ABSTRACT
Visible scarification following cosmetic eyelid surgery that is readily detectable is generally considered undesirable or unnatural. In addition to a negative impact on appearance, surface scarification may have the adverse consequences of anatomical distortion, ectropion, lid retraction, exacerbation of rosacea, and dry eye syndrome (1). Visible scarification and persistent wrinkling following blepharoplasty surgery have been reduced by the transconjunctival approach and laser resurfacing (2,3). Various techniques in blepharoplasty surgery are described in this chapter that may be used singularly or in combination to facilitate the procedure or minimize visible scarification and tissue trauma: (1) a diminished, laterally positioned upper lid incision with a tunneled approach or a transconjunctival approach to the medial upper fat pocket, (2) nonexcisional removal of hypertrophic orbicularis of the lower eyelid via two electrosurgical methods, (3) limited and irregularly patterned laser resurfacing with altered time sequence of delivery, (4) contralateral approach to the temporal lower lid fat pads, and (5) use of electrosurgically excised orbital fat for placement into distant facial rhytids or folds.
