IDEAS AND INNOVATIONS Upper Eyelid Approach to Lower Eyelid Blepharoplasty

Transcutaneous lower blepharoplasty addresses excess skin, muscle, and fat through an infraciliary cutaneous incision. This approach offers excellent exposure to the fat pads; however, violation of the orbital septum may result in postoperative lower eyelid retraction, with resultant aesthetic disfigurement as well as exposure keratoconjunctivitis.1 The transconjunctival approach to lower blepharoplasty avoids violation of the orbital septum, which may produce less postoperative eyelid retraction.2 The latter approach, however, can lead to inadequate fat removal, especially from the often hidden lateral lower eyelid fat pocket, due to limited exposure.3 Herein, we describe our experience to address lower eyelid lateral fat pocket through an upper eyelid approach and discuss its advantages, which include patients with only a prominent lateral fat pocket or upper eyelid dermatochalasis, with or without lateral canthal laxity.