Transconjunctival Lower Lid Blepharoplasty

Chapter 37. Transconjunctival Lower Lid Blepharoplasty

Kimberly A. Swartz, BA; Robert C. Silich, MD, FACS; Henry M. Spinelli, MD, FACS

INDICATIONS

The ideal candidate for this procedure is a younger patient who has no, or minimal, amount of skin redundancy but has prominent orbital fat pads. Another patient who is well suited for this procedure is the older individual who is unusually thin with minimal skin redundancy and does not have lower lid malposition. This technique allows nasojugal or lateral orbital rim depressions to be addressed through fat repositioning.

PREOPERATIVE PREPARATION

The transconjunctival approach is most successful in the younger patient, likely as a result of the greater skin elasticity when compared to an older patient. This elasticity allows conversion of the convex lid to a slightly concave lid to occur more easily. When the patient is older, it is best to plan to use this procedure as an adjunct to other procedures, such as laser procedures or a simple rhytidectomy with orbicularis suspension.

ANESTHESIA

Monitored anesthesia care (MAC) or general anesthesia can be used for this procedure.

POSITION AND MARKINGS

Generally there are no preoperative markings for the transconjunctival approach; however, standard medical photography is used intraoperatively. These photographs should include anterior, true lateral, and upward gaze views. The upward gaze views are particularly helpful in examining the periorbital fat pockets.