Lower Eyelid Blepharoplasty

Abstract

Concerns about lower eyelid appearance are common in middle-aged and elderly patients. These concerns often occur in patients also undergoing evaluation for upper blepharoplasty, so it is beneficial to be able to offer these patients options for improving conditions that affect the lower eyelids. The primary cosmetic issues of the lower eyelids involve herniated orbital fat and lower eyelid rhytides, which may occur simultaneously or independently. The surgeon must consider the patient’s age, appearance, skin type, and anatomy. The option of excising or repositioning herniated orbital fat or of performing direct skin excision, CO₂ laser skin resurfacing, mid-face lifting, or a combination of procedures can then be discussed with the patient. In this chapter, we describe techniques for lower eyelid evaluation, excision and repositioning herniated orbital fat, and direct lower eyelid skin excision.