Septo-capsulopalpebral fascial recession flap technique in lower blepharoplasty: An experience of 453 consecutive cases and a review of the literature.

[BACKGROUND] Lower blepharoplasty is one of the most common cosmetic rejuvenation procedures. Occasionally, adverse effects of the operation, ranging from operated and somewhat flattened unnatural look of the lower eyelid region to more severe cases of ectropion, retraction leading to functional disabilities, further compound the problem. The author has developed a technique focusing on two aspects in terms of the outcome of the operation in developing a technique that ensures a uniformly consistent and esthetically perceptible result.

[METHODS] The anatomic basis for the technique is reviewed and described. We performed lower blepharoplasty using the septo-capsulopalpebral fascial recession flap. The procedure requires skin incision, maintenance of pretarsal muscular roll, skin-muscle flap elevation, orbital septum release, orbital fat removal, septo-capsulopalpebral recession flap, skin excision, and closure.

[RESULTS] No complications have occurred in 453 patients, including hematoma and dry eye. Lid malposition such as entropion or lagophthalmos was not seen in any patient. Regardless of the preoperative variations in the lower lid, the method corrected the prolapsed lower eyelid and provided satisfactory esthetic result after the operation. Recurrences have not been observed during the follow-up period.

[CONCLUSION] Lower blepharoplasty using the septo-capsulopalpebral fascial recession flap is effective to correct baggy eyelid, with minimal risk of cicatricial ectropion or tarsal capsize and retraction. Further, the esthetic result is enhanced by the author's method of making the pretarsal muscular roll with prevention of its loss.