Seven Disadvantages of Transcutaneous Lower Blepharoplasty

1. Lower Eyelid Retraction Now

Because of internal anatomical disruption related to a long dissection, scarring is extensive. If contracture ensues, the eyelid may be pulled downward, become rounded, and the white of the eye may become exposed.

2. Lower Eyelid Retraction Later

Since a plane of scar is created in the normally flexible interior of the eyelid and the orbicularis muscle is weakened by cutting through it, retraction may first appear or, if already present, worsen with advancing age as the lid's support system loses some of its natural strength and a descending middle face transmits more force than the lid can handle.

3. Scar Extending Most of the Way Across the Lid

Since a skin incision must be made across the length of the eyelid, an external scar is created, even if only fat needs to be removed. While it eventually fades to white, a slightly pink color may remain for months or sometimes even permanently if the scar has been placed under prolonged tension from lid retraction.

4. Damage to the Orbicularis Muscle and Orbital Septum

For the surgeon to get from the skin surface to the deeper orbital fat requires cutting through assorted eyelid layers located in between, including the orbital septum, a supporting element, and the orbicularis muscle, the eye's closing muscle. Normal tissue is thus converted to scar and function may be compromised.

5. Interference with Closure and the Proper Handling of Tears

If the orbicularis muscle is weakened significantly, the eyelid's position relative to the eyeball may be altered and its closing and pumping function compromised. If eyelid retraction occurs as well, these problems can be aggravated to a point that the health of the eye's surface is threatened.