Pros and cons for extended lower Blepharoplasty?

Transcutaneous lower blepharoplasty carries more risk of lower eyelid distortion, including ectropion, retraction, etc, resulting in unnatural appearance and eye closure issue. Extended version adds even more risk. Of course surgical technique is important as well.

I am not sure exactly what an extended blepharoplasty is, and I write articles on this topic.Aggressive lower blepharoplasty procedures have a very high chance to alter eyelid shape by pulling down in the center or the side of the lower eyelid, creating a surprised appearance and causing dryness of the eye.In our practice, we have given up on conventional blepharoplasty entirely in favor of the short incision cheek lift.  The dynamics are just better for lifting the cheek, thereby liberating skin either for reconstruction of a pulled lower eyelid or prevention of pulling down while allowing tightening of the lower eyelid skin.

Using an incision under the eyelash line will allow the surgeon to tighten the skin and muscle as well as deal with the fat that causes bags.  Every patient's needs are different and there are advantages and disadvantages to any blepharoplasty technique.  Consultation with your board - certified surgeon should help answer these questions.

Cons - scar, potential for ectropion, may weaken orbicularis musclePros - removes excessive skin, allows for lateral lift or canthopexyThis procedure, if done judiciously, will not result in major changes to your eye shape.  But if done aggressively, will potentially change the shape/size of your eye.  I now prefer the transconjuctival approach and pinch blepharoplasty where only the excess skin is removed on the outside.

The extended lower blepharoplasty is useful in patients that have a lot of redundant lower eyelid skin and fairly prominent periorbital wrinkles. A successful result depends on good incision placement, orbicular muscle suspension and a lateral canthopexy. Because it is a 'bigger' lower blepharoplasty the risks of lower eyelid retraction are greater and techniques must be done for its prevention.

Hello sprmom7,There are more risks with transcutaneous lower blepharoplasty procedures because of the incision and the vector forces which tend  to pull the lower eyelid downward; but having said that, I perform transcuaneous lower blepharoplasty procedures quite commonly.  Technique and experience are very important in preventing the pitfalls of the surgery.  The main risks for a transcutaneous surgery are a noticeable scar, lumps and bumps, hollowing of the eye, and ectropion (lid sagging).  When I evaluate the patient, I am always looking at the eyelids support mechanisms and anatomy.  Some eyelids have a tremendous amount of skin laxity, festoon, and ptosis of the orbicularis oculi muscle.  If the orbit does not protrude and the bony orbital rim is well-developed, I may op to extend the lateral incision and suspend the orbicularis oculi muscle to the bone to get more of an improvement of the lower eyelid region.  So, I think in the right patient, the extended lower blepharoplasty procedure can be a powerful surgery in refreshing someone.  Good luck and I hope this was helpful.

 In our practice, we do not perform an extended lower blepharoplasty due to healing issues, scar contraction, and changing the shape of the lower eyelid.  The primary goal for lower eye lid surgery is to remove the excess fat in the lower lids creating the" puffy look". A minor and secondary goal is to remove any excess skin present at rest( not upon animation)  through and incision at the  lash line. A conservative amount of skin is removed and the incision is closed with tissue glue. For many examples, please see the link and video below

Dear Sprmom7,  I prefer to use a transconjunctival approach for most lower lid blepharoplasty. This allows the patient to look refreshed allowing the surgeon to remove and/or reposition the fat without any distortion to the shape of the eye, or risk of ectropian. I do not use an extended lower lid blepharoplasty incision due to many patients who come into my office complaining of this incision from other surgeons. It is always a personal choice of surgeons to use the approach they think is best for their patients best outcome. Best regards, Michael V. Elam, M.D.

I guess each consultant will have his/her own take on this. I personally perform the extended lower bleph fairly often without changes in lid shape. We do this when we want a lift to the tissues below the outer corner of the eye. It is called an Orbicularis suspension, and having done this over several years in selected patients we have no lid distortion so far. An example in a patient considered at risk for lid distortion is shown in the link below after the extended lower bleph.