Eye-Opening Effect Achieved by Modified Transconjunctival Lower Blepharoplasty.

Background: Enophthalmia (abnormally sunken eyeball in the socket) and ptotic upper lid, as well as lower lid symptoms, are commonly observed in patients seeking periorbital rejuvenation.

Objectives: The aim of this study was to assess the effect of transconjunctival lower blepharoplasty (TCLB) modified by adding deframing and decompression maneuvers to the lower orbital fat compartment (LOFC) and its support structures to obtain better results in both the lower and upper lids.

Methods: Modified TCLB was performed in patients with lower eyelid symptoms. Palpebral fissure height (PFH) (the distance between the upper and lower eyelids in vertical alignment with the center of the pupil) was measured before surgery and 12 months postoperatively from 3-dimensional photographs. These data were compared to validate the postoperative eye-opening effect. The weight of the excised fat from each LOFC was also measured and compared.

Results: Forty patients (36 females and 4 males) who underwent modified TCLB were followed up 12 months postoperatively. Mean [standard deviation] preoperative PFHs were 8.41 [1.15] mm (range, 6.1-10.7 mm) for the right and 8.41 [1.12] mm (range, 5.5-10.4 mm) for the left. Postoperative PFHs were 9.26 [0.95] mm (range, 6.4-11.1 mm) for the right and 9.21 [0.94] mm (range, 6.2-11.1 mm) for the left. The improvement in postoperative eye opening was statistically significant. The total excised LOFC was 0.43 [0.24] g (range, 0-1.2 g) for the right and 0.42 [0.25] g (range, 0-1.5 g) for the left. The largest amount of fat was excised bilaterally from the lateral LOFC, and the difference was statistically significant.

Conclusions: The results after the modified TCLB clearly demonstrate increased eye-opening ability and marked resolution of observable symptoms. The anatomical dynamics of the orbit involved in this procedure are detailed through scientific data.

Level of evidence: 4 (therapeutic):