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Khan et al. Modified lower eyelid blepharoplasty

the lateral orbital margin. Leaving 1-2 mm of excess Graefes Arch Clin Exp Ophthalmol 2011;249:1735-41.
skin while excising the extra lower eyelid skin prevents 2. Innocenti A. Couto RA, Waltzman JT, Drake RL, Zins JE. Evidence-
postoperative ectropion. based medicine: a graded approach to lower lid blepharoplasty. Plast
Reconstr Surg 2017;140:504e-5e.
The cheek lift and initial two orbicularis suspension 3. Chen JL, Liu CH, Yi CG. Indications of transconjunctival orbital
septum fat release and preservation for orbitopalpebral sulcus in lower
sutures raise the malar soft tissues whereas the eyelid blepharoplasty. Aesthetic Plast Surg 2017;41:753.
third orbicularis suture helps avoid overlapping of 4. Rostami S, de la Torre JI. Blepharoplasty, lower eyelid. Treasure
the muscles and prevents postoperative contour Island (FL): StatPearls Publishing; 2017
irregularities. The contouring suture lateral to the 5. Bater KL, Ishii M, Nellis JC, Joseph A, Papel ID, Kontis TC, Byrne
lateral canthus ensures a smooth trough appearance PJ, Boahene KDO, Ishii LE. A dual approach to understanding facial
which is a part of the normal anatomy of the eye thus perception before and after blepharoplasty. JAMA Facial Plast Surg
further enhancing the aesthetic outcomes. 2017.
6. Chatel H, Hersant B, Bosc R, La Padula S, Meningaud JP. Midface
rejuvenation surgery combining preperiosteal midcheek lift, lower
In conclusion, lower eyelid blepharoplasty is a complex blepharoplasty with orbital fat preservation and autologous fat grafting.
procedure and the malar complex must be considered J Stomatol Oral Maxillofac Surg 2017;118:283-8.
as a part of the lower eyelid when performing this 7. Hashem AM, Couto RA, Waltzman JT, Drake RL, Zins JE. Evidence-
procedure to obtain improved results. Our proposed based medicine: a graded approach to lower lid blepharoplasty. Plast
technique of a modified lower lid blepharoplasty is a Reconstr Surg 2017;139:139e-50e.
safe and effective alternative to the existing technique 8. Gasgarth RJ, Codner MA. Discussion: extended transconjunctival
which improves the aesthetic outcomes. lower eyelid blepharoplasty with release of the tear trough ligament
and fat redistribution. Plast Reconstr Surg 2017;140:283-5.
9. Wong CH, Mendelson B. Extended transconjunctival lower eyelid
This technique is valuable in a patient with a flat malar blepharoplasty with release of the tear trough ligament and fat
prominence and therefore its use is recommended in redistribution. Plast Reconstr Surg 2017;140:273-82.
the management of this patient cohort. 10. Yi MY, Choi HS, Jang JW, Kim SJ, Jang SY. Asymmetry of
preoperative incision design markings for upper blepharoplasty. J
Craniofac Surg 2017;28:e419-22.
DECLARATIONS 11. Miranda SG, Codner MA. Micro free orbital fat grafts to the tear
trough deformity during lower blepharoplasty. Plast Reconstr Surg
Authors’ contributions 2017;139:1335-43.
Concept and design: M.A.A. Khan, A.A. Javed, M. 12. Mutaf M, Temel M. A new technique for total reconstruction of the
Gorman, D. Othman, M. Riaz lower lid. Ann Plast Surg 2017;78:171-7.
Data collection and analysis: M.A.A. Khan, K. Aziz, 13. Miller CC. Cosmetic surgery: the correction of featural imperfections.
Chicago, IL: Oak Printing; 1907.
A.A. Javed, D. Othman 14. Bourguet J. Fat herniation of the orbit: our surgical treatment bull.
Write up: M.A.A. Khan, K. Aziz, A.A. Javed, M. Acad Med 1924;92:1270-2.
Gorman, D. Othman, M. Riaz 15. Espinoza GM, Holds JB. Evaluation and treatment of the tear trough
Review and final approval: M.A.A. Khan, K. Aziz, A.A. deformity in lower blepharoplasty. Semin Plast Surg 2007;21:57-64.
Javed, M. Gorman, D. Othman, M. Riaz 16. Hamra ST. The role of the septal reset in creating a youthful
eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg
Financial support and sponsorship 2004;113:2124-41; discussion 2142-4.
None. 17. Loeb R. Fat pad sliding and fat grafting for leveling lid depressions.
Clin Plast Surg 1981;8:757-76.
18. Hamra ST. Arcus marginalis release and orbital fat preservation in
Conflicts of interest midface rejuvenation. Plast Reconstr Surg 1995;96:354-62.
There are no conflicts of interest. 19. Hester TR Jr, Ashinoff RL, McCord CD. Managing postseptal fat
in periorbital rejuvenation: anatomic intraorbital replacement using
Patient consent passive septal tightening. Aesthet Surg J 2006;26:717-24.
Not applicable. 20. Goldberg RA. Transconjunctival orbital fat repositioning: transposition
of orbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg
2000;105:743-8; discussion 749-51.
Ethics approval 21. Mohadjer Y, Holds JB. Cosmetic lower eyelid blepharoplasty with fat
Not applicable. repositioning via intra-SOOF dissection: surgical technique and initial
outcomes. Ophthal Plast Reconstr Surg 2006;22:409-13.
REFERENCES 22. Murri M, Hamill EB, Hauck MJ, Marx DP. An update on lower lid
blepharoplasty. Semin Plast Surg 2017;31:46-50.
23. Garcia RE, McCollough EG. Transcutaneous lower eyelid
1. Liao SL, Wei YH. Fat repositioning via supraperiosteal dissection blepharoplasty with fat excision: a shift-resisting paradigm. Arch
with internal fixation for tear trough deformity in an Asian population. Facial Plast Surg 2006;8:374-80.

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