Evolution of Technique of the Direct Transblepharoplasty Approach for the Correction of Lower Lid and Midfacial Aging: Maximizing Results and Minimizing Complications in a 5-Year Experience

Hester, T. Roderick; Codner, Mark A.; McCord, Clinton D.; Nahai, Foad; Giannopoulos, Athina; Hamra, Sam T.

doi:10.1097/00006534-200001000-00066

Cited by 107 publications

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“…On the submuscular plane, it is fixed to the orbital rim by the orbital retaining ligaments, the protruded orbital fat placed on the ligaments, and the SOOF located beneath the ligaments [8][9][10]. LCJ descends gradually with aging, because the vertical length of the lower lid is increased by skin and muscle laxity, protruded orbital fat, and resorption of bone [2].…”

Section: Discussionmentioning

confidence: 99%

“…The authors' explanations are based on one study [2] proposing that LCJ descended with age. Meanwhile, in a cadaver dissection study [8], it was claimed that LCJ is unlikely to descend downward with age because of its fixation to the bone via orbital retaining ligaments.…”

Section: Discussionmentioning

confidence: 99%

“…However, with aging, it changes to V-shape, and is always located below the infraorbital rim. The vertical distance from the upper edge of the lower lid to the LCJ in youthful eyes is 8-12 mm, and this elongates to 15-18 mm in aged eyes in Westerners [2]. The most common surgical procedures used to improve aged lower eyelids are transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Kang¹,

Yang²,

Chai

2017

J Cosmet Med

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Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods:The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-toskeletal relationship. Results:The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n. Conclusion:Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Kang¹,

Yang²,

Chai

2017

J Cosmet Med

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“…Furthermore, fat grafting has been popularly used as a complementary procedure to rejuvenate it more perfectly. Generally, LCJ descends in aged persons or young persons with negative vector because the vertical length of the lower lid is increased by the laxity of the skin and muscle, protruded orbital fat, and resorption of bones [12]. However, after TSILB, the LCJ length was shortened, and its entire shape was shifted in the superolateral direction [2,3].…”

Section: Discussionmentioning

confidence: 99%

Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Kang¹,

Chai

2018

J Cosmet Med

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Background: Traditional subciliary incision lower blepharoplasty (TSILB) is commonly used for improving aged lower eyelid. Fat grafting has been popularly performed to correct shortcomings of TSILB such as infraorbital hollowness and incomplete blending of lid-cheek junction (LCJ). LCJ has been known as an objective index to measure the aging of lower eyelid. However, there was no study on the changes of LCJ length and shape with complementary fat grafting.Objective: This study aimed to evaluate the effect of complementary fat grafting by observing the changes in length and shape of the LCJ. Methods:Between 2010 and 2016, the authors observed the change of LCJ in 33 patients who were followed-up for more than 3 months among patients who underwent TSILB alone (Group 1, G1) or TSILB combined with fat grafting (Group 2, G2). The fat graft was performed by sequential autologous fat injection method, having the concept of volumetric face lifting. The groups were further divided into subgroups G1p, G1n, G2p, and G2n according to positive (p) or negative (n) globe-to-skeletal rim relations. Suborbicularis oculi fat lifting and lateral retinacular canthopexy were mainly performed in patients who had negative vector. Results:The length of LCJ in G2 decreased significantly compared to that of G1. There was no significant difference between G1p and G1n, and G2p and G2n. The shape of LCJ changed diversely from V-shape to flat shape and was more dramatic in G2 than in G1. In G1, superolateral shifting in lateral points of LCJ was a typical change, but in G2, superolateral shifting and vertical shifting of LCJ were more prominently occurred at medial and middle points of LCJ, which were mainly induced by fat grafting. Conclusion:Complementary fat grafting showed better rejuvenation effect through further changes of LCJ in length (shortening) and shape (flattening) than that of TSILB alone. Level of Evidence: IV

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“…The main causes of lower eyelid malpositioning are excessive skin resection (anterior lamella); inadvertent scarring of the orbital septum (middle lamella) 9 ; and the failure in cantus anchoring [10][11][12][13][14] . In order to prevent lower eyelid malpositioning, it is important to be careful in removing the excess skin on the lower eyelid; to suture the orbital septum, reducing the possibilities of an inadvertent scarring; and to anchor the lateral cantus, either with a canthopexy or cantoplasty 1,5,15,16 .…”

Section: Lower Eyelid Mal-positioningmentioning

confidence: 99%

Complications in blepharoplasty: how to avoid and manage them

Patrocínio¹,

Loredo²,

Arévalo³

et al. 2011

Braz. j. otorhinolaryngol. (Impr.)

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Complications in blepharoplasty are uncommon and, when they occur, they are usually mild and transient, such as hematomas and chemosis. However, sometimes they can be severe, such as blindness, or they might require surgical correction, such as ectropion. Objective To evaluate the results and complications of transcutaneous blepharoplasty performed in the same procedure, discussing how to treat and how to avoid them. Methods A retrospective study of 200 medical records of consecutive patients that underwent transcutaneous blepharoplasty from January 2007 to January 2009. The variables analyzed were age, gender, complications, clinical outcome, patient satisfaction, and photographic documentation. Results The incidence of complications was 9.5% (19 patients). The complications were 1 hematoma, 12 cases of chemosis and 13 patients who underwent canthoplasty, 6 patients with malposition of the lower eyelid (5 retractions and 1 ectropion). Medical treatment was performed in 12 patients and revision surgery in 7 cases of all the patients who had complications. Conclusions We demonstrated that blepharoplasty is a procedure with a high satisfaction and a low complication rate, and it is an excellent surgical procedure, when properly indicated.

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Evolution of Technique of the Direct Transblepharoplasty Approach for the Correction of Lower Lid and Midfacial Aging: Maximizing Results and Minimizing Complications in a 5-Year Experience

Cited by 107 publications

References 0 publications

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Complementary effect of fat grafting on traditional subciliary incisional lower blepharoplasty: estimated by the change of lid-cheek junction

Complications in blepharoplasty: how to avoid and manage them

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