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Surgical Pearls | AAFPRS Annual Fall Meeting Featured Article

Transcutaneous Skin-Muscle Flap Suspension Lower-Eyelid Blepharoplasty

Scott Shadfar, MD1,2; Stephen W. Perkins, MD1,2
[+] Author Affiliations
1Meridian Plastic Surgeons, Indianapolis, Indiana
2Department of Otolaryngology/Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
JAMA Facial Plast Surg. 2015;17(6):459-461. doi:10.1001/jamafacial.2015.1332.
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This Surgical Pearl with video details the procedure for transcutaneous lower-eyelid blepharoplasty with skin-muscle flap suspension for lower eyelid rejuvenation.

The transcutaneous lower-eyelid blepharoplasty is a commonly performed surgical technique and an important tool in the armamentarium of facial plastic surgeons. The facets of lower-eyelid blepharoplasty begin with proper patient selection and rely on several technical subtleties that are crucial to achieve an excellent cosmetic and functional result while avoiding potential complications. The senior author (S.W.P) has been using the transcutaneous approach with orbicularis oculi muscle suspension for 30 years to address redundant or excessive skin and muscle while gaining wide exposure to treat pseudoherniation of the orbital fat compartments.

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Figure 1.
The Transcutaneous Lower-Eyelid Blepharoplasty Technique

A and B, A subciliary incision is made, the orbital septum is identified at the lateral aspect, and blunt scissors are used to elevate the skin-muscle flap off of the orbital septum bluntly (spreading) in an avascular plane. C, Herniated fat is gently grasped, and bipolar cautery is used to cauterize the base of each fat pad prior to excision. D, While the assistant holds digital pressure, an inferiorly directed incremental cut is made in the skin at the lateral canthus, and the overlapping skin is conservatively excised. E, The periosteum of the lateral orbital rim at the level of tubercle is grasped using a 5-0 Monocryl suture (Ethicon), and then the suture is passed through the orbicularis oculi muscle on the skin-muscle flap. F, The lower eyelid is suspended.

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Figure 2.
A 45-Year-Old Woman With Evidence of Pseudoherniation of Orbital Fat and Vertical Skin Excess
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Transcutaneous Skin-Muscle Flap Suspension Lower-Eyelid Blepharoplasty

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