Refining transcutaneous lower blepharoplasty: Key steps for minimizing complications.

[PURPOSE] Lower blepharoplasty carries the risk of significant, long-lasting complications if not performed correctly. The aim of this study is to explore the outcomes, patient satisfaction, and complications of transcutaneous lower blepharoplasty, with a particular focus on key aspects of the surgical technique that enhance favorable results and minimize adverse effects.

[METHODS] A retrospective chart review of a primary lower transcutaneous blepharoplasty series conducted over a 2-year period was performed. Patients with a history of prior eyelid surgery were excluded. Preoperative demographic and morphological data, surgical techniques, the need for additional procedures, and complications were evaluated from patient charts and standardized photographs taken before and after surgery by an independent observer.

[RESULTS] A total of 265 patients underwent successful transcutaneous lower eyelid blepharoplasty (LLB), yielding satisfactory outcomes with high patient satisfaction during a median follow-up of 120 days. Increased scleral show occurred in 3 patients (1%), of those two underwent lower lid retractor release with lateral canthal support. Early intralamellar scarring requiring repeated 5-fluorouracil injections occurred in 5 patients (1.9%). No other complications were noted. No patients were dissatisfied with the final outcome.

[CONCLUSION] Transcutaneous LLB, which incorporates component steps including controlled skin resection, preservation of orbicularis muscle innervation, preseptal orbicularis suspension, and canthal support (when necessary), has demonstrated improved outcomes with exceptionally low complication and revision rates.