Traditional lower blepharoplasty: Is additional support necessary? A 30-year review

Background: Several refinements have been made in lower eyelid rejuvenation, and there is now strong belief that the traditional approach places too little emphasis on lower eyelid support. The purpose of this study was to retrospectively review the 30-year experience of the senior author (J.A.F.) performing primary lower blepharoplasty by the traditional approach and to determine the complication rate when lower lid-tightening procedures were not performed concomitantly. Methods: A retrospective chart review of all traditional blepharoplasties performed by the senior author over the past 30 years was performed. The traditional approach was performed through an external, subciliary incision. Concomitant lower lid-tightening procedures were not performed. The authors determined the complication rate of the procedure, such as symptomatic lower eyelid malposition and chemosis. Results: A total of 3014 patients underwent traditional lower blepharoplasties and, after applying the exclusion criteria, 2007 patients were studied. A postoperative complication was defined as the development of either chemosis or symptomatic lower eyelid malposition. Chemosis developed in only 1.2 percent of the patients (24 of 2007). Eight of the 2007 patients (0.4 percent) developed symptomatic lower eyelid malposition. Conclusions: This study proves that when performed meticulously and precisely, traditional lower blepharoplasty is safe and effective. Correction of preoperatively diagnosed lower lid laxity is essential; however, when lower eyelid tone is adequate, the authors believe that the routine addition of a tightening procedure for support or the routine use of combined internal and external approaches is unnecessary.