Analysis of two techniques for transcutaneous lower eyelid blepharoplasty: A prospective surgical trial by using random allocation.

Patients submitted to lower eyelid blepharoplasty by two different techniques. The Surgical Group 1 (SG1) consisted of standard fat-resection lower eyelid blepharoplasty. The Surgical Group 2 (SG2) - Subciliary incision was drawn 3 mm below entire lash line, from the punctum medially to the lateral canthal region. The lateral aspect was made 4 to 5mm from lateral canthal angle within an existing crow’s foot. A small incision through skin and muscle was made with a blade at the lateral end of the marking, measuring approximately 10 mm. Straight iris scissors beveling away from the pretarsal orbicularis completed the subciliary skin incision, leaving the pretarsal orbicularis undisturbed. The preseptal orbicularis was opened from mid-pupil to the lateral orbital rim. The scissors were used to develop a plane between the septum and the preseptal orbicularis, then the skin muscle flap was raised, preserving approximately 6 mm of pretarsal orbicularis, exposing the retromuscular space. This flap was dissected to the level of the orbital rim using cutting eletrocautery, thereby the septum orbitale, the capsulopalpebral fascia, the inferior orbital rim, and arcus marginalis were exposed. The junction of the septum orbitale and the periosteum of the inferior orbital rim (arcus marginalis) was released using cutting eletrocautery. After placing a traction stitch to hold the lower lid in extesion, the complex formed by septum orbitale and capsulopalpebral fascia was elevated and the orbital fat from each of the three compartments was released, and conservastively removed or preserved and then repositioned. Only the orbital fat from the medial and central compartments were transposed and sutured to the periosteum with 6-0 Vicryl (registered trademark). The tear trough was corrected by release of the muscular origin contributing to the deformity, addition of volume by fat transposition, and tightening of the skin muscle flap. Next, the junction of the septum orbitale and the periosteum of the inferior orbital rim was reset to its anatomical position (simply suture back to the orbital rim) with interrupted 6-0 Vicryl (registered trademark). Duration of procedure: SG1- 1h 15m SG2- 1h 25m