centre for Facial Plastic Surgery.

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 From the Departments of Plastic Surgery and Anatomy, Cleveland Clinic; and the Department of Plastic Surgery, Cairo University.

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 Jan;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

JAMA Facial Plast Surg 2014 Nov-Dec;16(6):425-31

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine2Beckman Laser Institute, University of California, Irvine.

Importance: Blepharoplasty is one of the most commonly performed facial aesthetic surgeries. While myriad techniques exist to improve the appearance of the lower eyelids, there is no clear consensus on the optimal management of the orbital septum.

Objectives: To evaluate the safety and feasibility of the use of the holmium:yttrium aluminum garnet (Ho:YAG) laser for orbital septal tightening, and to determine whether modest use of this laser would provide some degree of clinical efficacy. Read More

Br J Ophthalmol 2014 Dec 3;98(12):1686-90. Epub 2014 Jul 3.

Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK.

Purpose: We describe a minimally invasive technique and report our experience of posterior approach levator plication ('levatorpexy') for congenital ptosis.

Study Design: Retrospective review.

Participants: Consecutive series of 16 patients. Read More

Ophthalmic Plast Reconstr Surg 2014 May-Jun;30(3):271-2

Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York, U.S.A.

Purpose: To document the use of a transconjunctival approach to lower eyelid epiblepharon repair.

Materials And Methods: Retrospective chart review of all patients who underwent transconjunctival lower eyelid epiblepharon repair.

Results: Nine patients underwent repair via this approach. Read More

Plast Reconstr Surg 2014 May;133(5):1195-205

Providence, R.I. From the Department of Plastic Surgery, Rhode Island Hospital, and the Warren Alpert Medical School of Brown University.

Learning Objectives: After studying this article, the participant should be able to: (1) Identify the essential preoperative considerations for patients undergoing blepharoplasty. (2) Describe upper and lower eyelid anatomy and the relevance to blepharoplasty techniques. (3) Discuss a standard approach to upper and lower lid blepharoplasty, beginning with preoperative assessment, planning, and marking. Read More

Facial Plast Surg 2013 Aug 24;29(4):273-80. Epub 2013 Jul 24.

Center for Facial Appearances, Sandy Office, Sandy, UT 84070, USA.

Lower eyelid blepharoplasty is one of the most common procedures in aesthetic plastic surgery. Although patients desiring lower eyelid blepharoplasty typically describe their problem as "bags in the lower eyelids," there are many anatomical imperfections that should be assessed. With aging, the youthful single convexity of the lower lid separates into a double convexity with a valley at the intersection of the lower lid and midface. Read More

Facial Plast Surg 2013 Feb 20;29(1):32-9. Epub 2013 Feb 20.

Department of Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

The debate continues around transconjunctival versus transcutaneous approaches. Despite the perceived safety of the former, many experienced surgeons continue to advocate the latter. This review aims to present a balanced view of each approach. Read More

J Surg Case Rep 2013 Mar 21;2013(3). Epub 2013 Mar 21.

Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zürich,Zürich, Switzerland.

Orbital floor fractures are generally the result of blowout orbital and may be associated with orbital emphysema leading to proptosis and even to loss of vision. A 49-year-old woman fractured the orbital floor in a fall. After blowing her nose, she developed exophthalmos and severe reduction in vision. Read More

Aesthet Surg J 2012 Aug;32(6):692-9

Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA.

Background: Rejuvenation of the midface with a natural-looking, safe, and long-lasting result is a challenge in aesthetic surgery. The ideal approach should be easy to perform, with minimal risk and significant benefit. The combination of transconjunctival exposure and preservation of the periosteum may result in lower morbidity than traditional midface rejuvenation. Read More

J Plast Reconstr Aesthet Surg 2012 Jan 27;65(1):48-53. Epub 2011 Aug 27.

David Geffen School of Medicine at University of California Los Angeles, Division of Plastic and Reconstructive Surgery, Los Angeles, CA 90095-6960, USA.

Purpose: Lower eyelid scaring and malposition following violation of all three lamellae pose a significant ophthalmologic reconstructive challenge. The purpose of our study was to document a staged approach for this problem using: 1) transconjunctival scar release followed by palatal graft below the tarsal plate and subciliary scar release followed by full-thickness skin graft superficial to the tarsal plate and 2) subsequent autologous fat grafting to the lower eyelid.

