Several options for treating loose or damaged skin may be considered along with transconjunctival lower blepharoplasty:
• Wrinkles may be softened, skin quality improved, and the skin tightened slightly by the application of trichloroacetic acid (TCA chemical peel) immediately following the surgery.
• When indicated, a tiny strip of skin may be pinched and then excised from the area just below the lashes without disturbing the deeper eyelid structure (pinch blepharoplasty).
• When indicated, thinned or sagging tissues supporting the lower eyelid may be tightened (canthopexy) by attaching them to the lining or the bone or fascia surrounding the socket.
• Tissue-Sparing
Approached through a skin incision, bulging orbital fat is returned to its normal anatomic compartment, making fat removal unnecessary. There are both advantages and disadvantages to tissue-sparing lower blepharoplasty, which is a much newer technique that is still developmental and not without its own set of risks.
• Transcutaneous
Transcutaneous lower blepharoplasty (skin and fat removal undertaken through a skin incision) had not been employed in our practice for over fifteen years. Not only is the aesthetic outcome sub-optimal, but the risk of significant immediate and late complications is unacceptably high.
• Chart: Three approaches to lower eyelid fat reduction
Although still popular, we refrain from lower eyelid fat repositioning into the tear trough in the vast majority of patients. Less invasive, safer, and more effective approaches are available for filling upper cheek hollows. Moving substantial amounts of fat out of the orbit simply to camouflage a cheek depression introduces the possibility of causing eyelid hollowness.
