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?

Doctor Answers 5

No touch technique

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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 technique is fine with two possible exceptions.

First, the unsupported removal of skin from the outer lower eyelid. When skin is removed from the lower eyelid, the lid can pull down. There is a downward force on the eyelid, and no upward force. The lower eyelid is a very weak structure, particularly in patients with forward set globes or loose lower eyelid skin. A canthopexy alone is not always enough to prevent this problem, since it can lead to a severe upward cant to the outer corner of the eye when no cheek support is performed at the same time.

Therefore we support the canthus of the lower eyelid by elevating the cheek structure slightly during the performance of a lower eyelid blepharoplasty (ultrashort incision cheeklift- USIC).

Also a concern for the no touch technique as you have described is the risk for hollowness if fat is simply removed and not remodeled. Every patient is different, and every surgery has its pluses and minuses, so experience and a conservative attitude in your surgeon are important.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Excellent technique

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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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

It's fine

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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 patient needs a lot of skin and some muscle excised.

Let the surgeon do what is right for you. Don't dictate what they should do - perhaps you will both agree, but usually the surgeon is right.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

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

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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 of the skin.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Customized surgery

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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 lower lid bag concerns and your lid might require more support than can be accomplished with soft tissue. A small implant over the lower orbital rim (bone) might be more helpful to support the lid structures. A canthopexy might make things worse as well because the tightening might pull the lid further down on your eyeball.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.