Methods: Cadaveric anatomic dissections were performed. Read More

Graefes Arch Clin Exp Ophthalmol 2011 Nov 19;249(11):1735-41. Epub 2011 Aug 19.

Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.

Background: To investigate the efficacy and complications of fat repositioning via supraperiosteal dissection with internal fat-flap fixation for tear trough deformity in an Asian population.

Methods: This study is a retrospective chart review. From June 2005 to May 2010, 212 patients with lower eyelid fat prolapse and tear trough deformity underwent fat repositioning via supraperiosteal dissection with internal fat-flap fixation. Read More

J Craniofac Surg 2011 Jul;22(4):1489-90

Department of Plastic Surgery, and Center for Advanced Medical Education by BK21 Project, Inha University School of Medicine, Incheon, Korea.

The aim of this study was to elucidate a branch of the infraorbital artery (IOA) crossing the arcus marginalis into the orbit that might be vulnerable during a procedure of midface lift or fat sliding or a transposition in lower blepharoplasty.Eleven orbits of 6 Korean cadavers were dissected after injecting red latex into the external carotid artery. The IOA and nerve were identified. Read More

Aesthetic Plast Surg 2011 Aug 27;35(4):563-8. Epub 2011 Feb 27.

Division of Plastic Surgery, University of California San Diego, 4150 Regents Park Row Suite #300, La Jolla, San Diego, CA 92037, USA.

Background: Orbital fat repositioning in association with subperiosteal midface elevation has been variably described via both the transconjunctival and skin muscle flap approaches. Poor visualization, middle and posterior lamellar cicatricial fibrosis, technical difficulty, and incomplete release are disadvantages commonly ascribed to the transconjunctival approach. Lower eyelid malposition and retraction also are commonly seen in association with skin muscle flap approaches. Read More

Facial Plast Surg 2011 Feb 18;27(1):67-76. Epub 2011 Jan 18.

Rousso Facial Plastic Surgery Clinic, Birmingham, Alabama 35223, USA.

A patient presenting to a facial plastic surgeon with lower eyelid aging often has accompanying midface descent. Many surgical options exist to address these deformities. Blepharoplasty techniques include both the transcutaneous skin-muscle flap as well as the transconjunctival approach. Read More

Plast Reconstr Surg 2011 Jan;127(1):396-406

Ritz Cosmetic Surgery Clinic Tokyo, Tokyo, Japan.

Background: Although double eyelid plasty, levator aponeurotic surgery, and epicanthoplasty are well-accepted cosmetic treatments for Asian eyes, some patients are incompletely satisfied with the outcomes and request further surgery. Although lower eyelid descent is generally recognized as a symptom of aging or a complication after blepharoplasty, the authors propose a perceptional change: a lowering the lower eyelid procedure to vertically enlarge the palpebral aperture in selected Asian patients.

Methods: A total of 125 Japanese patients underwent the lowering the lower eyelid procedure between 2005 and 2009. Read More

Plast Reconstr Surg 2011 Jan;127(1):386-95

Division of Plastic Surgery, Weill-Cornell University Medical College, New York, NY, USA.

Background: Limitations associated with traditional skin-muscle flaps and later with transconjunctival fat resection combined with carbon dioxide laser resurfacing have led to newer concepts in lower blepharoplasty that emphasize fat preservation, blending of the lid-cheek junction, simplified skin excision, and less morbid resurfacing techniques. Avoiding incision through the orbicularis muscle to preserve its innervation and reduce translamellar scarring is favored, as is a more liberal use of lateral canthal tightening procedures. This study investigates the use of a transconjunctival approach to resect and transpose fat combined with a skin flap technique that permits skin excision and simultaneous resurfacing with 30% trichloroacetic acid. Read More

Br J Ophthalmol 2010 Nov 10;94(11):1513-8. Epub 2010 Sep 10.

Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK.

Introduction: We describe a surgical technique for ptosis correction in moderate to good levator function involving advancement of the levator aponeurosis via a transconjunctival posterior approach without resection of Müller's muscle. We present our experience of and the results from this method, and review the evolution of posterior approach ptosis surgery.

Purpose: To assess the efficacy and predictability of posterior approach white line advancement ptosis repair. Read More

Plast Reconstr Surg 2010 Jan;125(1):384-92

Division of Plastic Surgery, Scripps Clinic and Research Institute, La Jolla, Calif., USA.

