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Transconjunctival Lower Blepharoplasty: A 2-Sided Assessment of Results and Subjects’ Satisfaction

Kashkouli, Mohsen Bahmani M.D.; Pakdel, Farzad M.D.; Kiavash, Victoria M.D.; Ghiasian, Leila M.D.; Heirati, Abtin M.D.; Jamshidian-Tehrani, Mansooreh M.D.

Ophthalmic Plastic and Reconstructive Surgery: July/August 2013 - Volume 29 - Issue 4 - p 249–255
doi: 10.1097/IOP.0b013e31828ecfb9
Original Investigation

Purpose: To assess the results and satisfaction after transconjunctival lower blepharoplasty, evaluate the effect of associated aesthetic procedures on the satisfaction, and compare surgeon versus subjects’ perspective on the results.

Methods: In a retrospective cross-sectional study, a chart review was performed on transconjunctival lower blepharoplasty procedures performed by 1 eye plastic surgeon from April 2003 to April 2009. Subjects with less than 6 months follow-up time or reoperation were excluded. Demographic data, associated surgical procedures, intra and postoperative complications, subjects and surgeon’s perspectives on postoperative results, photographs (before and after the operation), and satisfaction score (Visual analogue scale score) at last follow-up time were recorded.

Results: There were 164 subjects (133 women, 81.1%) with mean age of 50.7 years (standard deviation = 11.6, range: 23–80). Mean follow-up time was 22.8 months (standard deviation = 11.5, range = 6–60 months). Complications, observed by the surgeon and subjects, were undercorrected fat excision (4.9% vs. 3.7%), eyelid retraction (1.2% vs. 1.2%), and tear trough deformity (9.7% vs. 0.6%). Subjects reported less complication rate (5.4%) than surgeon (15.8%). Mean visual analogue scale score was 92.8 (standard deviation = 0.36), which was significantly higher in subjects who had simultaneous upper blepharoplasty and lower in subjects with postoperative eyelid retraction.

Conclusions: Transconjunctival lower blepharoplasty is associated with a high satisfaction. Subjects reported less complication rate than surgeon especially for tear trough deformity. Postoperative eyelid retraction significantly decreased and simultaneous upper blepharoplasty procedure significantly increased the satisfaction.

Simultaneous upper blepharoplasty significantly increased and postoperative eyelid retraction significantly decreased the satisfaction among 164 subjects with transconjunctival lower blepharoplasty. Rate of complications was more from the surgeon’s than subjects’ perspective. Two sides’ perspectives were especially different on the rate of postoperative tear trough deformity.

Eye Plastic Unit, Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran

Accepted for publication February 21, 2013.

Presented at the annual meeting of European Society of Ophthalmology (poster), June 2011, Geneva, Switzerland, and in the annual meeting of European Society of Ophthalmic Plastic and Reconstructive Surgery (Oral), September 2011, Cernobbio, Italy.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Mohsen Bahmani Kashkouli, M.D., Eye Plastic Unit, Rassoul Akram Hospital, Sattarkhan-Niayesh St., Tehran 14455-364, Iran. E-mail:

© 2013 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.