Jules Stein Eye Institute
University of California
Los Angeles, UCLA School
100 Stein Plaza
Los Angeles, CA 90095
FREEMAN1 describes his experience with transconjunctival sub–orbicularis oculi fat pad lift blepharoplasty in 64 patients during 18 months. Of 17 patients with 1-year follow-up, 8 showed long-term improvement in the tear trough deformity.
Freeman points out concepts that, I believe, are now well accepted among eyelid aesthetic surgeons: Transcutaneous lower blepharoplasty with skin muscle flap has a high risk of lower eyelid retraction, canthal rounding, and change in the shape of the eyelid. Aging of the lower eyelid and midface is characterized by descent of the cheek fat and accentuation of the nasojugal fold or tear trough deformity. Skin problems are often related to overaction of the orbicularis muscle and loss of skin elasticity, conditions more effectively treated with botulinus toxin and skin rejuvenation techniques, such as laser resurfacing.
Goldberg RA. Lower Blepharoplasty Is Not About Removing Skin and Fat. Arch Facial Plast Surg. 2000;2(1):22. doi: