Cosmetic Eyelid Surgery in Beverly Hills – Dr. Guy Massry
27Sep/160

Long Term Results To Lower Blepharoplasty – What You Need To Know

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Recently our fellow and I reviewed my long term data on results to lower lid blepharoplasty. I could not find such an extensive review of data with this case number in the literature. The surgical series is over a 10 year period and includes 640 cases. Important to consider is that I only perform transconjunctival surgery so the information only applies to this approach. Appropriate surgical adjuncts were included when clinically deemed necessary. These additional procedures included: canthal suspension, skin excision, fat transposition (repositioning), oseocutaneous ligament release, fat grafting and orbicularis plication (suspension).

Below are the results identified from the data collected:

  1. 640 cases total
  2. Women – 505 cases; Men – 135 cases
  3. Average age - 56 years
  4. Average F/U - 14 months
  5. Transconjunctival blepharoplasty only - 60 cases (9%)
  6. Transconjunctival blepharoplasty with fat repositioning - 580 cases (91%)
  7. Chemosis - more than mild at more than two weeks post-op 41 case (6.4%)
  8. Trichiasis - 9 cases (1.4%) - all needed intervention
  9. Revise fat re-excision - 9 cases (1.4%)
  10. Hollows - 30 cases (4.6%) - most lateral lid/cheek junction – 25 of the 30 cases (83%) were pre-warned this may occur, but refused interventions to prevent.
  11. Complaints of wrinkles or skin excess post-op - 14 cases (2.2%)
  12. Cicatricial entropion requiring buccal graft - 3 cases (0.5%) - All had fat transposition.
  13. Ectropion (no skin manipulation) - 1 case - related unaddressed laxity
  14. Lower eyelid retraction (all mild) - 6 cases ( 1%); 4 cases (0.6%) had skin/muscle manipulation (ie. pinch); 2 cases (0.3%) had no skin/muscle manipulation – but did have prominent eyes with gradient (vector) worsening (even with fat transposition)
  15. Periorbital fat grafting - 83/640 patients (9.6%). 7 of these (1.4%) developed contour issues (most with older larger (2 mm) harvest cannulas). 4 of these patients were revised and happy. 2 patients tolerated their final outcome. 1 patient unhappy and actually angry.
  16. Infection/severe inflammation - 7 cases (1.4%).
  17. Satisfaction study not done
  18. Satisfaction study of last 86 patients with fat transposition only was done with 4.8/5 average score on 5 point Likert scale: 1: Very unsatisfied, 2: unsatisfied, 3: neutral, 4: satisfied, 5: Very satisfied. The procedure found to be safe and effective

What this has taught me is that 79% of surgery is on woman in their mid 50’s. In general complications are rare and treatable. Fat grafting contour issues occur in 8.4% of cases, which I feel is unacceptably high – but not surprising. This complication rate is most assuredly lower with the newer (smaller port) harvesting cannulas. As expected, patient satisfaction is high.

I certainly learned a lot from this lower blepharoplasty data. I hope it is of help to others.

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