Authors: Stephen W. Perkins, M.D., Paul K. Holden, M.D., M.S.
Master Techniques in Blepharoplasty and Periorbital Rejuvenation 2011, pp 159-172
Lower eyelid rejuvenation is among the most common cosmetic operations performed. Surgeons should approach each patient with a careful analysis to determine the most appropriate procedure for rejuvenation of the lower eyelid complex. The transcutaneous approach to lower eyelid blepharoplasty is an important tool in the armamentarium of aesthetic surgeons. Properly executed, and in the appropriate patient, the procedure conveys no added risk of lower lid malposition over other common techniques. Premorbid lower eyelid malposition and/or laxity must be identified and addressed at the time of surgery. Several intraoperative maneuvers such as preservation of the pretarsal orbicularis oculi muscle, conservative resection of skin and muscle, and suspension of the tarsus and/or pretarsal orbicularis oculi muscle to the periosteum of the lateral orbital rim help minimize the risk of postoperative lower lid malposition. If the lower lid demonstrates laxity or poor tone preoperatively, then a lateral canthoplasty is performed in conjunction with lower lid blepharoplasty. Employing a standardized, logical approach to patients will ensure optimal outcomes for lower lid rejuvenation.