Background: Effective lower eyelid blepharoplasty is possible in a virtually closed fashion without either an anterior subciliary skin incision or a transconjunctival incision, both of which put the patient at risk for lower lid retraction.
Methods: Over a 6-year period, the author performed lower lid rejuvenation with only a lateral incision in 89 consecutive cases in 86 women and three men ranging in age from 42 to 65 years. Patients with lower lid laxity, prior surgery, trauma, significant excess skin, or festoons were excluded. Grading the aged eyelid in stages 1 to 3, with 3 being advanced, this procedure is indicated for stage 1 and 2 patients, characterized by deep nasojugal grooves, herniated lower lid compartment fat, mild to moderate rhytides, and increased lower lid height. The technique uses a lateral incision with dissection under the orbicularis and anterior to the orbital septum with release of the orbitomalar ligament. Loupe magnification is used. The nasal orbicularis fibers are released and the fat compartments are released and sewn to the midface fat using 6-0 transcutaneous sutures. An orbicularis muscle lift is performed for support and a lateral retinacular suspension is performed if necessary.
Results: Follow-up ranged from 3 months to 6 years, and there have been no major complications. All patients have been satisfied with the results.
Conclusions: Lateral incision-only lower lid blepharoplasty allows all necessary structures to be addressed for rejuvenation by recontouring in selected patients without anterior or posterior incisions into the central part of the lid.
Clinical question/level of evidence: Therapeutic, IV.