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Background <p>Lower blepharoplasty (LB) can be performed using a transcutaneous or transconjunctival approach. The transconjunctival approach is currently the most widely used, as it is a simple, straightforward, and quick technique with less chance of complications. Sequelae of LB include eyelid malpositions due to tissue over-resection or denervation, especially in external approaches.&#xa0;We aimed to standardize the management and selection of the surgical technique for LB based on preoperative assessment and analysis of tarsoligamentary variables.</p> Methods <p>A 4-year retrospective study was conducted with patients who underwent LB. Surgical criteria was based on preoperative ophthalmological assessment and analysis of age, eyelid function and tarsoligamentary elasticity tests. The procedures included were Transconjunctival blepharoplasty (TB), TB and skin resection with or without lateral canthopexy (TBSR, TBSRLC), and percutaneous technique with canthoplasty (PBSRTS). All patients were given a Likert like satisfaction questionnaire six months after surgery.</p> Results <p> Forty two patients were included, 36 patients under 50 years of age with normal snap back, retraction and external canthus tilt tests underwent TB. TBSR was done in 27 cases while was TBSRLC performed in 9 patients, they were mainly over 50 year-old with diverse test results. Seven patients over 65 year-old with abnormal tests underwent PBSRTS. Complications were reported in 4 patients; two with dry eye and two with chemosis. No patient presented malposition of the lower eyelid. Likert like satisfaction survey, reported absence of discomfort in 92.8% (39 patients) and 95.2% (40 patients) reported satisfaction. After reviewing patient outcomes, an algorithm for appropriate selection of patients and recommended surgical procedure was proposed.</p> Conclusions <p>The management sequence based on ophthalmological assessment and tarsoligamentary elasticity tests herein presented is a safe and reproducible tool that minimizes complications due to malposition.</p> <p>Level of evidence: Level IV, therapeutic study. </p>

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Therapeutic algorithm to prevent or resolve eyelid malpositions in lower blepharoplasty: a 4-year retrospective study

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Alfonso Vallarta-Rodriguez,
  • Ivan Garcia-González,
  • Estela Velez-Benitez,
  • Santiago Vallarta-Compean,
  • Cynthia Euan-Vazquez,
  • Alessandra Manzali-Flores,
  • Alejandro Covarrubias-Noriega

摘要

Background

Lower blepharoplasty (LB) can be performed using a transcutaneous or transconjunctival approach. The transconjunctival approach is currently the most widely used, as it is a simple, straightforward, and quick technique with less chance of complications. Sequelae of LB include eyelid malpositions due to tissue over-resection or denervation, especially in external approaches. We aimed to standardize the management and selection of the surgical technique for LB based on preoperative assessment and analysis of tarsoligamentary variables.

Methods

A 4-year retrospective study was conducted with patients who underwent LB. Surgical criteria was based on preoperative ophthalmological assessment and analysis of age, eyelid function and tarsoligamentary elasticity tests. The procedures included were Transconjunctival blepharoplasty (TB), TB and skin resection with or without lateral canthopexy (TBSR, TBSRLC), and percutaneous technique with canthoplasty (PBSRTS). All patients were given a Likert like satisfaction questionnaire six months after surgery.

Results

Forty two patients were included, 36 patients under 50 years of age with normal snap back, retraction and external canthus tilt tests underwent TB. TBSR was done in 27 cases while was TBSRLC performed in 9 patients, they were mainly over 50 year-old with diverse test results. Seven patients over 65 year-old with abnormal tests underwent PBSRTS. Complications were reported in 4 patients; two with dry eye and two with chemosis. No patient presented malposition of the lower eyelid. Likert like satisfaction survey, reported absence of discomfort in 92.8% (39 patients) and 95.2% (40 patients) reported satisfaction. After reviewing patient outcomes, an algorithm for appropriate selection of patients and recommended surgical procedure was proposed.

Conclusions

The management sequence based on ophthalmological assessment and tarsoligamentary elasticity tests herein presented is a safe and reproducible tool that minimizes complications due to malposition.

Level of evidence: Level IV, therapeutic study.