Blepharoplasty "No Touch" Technique?

In Blepharoplasty, what do you think about the "no touch technique", where the surgeon removes fat transconjunctively and then removes skin transcutaneously, by going around the eye muscle without cutting into the orbital septum, for preserving the shape and functionality of the eye and avoiding retraction/ectropian?

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5 Doctor Answers | Asked by crystalgurl in NY

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Excellent technique

The “no-touch” is an excellent technique whereby fat is removed from the transconjunctival approach, and then a small amount of skin removed transcutaneously. The “no-touch” technique involves not touching the eye muscle so as to avoid a pull-down or a sagging of the lower eyelid. This has been popular in our office for 20 years.

No touch technique

Many surgeons who perform a large amount of midface or lower eyelid surgery have come to the conclusion that you should leave the orbital septum alone if possible. That is the layer above the fat but below the skin. If blood deposits or scarring forms in the orbital septum, the eyelid can pull down, causing the eyes to be overexposed. Likewise, aggressive lower eyelid surgery where lots of skin is removed leads to significant, often unrepairable problems of the lower eyelid. The no touch... more

It's fine

If you go to a good plastic surgeon, they will tell you what procedure is right for you. Not all patients are good candidates for what you describe. This is something that we learn over time, I have over 30 years of experience and know what is right for what patient. If there is more than one procedure that will work, we discuss it. What you are describing is a standard transconjunctival Blepharoplasty with some external skin excised (pinch technique). It works well, but not if a... more

It is always better to avoid cutting the orbicularis muscle if possible

We always prefer preservation of the muscle as you described when performing a lower eyelid bleopharoplasty. This can be done by removing fat from the "internal approach" and skin from an external "limited incision" approach. In this manner the orbicularis muscle or the muscle which provides support for the lower lid is preserved. At times we will come back in three months and do a phenol peel of the lower lid in order to provide further tightening and rejuvenation... more

Customized surgery

Each patient needs customization of their surgical plan. No touch technique might be all well and good, but it doesn't mean that particular plan is appropriate for you. Your photo suggests a lack of structural support under your lower eyelid because of the hollowness below your lower lid bags and the white showing above the lid margin. I would suspect that you have what is known as a negative vector alignment to your orbital anatomy.This means that fat removal may not be the answer to your... more