Lower Blepharoplasty in Aged Persons

Cho, In Chang

Abstract

With increase in average life expectancy, more patients of an older demographics are undergoing periocular facial rejuvenation procedures. One of the most common procedures performed for periocular rejuvenation is the lower blepharoplasty. One of the most common and challenging postoperative complication after this procedure is lower lid retraction. The degree of lower lid retraction can be presented in a varying range from lateral canthal rounding and scleral show to cicatrical ectropion. Causes of lower eyelid retraction seem to be multifactorial and there are a variety of surgical approaches for correction of lower eyelid retraction. According to the cause and degree of lower lid retraction, the author must incorporate a customized approach for each deformity. Techniques used to correct lower lid retraction include midface lift, lateral canthopexy or canthoplasty, oculi muscle suspension, and a spacer graft. To effectively correct the retraction, the surgeon must have a sound understanding of the anatomy of lower eyelid. Technically, key essential fundamentals to correct lower lid retraction include: knowledge of elevating the mid face, anchoring the lateral canthal tendon securely, and proper insertion of the spacer graft. The author presents multiple techniques to correct significant postsurgical lower lid malposition without the use of skin grafts.