Lower Blepharoplasty: Skin, Transconjunctival and Transcutaneous with Fat Transposition Approach

The mid-cheek is comprised of the lid-cheek segment, the malar segment, and the nasolabial segment. Whereas the youthful mid-cheek typically appears as a uniform rounded fullness, aging makes these three segments evident, separated by the palpebromalar groove (tear valley), the nasojugal groove medially, and the mid-cheek groove. Consequently, contemporary lower blepharoplasty focuses on smoothing the lid-cheek junction. This can be achieved by a variety of techniques that include the release of retaining ligaments, fat transposition, and mid-face augmentations or suspension. In recent years, lid-tightening procedures such as canthopexy and canthoplasty have been emphasized as adjunctive procedures to both the transcutaneous and transconjunctival approaches to treat any lid laxity and as a preventive measure to avoid postoperative lower eyelid malposition. This book chapter provides a thorough overview of lower eyelid rejuvenation surgery and a detailed description of the currently most advanced surgical techniques for both the transconjunctival and transcutaneous approach, including the “Boomerang Technique” and the “Three-Vector Suspension Technique.”