ABSTRACT
Aging of the lower eyelid involves a complex series of anatomic and physiologic changes
that occur over time. Rejuvenation of the lower eyelid complex must systemically address
the various contributions of soft tissue laxity, pseudoherniation of orbital fat,
and loss of periorbital volume. This article outlines the evolution of our approach
to lower eyelid blepharoplasty with a specific focus on the importance of management
of fat in the periocular region. A discussion of various surgical approaches with
their advantages and disadvantages is presented, and the importance of maintaining
a safe lower eyelid is emphasized. A comprehensive and systematic approach to restoration
of the lower eyelid is highlighted with specific postoperative results.
KEYWORDS
Blepharoplasty - orbital fat - lipotransfer - periorbital rejuvenation
REFERENCES
1 Rankin B S, Arden R L, Crumley R L.
Lower eyelid blepharoplasty . In: Papel I, Frodel J, Holt G, et al Facial Plastic and Reconstructive Surgery.
2nd ed. New York, NY; Thieme Medical Publishers 2002: 196-207
2
Hamra S T.
A study of the long-term effect of malar fat repositioning in face lift surgery: short-term
success but long-term failure.
Plast Reconstr Surg.
2002;
110
940-951
discussion 952-959
3
DeFatta R J, Williams III E F.
Evolution of midface rejuvenation.
Arch Facial Plast Surg.
2009;
11
6-12
4
Morax S, Touitou V.
Complications of blepharoplasty.
Orbit.
2006;
25
303-318
5
Garcia R E, McCollough E G.
Transcutaneous lower eyelid blepharoplasty with fat excision: a shift-resisting paradigm.
Arch Facial Plast Surg.
2006;
8
374-380
6
Codner M A, Wolfli J N, Anzarut A.
Primary transcutaneous lower blepharoplasty with routine lateral canthal support:
a comprehensive 10-year review.
Plast Reconstr Surg.
2008;
121
241-250
7
Freeman M S.
Transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty: a new
technique for the effacement of nasojugal deformity.
Arch Facial Plast Surg.
2000;
2
16-21
8
Nassif P S.
Lower blepharoplasty: transconjunctival fat repositioning.
Otolaryngol Clin North Am.
2007;
40
381-390
9
Marotta J C, Quatela V C.
Lower eyelid aesthetics after endoscopic forehead midface-lift.
Arch Facial Plast Surg.
2008;
10
267-272
10
Pontius A T, Williams III E F.
The evolution of midface rejuvenation: combining the midface-lift and fat transfer.
Arch Facial Plast Surg.
2006;
8
300-305
11
Ciuci P M, Obagi S.
Rejuvenation of the periorbital complex with autologous fat transfer: current therapy.
J Oral Maxillofac Surg.
2008;
66
1686-1693
12
Coleman S R.
Long-term survival of fat transplants: controlled demonstrations.
Aesthetic Plast Surg.
1995;
19
421-425
Cory C YehM.D.
Williams Center Plastic Surgery Specialists
1072 Troy-Schenectady Road, Latham, NY 12110
Email: coryyeh@gmail.com