Lower eyelid blepharoplasty

Abstract

Patients middle-aged and older commonly present with concerns about lower eyelid appearance. Some of these patients may be undergoing simultaneous evaluation for upper lid blepharoplasty or other facial surgery, and others may not be aware of concomitant changes in associated facial structures. Common cosmetic complaints of the lower eyelid region often involve rhytides and herniated orbital fat, which may occur simultaneously or independently in a given patient. Selection of an appropriate procedure to meet the desired goal of rejuvenation requires assessment of the patient's age, overall appearance, skin pigmentation, and facial anatomy. The lower lids are not to be considered in isolation, but as a continuum with the midface and periocular regions. Once the patient's needs and desired aesthetic outcome are determined, the surgeon may then choose from herniated orbital fat resection or transposition/reposition, direct skin excision, laser skin resurfacing, midface lifting, or a combination of these techniques. Additionally, a minimally invasive strategy of volume augmentation via injectable fi llers may be indicated for tear trough deformity. Modern approaches of lateral canthoplasty and orbicularis suspension also can be done to improve outcomes and patient satisfaction.