April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Volume 137, Number 1 • Simplifying Blepharoplasty

Fig. 6. Algorithm for lower lid blepharoplasty. This algorithm can be used as a general guideline in surgical planning for lower lid blepharoplasty. Figure 6 demonstrates the sec- tion of the algorithm for those patients with visible herniated orbital fat on examination. Figure 7 demonstrates the section of the algorithm for those patients with no visible herniated orbital fat on examination. Note that the surgeon’s experience, the individual patient findings, and the particular expectations from surgery will ultimately dictate which technique is best suited for the aging eyelid patient. Patients with moderate to severe lid laxity may require a lid shortening canthoplasty or a canthopexy. Care should be taken when excising skin in patients with a negative vector. Caution should also be taken when performing skin resurfacing (chemical peel or laser) in those with a Fitzpatrick score of 4 or greater.

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