Different technical approaches for blepharoplasty in eyelid rejuvenation surgery.

The authors have reviewed their clinical experiences with 92 cases of blepharoplasties treated during the past 10 years and discuss the principal approaches used, depending on the age of the patient, the amount of adipose tissue present, the degree of lower lid tarsal and muscle laxity present, and the quality of the skin excess encountered. On the upper eyelid, skin excision is combined with an orbicular muscle strip and in older patients a suspension of the lateral canthus. On the lower eyelid the transconjunctival approach is emphasized in young and or colored patients, using an undermined musculocutaneous flap in the classical technique. A good choice between these different approaches avoids the rare complications of ectropion and scleral show because the procedure used is considered to be a variable "geometric" operation.