Background: Transconjunctival blepharoplasty remains a popular and safe technique to treat periorbital aging. In the lower lid, it can be used successfully for orbital fat excision, redistribution, or septal tightening. In the upper lid, transconjunctival blepharoplasty has a role in removal of the nasal fat pad via an isolated, direct approach. Read More

J Craniofac Surg 2009 Sep;20(5):1412-5

Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215, USA.

Transconjunctival incisions are used in cases of orbitozygomatic trauma and elective lower eyelid blepharoplasty. Although this approach has reduced the rates of ectropion, there is a rare but reported incidence of entropion. We review our experience with craniofacial trauma between 1998 and 2008 and our use of the transconjunctival, subtarsal, and subciliary approaches. Read More

Ann Plast Surg 2008 May;60(5):532-7

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19106, USA.

Lower lid blepharoplasty is performed with great variation in technique. Conventional lower lid blepharoplasty with anterior fat removal via the orbital septum has a potential lower lid malposition rate of 15% to 20%. Lower lid malposition and the stigma of obvious lower lid surgery have led plastic surgeons to continue to change their approach to lower lid rejuvenation. Read More

Ophthalmic Plast Reconstr Surg 2008 Jan-Feb;24(1):7-9

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Purpose: To evaluate the effect of transconjunctival lower blepharoplasty with or without a skin pinch on lower eyelid position.

Methods: Retrospective analysis of patients undergoing bilateral lower blepharoplasty using a transconjunctival approach with or without a skin pinch. Patients undergoing other surgical procedures that could affect lower eyelid position were excluded. Read More

Plast Reconstr Surg 2007 Aug;120(2):521-9

Division of Plastic Surgery, University of Florida, Gainesville, FL 32610-0286, USA.

Background: The need for a safer lower-lid blepharoplasty procedure than the classic subciliary approach has long been recognized. In 1996, de la Plaza and de la Cruz first theorized septal suturing via a transconjunctival approach that preserves both muscle and infraorbital fat. This is the first report of a series of patients treated with this technique. Read More

Orbit 2007 Mar;26(1):23-8

Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.

Purpose: To compare the effects of CO(2) laser transcutaneous blepharoplasty with CO(2) laser transconjunctival blepharoplasty with simultaneous resurfacing for the treatment of lower lid dermatochalasis.

Methods: Thirteen men and 23 women, between 42 and 67 years of age, participated in this study. Patients were divided into two groups: (1) CO(2) laser transconjunctival blepharoplasty with resurfacing or (2) CO(2) laser transcutaneous blepharoplasty by the skin-muscle approach without resurfacing. Read More

Aesthetic Plast Surg 2007 May-Jun;31(3):279-84

Department of Plastic Surgery, Kobe University, Graduate School of Medicine, Kobe, Hyogo, Kobe, Japan.

The number of patients with acquired ptosis is on the rise, and correction of blepharoptosis without any postsurgical scars on the eyelid is desired by most. Despite the advantages of the transconjunctival approach for blepharoptosis surgery, its use has been diminishing. The authors performed transconjunctival levator aponeurotic surgery without resecting Müller's muscle for 21 eyelids in 14 patients with blepharoptosis. Read More

J Fr Ophtalmol 2006 Apr;29(4):381-90

Services d'Ophtalmologie, Fondation ophtalmologique Adolphe de Rothschild, Paris.

Purpose: To develop a virtual model of the orbital cavity and the eyelids using a three-dimensional model.

Methods: Amapi Designer 7 and Carrara 3 Studio (Eovia, Mountain View, CA, USA) software were used to obtain 3D models of the orbital cavity and the eyelids. Three-dimensional creation is divided into two main processes. Read More

Ophthalmic Plast Reconstr Surg 2006 May-Jun;22(3):214-5

Department of Maxillo-Facial and Oral Surgery, University Hospital of Montpellier, France.

The transconjunctival CO(2) laser approach to lower eyelid blepharoplasty was used to treat a 66-year-old man presenting with bilateral lower eyelid herniated fat without excess skin. Early postoperative examination revealed left eye blindness. This report presents clinical circumstances of this rare complication and further discusses the most likely causative factors. Read More

Acta Ophthalmol Scand 2006 Apr;84(2):246-9

Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.

Aim: We describe the technique and our results in managing lower eyelid involutional medial ectropion using a combination of lateral tarsal strip to address horizontal eyelid laxity, and transconjunctival inferior retractor plication to address inferior retractor dehiscence.

