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Simplifying Blepharoplasty

Zoumalan, Christopher I., M.D.; Roostaeian, Jason, M.D.

Plastic and Reconstructive Surgery: January 2016 - Volume 137 - Issue 1 - p 196e–213e
doi: 10.1097/PRS.0000000000001906
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Learning Objectives: After reading this article, the participant should be able to: 1. Identify pertinent eyelid and periorbital anatomical structures when evaluating a patient for blepharoplasty. 2. Adequately evaluate a patient by performing a focused history-taking and medical examination tailored for the aging eyelid patient. 3. Identify the aging changes that have occurred, and determine the particular changes that will be addressed surgically. 4. Determine a safe and effective surgical plan.

Summary: Blepharoplasty remains one of the most common aesthetic procedures performed today. Its popularity stems partly from the ability to consistently make significant improvements in facial aesthetics with a relatively short operation that carries an acceptable risk profile. In this article, the authors attempt to simplify the approach to both upper and lower lid blepharoplasty and provide an algorithm based on the individual findings for any given patient. The recent trend with both upper and lower lid blepharoplasty has been toward greater volume preservation and at times volume augmentation. A simplified approach to upper lid blepharoplasty focuses on removal of excess skin and judicious removal of periorbital fat. Avoidance of a hollow upper sulcus has been emphasized and the addition of volume with either fat grafting or fillers can be considered. Lower lid blepharoplasty can use a transcutaneous or a transconjunctival approach to address herniated fat pads while blending the lid-cheek junction through release of the orbitomalar ligament and volume augmentation with fat (by repositioning and/or grafting) or injectable fillers. Complications with upper lid blepharoplasty are typically minimal, particularly with conservative skin removal and volume preservation techniques. Lower lid blepharoplasty, conversely, can lead to more serious complications, including lid malposition, and therefore should be approached with great caution. Nevertheless, through an algorithmic approach that meets the needs of each individual patient, the approach to blepharoplasty may be simplified with consistent and predictable results.

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Los Angeles, Calif.

From the Division of Oculoplastic Surgery, Department of Ophthalmology, Keck School of Medicine of the University of Southern California; and the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles.

Received for publication December 4, 2014; accepted August 26, 2015.

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Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Jason Roostaeian, M.D., Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 465, Los Angeles, Calif. 90095,

©2016American Society of Plastic Surgeons