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Primary Transcutaneous Lower Blepharoplasty with Routine Lateral Canthal Support: A Comprehensive 10-Year Review

Codner, Mark A. M.D.; Wolfli, James N. M.D.; Anzarut, Alexander M.D.

Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 241-250
doi: 10.1097/01.prs.0000295377.03279.8d
Cosmetic: Original Articles

Background: Rejuvenation of the lower eyelid often requires tightening of excess skin and muscle and removal or transposition of orbital fat. Although transcutaneous lower blepharoplasty can accomplish these aesthetic demands, it has been associated with an increased risk of lower lid malposition. Routine lateral canthal support during lower blepharoplasty has recently been advocated to minimize this risk. This study reviewed the outcome of a surgeon’s 10-year experience with primary lower transcutaneous blepharoplasty and lateral canthal support consisting of canthopexy, canthoplasty, and orbicularis suspension.

Methods: A retrospective chart review of a primary lower transcutaneous blepharoplasty series over a 10-year period was performed. Patients with a history of prior eyelid surgery for blepharoplasty or midface lift were excluded. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical technique and management of complications were determined from operative reports and clinical notes.

Results: There were 264 patients with a median follow-up of 264 days (range, 60 to 2410 days). Lid malposition requiring operative correction occurred in nine patients (3.5 percent). Additional complications included orbital hematoma in one patient (0.4 percent), chemosis in 32 patients (12.1 percent), and blepharitis in 10 patients (3.8 percent). Minor surgical revisions unrelated to lid malposition were performed on 31 patients (11.7 percent) for correction of subciliary incision cysts or granulomas, canthal suture inflammation, and canthal webbing.

Conclusions: Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty to obtain the desired aesthetic result and maintain the natural appearance of the eyelid shape. The associated complication rate is acceptable.


Atlanta, Ga.; and Edmonton, Alberta, Canada

From Paces Plastic Surgery; the Department of Plastic Surgery, Emory University; and the Department of Plastic and Reconstructive Surgery and Epidemiology Coordinating and Research (EPICORE) Center, University of Alberta.

Received for publication March 20, 2006; accepted July 26, 2006.

Disclosure: No financial support was provided for this article.

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Mark A. Codner, M.D., Paces Plastic Surgery, Suite 640, 3200 Downwood Circle, Atlanta, Ga. 30327,

©2008American Society of Plastic Surgeons