Eye-Opening Effect Achieved by Modified Transconjunctival Lower Blepharoplasty.

Background: Enophthalmia (abnormally sunken eyeball in the socket) and ptotic upper lid as well as with lower lid symptoms are commonly observed in patients seeking periorbital rejuvenation. It is not only functionally disruptive, causing restricted eye opening, but also aesthetically displeasing, thus creating a demand for more sophisticated solutions.

Objectives: Conventional transconjunctival lower blepharoplasty (TCLB) has been performed mainly for lower lid symptoms with the removal and transposition of excess lower orbital fat compartment (LOFC). In this study, TCLB is modified by adding de-flaming and decompression maneuvers to the LOFC and its support structures to obtain better results in both the lower and upper lids. The results after the modified TCLB clearly demonstrate increased eye-opening ability and marked resolution of observable symptoms. The anatomical dynamics of the orbit involved in this procedure are detailed through scientific data.

Methods: Modified TCLB was performed in patients with lower eyelid symptoms. Palpebral fissure height (PFH) (the distance between the upper and lower eyelids in vertical alignment with the center of the pupil) was measured before surgery and 12 months postoperatively using 3 dimensional photographs. This data was compared to validate the postoperative eye-opening effect. The weight of the excised fat from each LOFC was also measured and compared.

Results: Forty patients (36 females and 4 males) who underwent modified TCLB in 2022 were followed up 12 months postoperatively. Preoperative PFHs were 8.41±1.15 (6.1-10.7) mm for the right and 8.41±1.12 (5.5-10.4) mm for the left. Postoperative PFHs were 9.26±0.95 (6.4-11.1) mm for the right eyelid and 9.21±0.94 (6.2-11.1) mm for the left eyelid. The improvement in postoperative eye opening was statistically significant. The total excised LOFC was 0.43±0.24 (01.2) g for the right and 0.42±0.25 (0-1.5) g for the left. The largest amount of fat was excised bilaterally from the lateral LOFC, and the difference was statistically significant.

Conclusions: The modified TCLB with de-framing and decompression of the LOFC was not only effective in improving symptoms present in the lower lid but also increased the eye-opening ability with marked aesthetic improvements in most patients.