Methods: Patients with symptoms of epiphora or signs of medial ectropion were offered this procedure. All had the following characteristics: medial lower eyelid eversion, punctal eversion >3 mm, medial canthal tendon laxity <4 mm, significant horizontal eyelid laxity and lacrimal systems that were patent to syringing. Read More

Facial Plast Surg 2005 Nov;21(4):279-85

Perkins/Van Natta Center for Cosmetic Surgery, Indianapolis, Indiana 46290, USA.

Blepharoplasty is one of the most common cosmetic surgeries performed on the male patient. Whereas in the past the male patient would present later in life for eyelid surgery to address functional issues, he now presents earlier in life with an interest in aesthetic improvement as the primary motivating factor. This article reviews the approach of the senior author (SWP) to rejuvenation of the lower eyelid complex. Read More

Korean J Ophthalmol 2005 Dec;19(4):247-51

Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.

Purpose: To evaluate the efficacy of porous expanded polytetrafluoroethylene (e-PTFE, Goretex) containing large pores made with a 21-gauge needle as a graft for the correction of lower lid retraction.

Methods: e-PTFE grafts were implanted between the tarsus and lower lid retractor via a transconjunctival approach with/without amniotic membrane transplantation, or via a transcutaneous approach. Rabbits were examined and assessed for comeal and conjunctival complications and for e-PTFE graft status. Read More

Rev Stomatol Chir Maxillofac 2005 Dec;106(6):344-8

Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Montpellier, Hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5.

The transconjunctival approach is the appropriate standard for lower eyelid blepharoplasty in patients presenting with lower eyelid herniated fat without excess skin. A transconjunctival incision is made approximately 2 mm below the tarsal border and extended inferiorly following a plane posterior to the orbital septum. No conjunctival suture is necessary. Read More

Skin Therapy Lett 2005 Sep;10(7):4-7

Division of Dermatologic Surgery, Stanford University School of Medicine, Stanford, CA, USA.

A tell-tale sign of the aging face is upper eyelid skin redundancy and lower eyelid bags. These changes can contribute to a "tired" appearance. Upper and lower blepharoplasty procedures can correct these processes. Read More

Aesthetic Plast Surg 2005 Jul-Aug;29(4):313-6

Department of Plastic and Reconstructive Surgery, Keio University, School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

The case of a patient who experienced temporary myopic change after transconjunctival blepharoplasty using the carbon dioxide (CO(2)) laser is reported. Transconjunctival lower lid blepharoplasty using the CO(2) laser, one of the most frequent laser procedures performed in aesthetic surgery, is considered to be a safe and reliable approach that does not incur significant complications. This report describes temporary myopia in a 38-year-old woman as a rare complication after this procedure. Read More

Curr Opin Otolaryngol Head Neck Surg 2005 Aug;13(4):248-54

Plastic and Cosmetic Surgery Center of Eastern Virginia Medical School, 5589 Greenwich Road, Virginia Beach, VA 23455, USA.

Purpose Of Review: Lower lid anatomy and the subtleties of this region have been studied extensively in the past. The variations that are found in the lower eyelid can lead to complications if the surgeon does not have a complete understanding. Lower lid blepharoplasty techniques have progressed over the past from simple skin excisions to midface and lower eyelid repositioning. Read More

J Fr Ophtalmol 2004 Jun;27(6 Pt 1):651-7

Cabinet de Chirurgie Plastique Ophtalmologique Reconstructrice et Esthétique, Nice, France.

Baggy lower eyelids result from herniated orbital fat, excess skin, hypertrophic or lax orbicularis sometimes associated with lower lid laxity resulting from degeneration of the lateral canthal tendon with age. Two main approaches are used: skin-muscle flap or the transconjunctival approach in younger patients who have herniated orbital fat with minimal or not excessive lower eyelid skin. Preoperative evaluation of the patient is extremely important in lower lid blepharoplasty before any surgical procedure: excessive skin, herniated orbital fat, retraction and laxity must be evaluated. Read More

Plast Reconstr Surg 2004 Sep;114(3):785-93; discussion 794-6

Plastic Surgery Service, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.

This article discusses the new trends in lower blepharoplasty. Many different techniques have been described for the treatment of lower lid deformities, some favoring the transconjunctival approach that avoids touching the orbicularis oculi muscle, others recommending the muscle cutaneous flap. In some cases, maintenance of the fat is indicated, whereas in others its removal is recommended. Read More