The Skin in Lower Lid Blepharoplasty: General Principles
In cases of fat removal or repositioning or pseudoherniation of orbital fat, enhancement of the deficient suborbital portion of the malar complex is the principal component of modern lower eyelid blepharoplasty. Skin removal is usually unnecessary since there is typically inelasticity rather than actual excess of skin. The widely preferred approach is transconjunctival incision, which results in less eyelid retraction, less scleral show, and less postoperative ectropion than other methods. Some surgeons prefer a transcutaneous approach in patients who have hypertrophy of the orbicularis oculi muscle and therefore require muscle excision.