Invited Discussion on: “A combination of Three-Step Lower Blepharoplasty to Correct Four Types of Lower Eyelid Deformities in Asian People”

AbstractBackgroundLower blepharoplasty is one of the most commonly performed aesthetic surgeries in the world. However, there are no studies to directly compare patients who had fat excision vs fat transposition.ObjectivesThe authors sought to compare and contrast aesthetic results of fat excisional and fat transpositional lower blepharoplasty.MethodsA retrospective review was conducted of 60 patients (120 eyelids) who underwent transconjunctival lower blepharoplasty, either with fat excision or fat transposition into a preperiosteal plane. Marginal reflex distance-2, lower eyelid length, nasojugal fold depth, and pretarsal orbicularis definition were measured.ResultsMean follow-up was 5.6 months. Mean marginal reflex distance-2 did not significantly differ after either fat excision or fat transposition. Mean lower lid length decreased after fat excision only (P < 0.001), and postoperative fat excision patients had a shorter lower eyelid length than patients who underwent fat transposition (13.5 ± 2.1 mm vs 16.1 ± 1.9 mm, P < 0.0001). Pretarsal orbicularis definition increased after both surgeries (P < 0.001), and the groups did not differ (1.0 ± 0.8 vs 1.1 ± 0.9, not significant). Mean nasojugal fold depth was effaced after surgery in both groups (P < 0.001), although the nasojugal fold was significantly more effaced after fat transposition (1.5 ± 0.7 vs 0.48 ± 0.6, P < 0.001).ConclusionsIn lower blepharoplasty, fat excision resulted in a shorter lower eyelid, and fat transposition resulted in a more effaced lid-cheek junction. Surgeons should be able to balance both techniques to deliver a customized aesthetic result.Level of Evidence: 3

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Observations on the Tear Trough

Aesthetic Surgery Journal ◽

10.1093/asj/sjz345 ◽

2019 ◽

Vol 40 (9) ◽

pp. 938-947 ◽

Cited By ~ 1

Author(s):

Sathyadeepak Ramesh ◽

Robert Alan Goldberg ◽

Allan Edward Wulc ◽

Alan Bart Brackup

Keyword(s):

Lower Eyelid ◽

Surgical Patients ◽

Level Of Evidence ◽

Erbium Laser ◽

Laser Resurfacing ◽

Men And Women ◽

Lower Blepharoplasty ◽

Tear Trough ◽

Midface Lift ◽

Topographic Structure

Abstract Background The tear trough is a prominent structure of the midface. Many surgical and nonsurgical techniques have been devised to efface this feature. Objectives The aim of this study was to define an aesthetically pleasing tear trough and understand the effect of various surgical procedures on its appearance. Methods We undertook a retrospective review of “ideal” subjects (ie, young men and women as well as male and female models) as well as surgical patients undergoing lower blepharoplasty with fat excision, fat transposition, erbium laser resurfacing of the eyelids and midface, or endoscopic midface lifting. Marginal reflex distance-2, lower eyelid length, and nasojugal fold depth were measured and analyzed for all patients. Results The nasojugal fold was significantly less prominent in ideal female models than in all other groups (P < 0.0001). Lower eyelid length was significantly shorter after fat excisional lower blepharoplasty, laser resurfacing, and midface lift (P < 0.0001), and did not change after fat transpositional lower blepharoplasty. Postsurgical reduction in lower eyelid length was significantly less with fat transpositional lower blepharoplasty than in all other groups (P < 0.0001). The nasojugal fold was significantly effaced after all types of procedures (P < 0.0001), but was significantly more effaced after fat transpositional lower blepharoplasty (P < 0.01) than after all other procedures. Conclusions A slight, medial tear trough is present in youth in many patients. The clinical tear trough is a virtual topographic structure distinct from the anatomic tear trough ligament and can be altered in a variety of ways. Level of Evidence: 4

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Surgical anatomy of the lower eyelid relating to lower blepharoplasty

Anatomy & Cell Biology ◽

10.5115/acb.2010.43.1.15 ◽

2010 ◽

Vol 43 (1) ◽

pp. 15 ◽

Cited By ~ 11

Author(s):

Kun Hwang

Keyword(s):

Lower Eyelid ◽

Surgical Anatomy ◽

Lower Blepharoplasty

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Lower Eyelid Blepharoplasty

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr.03.01.1 ◽

2019 ◽

Vol 3 (1) ◽

Keyword(s):

Side Effects ◽

Surgical Approach ◽

Lower Eyelid ◽

Facial Rejuvenation ◽

Steady Increase ◽

Operative Techniques ◽

Lower Blepharoplasty ◽

Midface Lift ◽

Lower Lid Blepharoplasty

The eyelids and periorbital tissues undergo significant changes with aging and often constitute a major concern for those seeking facial rejuvenation. Over the last decade, there has been a steady increase in the demand for lower eyelid rejuvenation. Many techniques and approaches exist to address these concerns, including both noninvasive (filler, lasers, or chemical resurfacing) and invasive (Blepharoplasty or midface lift) procedures. The danger of side effects when performing lower blepharoplasty has kept many patients and physicians away from the surgery, yet advances in lower eyelid blepharoplasty techniques made this procedure more relevant. The exact surgical approach remains controversial and is largely dependent upon surgeon preference and a patient’s cosmetic desire. Here we review the aging changes in the lower lid, indications, preoperative considerations, operative techniques, and complications of lower lid blepharoplasty.

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