Lower Lid Malposition after Skin-Muscle Flap Blepharoplasty: How Common Is It?

Goals/Purpose: Despite the aesthetic benefits of traditional lower lid blepharoplasty through skin-muscle flaps, applications of these procedures has decreased in popularity over the past decades. Potential complications such as lower lid malposition, scleral show, and rounded palpebral fissures have contributed to the reluctance of performing these procedures. As a result, we designed a study to evaluate the senior author’s (F.N.) experience of facelifts with concurrent lower lid blepharoplasty through skin-muscle flaps to evaluate the prevalence of common ophthalmologic conditions (e.g., chemosis, dry eyes, epiphora), symptomatic lid malposition, scleral show, and rounded palpebral fissures after surgery.

Methods/Technique: We performed a retrospective review of 100 consecutive patients who underwent facelift and concurrent skin-muscle flap lower lid blepharoplasty with the senior author between 2004 and 2010. Ophthalmologic complications were analyzed.

Results/Complications: Of the 100 patients who underwent facelift and concurrent lower lid blepharoplasty, nearly all (98.0%) were women and average age was 59.5 ± 7.2 years old. All patients underwent lower lid skin-muscle flap blepharoplasty, of whom 95% had concurrent canthopexy and 5% had concurrent canthoplasty. Minor ophthalmologic complications that resolved included chemosis (13%), dry eyes (4%), and epiphora (3%). Although six patients experienced temporary lower lid malposition, only two primary blepharoplasty patients and one with pre-existing lid retraction required a revision anchoring procedure. None of these patients developed scleral show or rounded palpebral fissures.

Conclusion: In the senior author’s experience of 100 consecutive facelift and concurrent lower lid skin-muscle flap blepharoplasty, complications such as chemosis, dry eyes, and epiphora were lower than previously published experiences. Moreover, only 3% of patients had symptomatic lid malposition requiring a revision procedure, supporting the safety and effectiveness of this procedure.