Purpose

To evaluate the impact of different lower blepharoplasty approaches on eyelid position and tear trough deformity of the patients and the alterations of the lid-cheek junction on long-term follow-up.

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Methods

The patients were observed for a one-year postoperative period. Data were collected retrospectively for patients undergoing lower lid blepharoplasty via transconjunctival, transconjunctival with skin pinch and subciliary approaches. Pupil to Tear trough Distance (PTD), Barton’s grading system and Marginal reflex distance 2 (MRD2) measurements were used to assess the lower eyelid position and tear trough defect at preoperative and late postoperative (one year) visits. Images were analyzed with ImageJ software (ImageJ program 1.42; National Institutes of Health, Bethesda, MD).

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Results

Regarding the lid-cheek junction alterations, a significant decrease in PTD and a lower Barton’s grade were observed across all surgical groups. The transconjunctival with skin pinch group demonstrated the most pronounced improvement in the late postoperative period, with a mean PTD reduction of -3.53 ± 1.58 mm. In comparison, the subciliary approach group showed a mean PTD decrease of -2.98 ± 1.47 mm during the same period. Accordingly, mean Barton’s grading scores decreased from a baseline of 2.57 to 1.50 in the early postoperative period, and further dropped to 1.30 in the late postoperative period. In terms of eyelid position changes, the subciliary approach resulted in the greatest degree of lower eyelid position lowering, with a mean MRD2 change of +0.35 ± 0.74 mm.

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Conclusion

The surgical approach in lower lid blepharoplasty directly influences the final outcome of the lid-cheek junction. Here, we found that, while both subciliary and transconjunctival techniques-with or without skin pinch resection-differentially affect the grade and severity of tear trough deformities, lower eyelid positions. Consequently, on clinical and cosmetic grounds, the surgical approach for lower blepharoplasty should be carefully assessed and tailored for each patient.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mehmet Fatih	Ozkan	Yeditepe Universtity Hospital Ophthalmology Clinic

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