Long-Term results with the Extended Transconjunctival Lower Eyelid Blepharoplasty: A Prospective Study of 200 Consecutive Cases.

[INTRODUCTION] We first described the extended transconjunctival lower eyelid blepharoplasty in 2017. In this prospective study, we present our long-term outcomes with this technique.

[MATERIALS AND METHODS] Two hundred consecutive patients who underwent the extended transconjunctival lower eyelid blepharoplasty between June 2017 and December 2024 were prospectively evaluated. Ninety-six percent of patients received concomitant mid cheek fat grafting. The mean follow-up was 22 months. Two specific aspects unique to our technique were analyzed: (1) the long-term effects of releasing the tear trough ligament and orbicularis oculi origins, and (2) the use of free fat grafts, fashioned from excised orbital fat, placed along the orbital rim. Patients were evaluated for aesthetic outcomes, lower eyelid position stability, and dynamic changes with smiling. Patient satisfaction was assessed with an outcome questionnaire.

[RESULTS] This technique is both effective and safe in addressing eye bags and the tear trough deformity. No increase in the incidence of scleral show was observed. Free fat grafting, utilizing excised orbital fat, effectively corrected the tear trough deformity and softened the lid-cheek junction. Release of the orbicularis oculi origins consistently resulted in, long-lasting improvement in periorbital aesthetics during smiling, without compromising orbicularis oculi function. Patient satisfaction was high. The overall complication rate was low, with fat necrosis occurring in 3.0% of patients and a revision rate of 1.0% for residual lower eyelid bulges.

[CONCLUSIONS] This technique delivers superior aesthetic outcomes compared with conventional approaches that do not release the tear trough ligament. A novel finding in this study is that the technique predictably improves the aesthetics of the smile, which is a significant benefit.