Abstract

Objectives: Blepharoplasty surgery is considered one of the most common cosmetic surgeries done. Lower blepharoplasty always holds the challenge of maintaining the integrity and position of the lower eyelid. The incidence of lower eyelid ectropion after transcutaneous blepharoplasty is not uncommon. With the advances in laser tightening procedures, the more conservative and preservative transconjunctival blepharoplasty is now performed. That avoids the risks that we could face after transcutaneous blepharoplasty whether scarring or ectropion. Introduction: The demand on lower eyelids rejuvination is always present. A very challenging procedure; especially the transcutaneous technique. Recently, the transconjunctival approach gives very satisfactory results with faster healing and a dramatic decline in the incidence of complications compared to the traditional transcutaneous approach. The current and continuous advancements in the field of laser tightening technologies is helping in treating more cases by the transconjunctival approach and deal with skin redundancy using laser tightening sessions. Materials / method: The procedure is done under local anaesthesia. Usually takes around 30 - 45 minutes. The incision is done to the conjuctival side of the eyelid just at the lower border of the tarsus. Orbicularis oculi muscle is then cut and dissected to expose the septum.Beginning with the medial fat pad makes it easier to recognize and avoid injuring the inferior oblique muscle. Then the rest of the fat pads are exposed and extra fat is removed. Removal of extra fat is not recommended to avoid hollowness, instead a fat stump is always left and cauterized to stick to the orbital rim to preserve volume. Results: It has been the procedure of choice recently.Complications are rare to happen somehow, it is a straightforward procedure knowing the anatomy and the amount of fats needed to be removed. More than 500 eyelids were operated upon by this approach. Patients satisfaction is present in over 90% of the cases. Postoperative hollowness is seen in almost 12% of the cases with different degrees. Postoperative skin redundancy is seen in 20% of the cases. Postoperative undercorrection with residual puffiness only seen in 3% of the cases. And all these could be easily corrected to provide the desired result Conclusion: Transconjunctival blepharoplasty is a safe and efficient procedure in rejuvinating the area of the lower eyelids. Minimal rate of complications is present. Fast healing. Could be combined with other procedures to provide the best desired results.