Summary: Many techniques have been described for lower eyelid surgery, and the evolution of these procedures has seen significant advances, from simple skin excision to fat preservation and repositioning. Lower lid blepharoplasty can address lid-cheek junction and tear-trough deformities, which cause significant aesthetic concerns for patients, giving the appearance of fatigue and sadness. However, there is potential for serious functional and aesthetic complications, including dry eyes, scleral show, and ectropion. In addition, many surgeons perceive a steep learning curve and difficulty of reliably obtaining excellent cosmetic results. However, the authors have found that an extended lower blepharoplasty can significantly improve eyelid and midface contour, creating substantial aesthetic improvements without visible scars or an operated appearance. In this article, the authors review the relevant pathoanatomical causes of periorbital contour deformities and the evolution and history of lower eyelid surgery, and present the results of their extended blepharoplasty technique in over 300 patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.