Blepharoplasty of the Lower Eyelid

Context

The phrase “lower blepharoplasty” refers to a group of surgical procedures used to enhance the look of the lower eyelids. Lower blepharoplasty, historically, was a reduction treatment when fat and/or skin were removed to eliminate bulging fat, skin redundancy, and wrinkles on the lower eyelids. Modern lower blepharoplasty still involves fat and skin removal, but current practices adhere to a tissue-preserving philosophy and may involve fat transfer procedures to restore apparent volume loss brought on by face aging, as well as orbital and sub-orbicularis fat relocation. Hyaluronic acid-based dermal fillers first became popular as an off-label method of infra-orbital and lower eyelid volumization in the early 2000s. The lower eyelids have also been treated using laser energy and light-based procedures, offering non-surgical alternatives for lower blepharoplasty or non-surgical supplements to incisional blepharoplasty.

Read More: blefaroplastica inferiore

Procedure for surgery

A successful surgical procedure for lower eyelid rejuvenation attends to the patient’s concerns that line up with anatomic problems found during inspection. The subtleties and appropriate approaches used by surgeons might differ. The intended outcome may be attained by a single operation or by a combination of methods (e.g. transconjunctival fat manipulation with anterior skin squeeze).

The patient is generally sitting during marking procedures. Using a surgical pen, the steatoblepharon and hollowing boundaries are drawn.

At the site of surgery, a local anesthetic including lidocaine, bupivacaine, and/or epinephrine is infused. Aesthetic droplets are injected into the lower cul-de-sac. There may be a corneal shield applied. There is a sterile preparation.

The transconjunctival method

Transconjunctival approach is one of the most often utilized procedures for lower eyelid blepharoplasty. For individuals who have a prolapse of lower eyelid fat rather than an oversupply of lower eyelid skin, this is an excellent alternative.[1] Many methods are possible[2], but the following describes one of the most widely used ones.

Exposure is achieved by a desmarres retractor, and an infratarsal incision is made using lower eyelid retractors and conjunctiva. The globe ballooning aids in identifying the fat pads and the ideal site for the incision. Exposure is facilitated by traction sutures positioned on the proximal conjunctival margin. Lateral canthotomy and inferior cantholysis may be necessary if exposure is insufficient. Without causing any damage to the orbital septum, the three lower eyelid fat pads are directly accessible.

Debulked or mobilized as pedicles, the orbital fat pads are repositioned to regions of concavity below the orbital rim. Utilizing either monopolar or bipolar cautery, strict hemostasis is maintained. It is seen that the inferior oblique muscle is intact. Following the creation of a pocket and the release of attachments, fat redraping may take place in the suborbicularis or subperiosteal plane. Percutaneous or internal absorbable sutures are used to anchor the fat pedicles. Through a transconjunctival incision, the suborbicularis oculi fat (SOOF) may be raised and anchored to the orbital rim periosteum with absorbable sutures. A SOOF lift assists in effacing the tear trough and infraorbital hollows, much as orbital fat repositioning.

Absorbable sutures can be used to approximate the conjunctival incision, or it can heal naturally without needing to be closed.

Skin method (intraculiar)

A lateral eyelid crease is reached via an incision made 1-2 mm below the eyelash line or inside an already-existing infraciliary crease. By using a hemostat to compress the skin without generating traction on the edge of the eyelid, a skin “pinch” can be performed to assess the degree of redundancy in the skin. As an alternative, a skin flap that extends as far as required to provide sufficient mobilization can be made without changing the geometry of the eyelid opening. Skin is excised in a cautious manner to prevent anterior lamellar deficiency. To determine the appropriate quantity of skin trim, the patient is advised to open their mouth and look upward. By starting a flap deep in the orbicularis, the skin-muscle technique enables greater advancement and trimming of the skin and muscle separately or together. The infraciliary incision provides access to the orbital fat pads and SOOF, which are treated in a manner similar to that of the transconjunctival approach. The orbicularis muscle and the orbitomalar ligament, which can be raised and suspended to the external lateral orbital rim periosteum in order to lift and support the eyelid, are accessible through a full or lateral infraciliary incison. The same incision can also be used for lateral canthopexy, which is frequently combined with infraciliary blepharoplasty to preserve or raise the lower eyelid’s position.

Extra steps

Canthopexy or lateral canthoplasty are used to treat significant lower lid laxity that has been detected before blepharoplasty.

To enhance volume to the lid-cheek junction and the infraorbital hollows, fat grafting procedures can be employed. Malar and orbital rim implants made of polymer can also help with deficiency in volume and projection.

In suitable individuals, chemical peels or non-ablative laser skin resurfacing enhance the condition of the skin on the lower eyelids and lessen dyschromia and rhytidosis.

Unwanted noticeable prominent lower eyelid veins can be lessened or completely removed using ligation, sclerotherapy, or laser treatment.