Treatment Evolution Of The Lower Eyelid

Background: Lower blepharoplasty is one of the most popular cosmetic procedures to improve facial aesthetic.Lower eyelid and midface changes are frequently the first aesthetic complaints of an aging patient.Aging changes in the lower eyelid occur variably in each patient including pseudoherniated fat,tear trough deformity,lid laxity or orbital retrusion.A customized approach considering each patient’s lower eyelid configuration is important.Current method of periorbital rejuvenation to restore a youthful appearance is through a conservative and concise preoperative assessment and focuses on limited skin resection.Therefore,surgical techniques related to lower blepharoplasty have been widely proposed and used to improve postoperative outcomes and avoid complications.Objective: The purpose of this study is to better understand various approaches on treating the lower eyelid changes associated with aging,and to review the evolution of lower blepharoplasty technique.The advantages and disadvantages of various approaches are summarized,as well as the management of the most common complications presented in lower blepharo-plasty technique.Methods: A review of literature was conducted in the Pub Med database from January 2000 until January 2020.Keywords that were used alone or in combination for literature search were: “lower blepharoplasty","periorbital rejuvenation",“complications”,"fat repositioning","septal reset",“fat augmentation”,“arcus marginalis release”,"fat preservation",and "fat filler".Titles and abstracts were scanned to include the most relevant articles,yielding103 potential articles to go through the full text.Results :A total of 48 studies met the inclusion criteria and were selected for the review.Among these studies,31 studies described various techniques of lower blepharoplasty,8 studies described lower lid bags,9 studies described complications of post lower blepharoplasty.A narrative synthesis of data was finally undertaken with particular attention to the evolution of various lower blepharoplasty techniques,and common complications of the lower blepharoplasty procedures.Studies evaluating fat conservation,fat augmentation,fat repositioning,ORL release,and septal reset are also analyzed and discussed.Conclusions: The improvement in periorbital rejuvenation have been made over the last few decades.With the better understanding of periorbital changes associated with aging,one understands that one technique cannot fit all patients.In order to restore and blend the lid-cheek junction for facial rejuvenation,different components of periorbital aging needs to be addressed.Evolving trend was aggressive skin,fat and muscle removal to fat repositioning to blending lidcheek junction currently with minimal skin and fat excision.Evolution continues towards deep fat compartment volume enhancement for cheek rejuvenation in addition to blending lid-cheek junction.Volume preservation and enhancement rather than excessive tissue removal define modern blepharoplasty.This report provides the current evolution of surgical approaches in the management of lower eyelid cheek areas for facial rejuvenation..