Lower Eyelid Blepharoplasty

In no other area of facial aesthetic surgery is such a fragile balance struck between form and function as that in eyelid modification. Owing to the delicate nature of eyelid structural composition and the vital role the eyelids serve in protecting the visual system, iatrogenic alterations in eyelid anatomy must be made with care, precision, and thoughtful consideration of existing soft tissue structures. A brief anatomical review is necessary to highlight some of these salient points. With the eyes in primary position, the lower lid should be well apposed to the globe, with its lid margin roughly tangent to the inferior limbus and the orientation of its respective palpebral fissure slanted slightly obliquely upward from medial to lateral (occidental norm). An inferior palpebral sulcus (lower eyelid crease) is usually identified 5 to 6 mm from the ciliary margin and roughly delineates the inferior edge of the tarsal plate and the transition zone from pretarsal to preseptal orbicularis oculi1 (Fig. 23.1).