Lower eyelid blepharoplasty: a procedure in evolution.

The commonly perceived aging changes in the lower eyelid are a natural consequence of the anatomic attachments and age-related changes in the periorbital tissues. A variety of techniques have evolved to address cosmetic concerns in the lower eyelid including subtractive blepharoplasty techniques, elevation of ptotic eyelid and midface tissues, and the injection or implantation of autogenous or alloplastic materials to diminish lower eyelid "bags." Greater anatomic understanding of the pathogenesis of aging changes in the lower eyelid has led to more anatomically conservative and appropriate cosmetic surgical treatments. The decline in purely subtractive surgical techniques in blepharoplasty surgery and the advent of fat repositioning and other volume enhancement techniques has improved surgical outcomes.