AAPS
Twitter YouTube LinkedIn
2008 Annual Meeting Abstracts

Back to 87th Annual Meeting
Back to Program Outline


Traditional Lower Blepharoplasty: a 30 Year Review. Is Additional Eyelid Support Necessary?
Terry R. Maffi, M.D.1, Shiliang Chang, M.D.2, Jack A. Friedland, M.D.1.
1Mayo Clinic College of Medicine, Rochester, MN, USA, 2Maricopa Medical Center, Phoneix, AZ, USA.

PURPOSE:
Blepharoplasty is one of the most commonly performed plastic surgical procedures in the United States. Techniques have continuously evolved and there is now strong belief that the traditional blepharoplasty operation places too little emphasis on lower lid support. Many surgeons are advocating newer techniques that include support, such as canthoplasty, canthopexy, transpalpebral elevation of the brow and midface, as well as periorbital fat preservation and repositioning.
This study retrospectively reviewed over 2000 patients who underwent traditional lower blepharoplasties through an external approach. Our goal was to determine the efficacy, as well as the complication rate of the traditional technique, when lower lid tightening procedures were not concurrently performed.
METHODS:
All patients had blepharoplasties performed by the senior author over the past 30 years. The lower lid procedures were performed through an external approach with a transcutaneous skin-muscle flap and, if necessary, excision of bulging peri-orbital fat. We evaluated patients who underwent combined upper and lower blepharoplasties, those who underwent upper or lower eyelidplasties only, and patients who underwent lower eyelid tightening or anchoring procedures concomitantly with traditional lower blepharoplasties when preoperative laxity was diagnosed. In addition, we determined the number of patients who developed complications after traditional lower blepharoplasties, such as scleral show or ectropion.
Patients who underwent lower lid tightening procedures to correct postoperative complications from blepharoplasties performed by other surgeons, tightening or anchoring procedures performed for the treatment of congenital disorders or trauma, and patients who underwent a transconjunctival approach were excluded from the study.
RESULTS:
A total of 2007 traditional lower blepharoplasties were performed. Thirty-one patients (1.5%) underwent a concomitant tightening procedure when lower lid laxity was diagnosed preoperatively. A postoperative complication, for this study, was defined as the development of either scleral show or ectropion that required surgical intervention for treatment. Only eight out of the 2007 patients (0.4%) developed a complication. Two of these patients (0.1%) required scar release, and six patients (0.3%) required either a canthoplasty or canthopexy. Surgical intervention appropriately treated the complication in all of these patients and none developed further sequelae.
CONCLUSION:
Traditional lower blepharoplasties, performed through an external approach, utilizing a skin-muscle flap, have come under considerable scrutiny over the past few years. Some surgeons believe that producing an incision in the orbicularis leads to denervation of the muscle and significantly increases the chance of developing postoperative scleral show or ectropion, despite normal preoperative lower lid tone. This study demonstrates that the results of over 2000 blepharoplasties performed in the manner described has not proven this to be true, noted by the extremely low complication rate. Less than one percent of those undergoing this procedure developed scleral show or ectropion that required surgical correction.
When performed meticulously and precisely, traditional lower blepharoplasty is safe. Correction of pre-operatively diagnosed lower lid laxity is essential, however when lower eyelid tone is adequate, we believe, as a result of this study, that the routine addition of a tightening procedure for support is unnecessary.


Back to 87th Annual Meeting
Back to Program Outline

Quick Links
About
Membership
Annual Meeting
Awards
Publications
Pledge
 
Twitter YouTube LinkedIn