Lower Blepharoplasty: Skin-Muscle Flap Approach

Lower blepharoplasty has evolved significantly over the last several decades from a volume-depleting procedure to a volume-preserving procedure. In the days past, the surgeon would remove significant amounts of fat with aggressive skin-muscle resection utilizing the skin-muscle flap approach. This led to a hollowed, surgical look that soon began to fall out of favor not to mention an unacceptably high incidence of lower eyelid retraction [1]. In the last two decades, lower eyelid blepharoplasty has progressed to a volume conservation procedure with more conservative resection of fat or repositioning of fat using a transconjunctival approach with skin maintenance using a separate method such as laser resurfacing, skin pinch, lateral orbicularis muscle or lateral canthal tightening, or excising skin laterally [2–4]. This maximally preserves orbital septum and infraciliary orbicularis muscle minimizing the risk of lower eyelid retraction and ectropion.