eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Blepharoplasty, Subciliary Approach: Follow-up

Author: Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Coauthor(s): Juan Trinidad Pinedo, MD, FACS, Ad-Honorem Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical School
Contributor Information and Disclosures

Updated: Sep 11, 2009

Outcome and Prognosis

In the proper patient, any well-executed blepharoplastic approach, with precise attention to details, yields a satisfactory result for both the patient and the surgeon with minimal transient complications.

However, at present, no one particular approach achieves the best results in all patients. Selection must be on a case-by-case basis. According to recent blepharoplastic literature, selection of a specific approach is dictated by the particular characteristics of the patient, such as age, eyelid and orbital aging changes, and the presence or absence of adequate eyelid tone.

The subciliary approach has the advantage of an open flap with adequate exposure for resection of fat pads, orbicularis muscle, and skin and the possibility of correcting eyelid tone laxity if present. The main disadvantage is the increased possibility of eyelid retraction, malposition, and ectropion. Therefore, proper selection of candidates and a conservative approach in the resection of eyelid skin are advisable when applying this approach to avoid, in part, these problems.

The transconjunctival approach has the advantage of less trauma with the possibility of removing fat pads without causing eyelid retraction, malposition, or ectropion. The disadvantage is that eyelid skin and orbicularis muscle are not removed, giving less exposure and an inability to correct, if present, eyelid tone laxity. Therefore, proper selection of candidates for this approach is necessary in order to achieve the best possible result.

The repositioning/fat preservation blepharoplasty has been reported in recent publications to yield good results. It is a well-designed concept and approach that addresses the herniated fat problem. However, it is still in evolution, and the long-term results need to be evaluated further.

Standardization in the selection of the different approaches has not yet been fully achieved worldwide.

Future and Controversies

Information on cosmetic blepharoplasty will be made more available to the public due to the increase in information technology.

Cosmetic blepharoplastic web sites will become more interactive. Integration of voice, photography, and video capabilities will be available to patients and blepharoplastic surgeons alike.

The virtual cosmetic blepharoplastic office will become a reality. Dynamic interaction will increase among prospective patients, staff, and cosmetic surgeons. Postoperative blepharoplastic images will be available on the Internet for prospective candidates, even without having been seen in the surgeon's office.

For all the above reasons, cosmetic blepharoplasties and blepharoplasty revisions will probably increase in the future. Selection of the potential candidates will remain the most important step. Better standardization worldwide among blepharoplastic surgeons using the different approaches is very possible.

The question of which blepharoplastic approach achieves the best results is tricky. No particular blepharoplastic approach yields the best results for all patients. One approach cannot be judged better than another. This judgment depends on the particular characteristics of the patient, such as age, eyelid and orbital aging changes, and the presence or absence of adequate eyelid tone. However, questions remain about (1) whether the contemporary suspension/fat pad preservation technique will achieve popularity and satisfactory long-term results worldwide and (2) which patients and which eyelid changes will benefit the most from this particular technique.

 
Acknowledgments

The authors wish to acknowledge Joan Flaherty, RN, for her editorial assistance and Gustavo Díaz, MD, for taking the digital surgical pictures.



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References
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Further Reading

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Keywords

blepharoplasty, subciliary approach blepharoplasty, infraciliary approach blepharoplasty, infraciliary-approach blepharoplasty, transcutaneous lower lid blepharoplasty, cosmetic eye surgery, eye surgery, eyelid surgery, eye lid surgery, lid lift, eye lift, blepharoplasties, transcutaneous lower eyelid blepharoplasty, eyelid reconstruction, cosmetic facial procedure, blepharochalasis, dermachalasis, baggy eyelid, eye telangiectasias, eyelid telangiectasias, eye keratosis, eyelid keratosis, eye syringoma, eyelid syringoma, eye xanthelasma, eyelid xanthelasma, benign eye tumor, benign eyelid tumor, malignant eye tumor, malignant eyelid tumor

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Contributor Information and Disclosures

Author

Antonio Riera March, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico School of Medicine
Antonio Riera March, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, and Society for Ear, Nose and Throat Advances in Children
Disclosure: Nothing to disclose.

Coauthor(s)

Juan Trinidad Pinedo, MD, FACS, Ad-Honorem Professor, Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico Medical School
Juan Trinidad Pinedo, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Puerto Rico Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Allergan Honoraria Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Keith A LaFerriere, MD, Clinical Professor, Fellowship Director, Department Otolaryngology-Head and Neck Surgery, University of Missouri at Columbia
Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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