Lower eyelid blepharoplasty: Since the most common adverse reaction following lower eyelid cosmetic surgery using the traditional skin incision is eyelid retraction, this approach is best avoided. Transconjunctival lower blepharoplasty is a less invasive and safer operation that is essentially free of the risk of lower lid retraction.
Upper eyelid blepharoplasty: Surgery performed under local anesthesia with sedation (as opposed to general or deep intravenous anesthesia) allows for more intraoperative feedback and thus the chance of inadvertent overcorrection is greatly decreased. Skin is removed conservatively. The orbicularis muscle (the closing muscle) is button-holed rather than opened widely to access the fat pockets, and no muscle is trimmed. Not only does this preserve the strength of the blinking mechanism, but it also decreases the chance of later hollowing.
Use of artificial tears: Since any form of blepharoplasty may temporarily lessen the force of blinking in the immediate post-operative period, the liberal application of preservative-free artificial tears is advised, including the use of an artificial tear lubricating ointment applied at bedtime.
