Blepharoplasty: Avoiding Plastic Eyelids

Abstract

\s=b\The goal of a facial plastic surgeon should be to correct the undesirable conditions for which he has been consulted and to avoid leaving his mark on the patient. By embracing the concept that prevention is better than cure, it is generally possible to avoid the "operated-on look" following cosmetic surgery. We describe a number of safeguards we use to preserve natural-looking eyes following lower lid blepharoplasty in men and women. The most common, permanent complication described following conventional lower lid blepharoplasty is the round eye. The condition is readily identified by an increase in scleral show between the limbus and lower lash margin. Closer evaluation will reveal infero\x=req-\ medial displacement of the lateral commissure, increased slope of the lateral third of each eyelid, a flattened, unanimated, pretarsal component, and an unnatural infralash crease produced by the healed incisional scar. These findings are one step short of ectropion; therefore, the methods herein described should help reduce the incidence of this more dreaded and serious complication of blepharoplasty.(Arch Otolaryngol Head Neck Surg

Transcutaneous Lower Eyelid Blepharoplasty With Fat Excision

“…By leaving more of the superior skin-muscle-tarsal complex intact, many of the suspensory components of the lower eyelid are preserved, and there is less chance for contracture and eyelid malposition. 2 The placement of the incision at the level described herein has given predictable and acceptable results. By respecting meticulous operative techniques in skin closure, the incision line becomes imperceptible to the naked eye.…”

Lower Eyelid Blepharoplasty

“…The subciliary skin incision was originally made 2 mm inferior to the lash line, to limit the visibility of a scar. Recently, McCollough, et al introduced a technique involving an incision 4 mm inferior to the lash line, usually at the superior horizontal rhytid of the eyelid, to protect the integrity of the lower tarsus [20,21].…”

An Update on Lower Lid Blepharoplasty

“…As originally described by Castanares, 14 this incision is made 2 mm inferior to the lash line of the lower lid. Recently, McCollough et al have popularized a technique involving a subciliary incision 4 mm inferior to the lash line, 15 typically at the most superior horizontal rhytid of the lower lid, 16 to protect the integrity of the tarsofacial hammock. Once the incision has been made, the surgeon dissects the subcutaneous plane between the lower eyelid skin and the orbicularis muscle.…”