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Evidence-based medicine: Blepharoplasty.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: (1) Identify the essential preoperative considerations for patients undergoing blepharoplasty. (2) Describe upper and lower eyelid anatomy and the relevance to blepharoplasty techniques. (3) Discuss a standard approach to upper and lower lid blepharoplasty, beginning with preoperative assessment, planning, and marking. 4. Describe the major considerations in periorbital rejuvenation and the critical steps taken during blepharoplasty to create aesthetic improvements.

SUMMARY: Blepharoplasty is one of the most common aesthetic procedures performed in the United States. Significant improvements in facial aesthetics can be made with a relatively short operation that can be performed under intravenous sedation or entirely with local anesthesia. Upper blepharoplasty focuses primarily on removal of excess skin and aesthetic placement of the supratarsal crease, along with filling and contouring of a deep upper orbital sulcus with injections when necessary. Lower blepharoplasty addresses the orbitomalar sulcus (lid-cheek junction and tear-trough abnormalities) and pseudoherniation of periorbital fat, and is based on selective removal and repositioning of fat. Upper blepharoplasty generally does not require fat removal. In addition, lower blepharoplasty involves releasing deep structures, whereas upper blepharoplasty is generally more superficial. In general, the upper lid should be approached transcutaneously, whereas lower blepharoplasty can be safely performed through a transconjunctival or a transcutaneous incision. Complications of upper blepharoplasty are uncommon with more current techniques, but lower lid blepharoplasty has potentially disastrous complications. Blepharoplasty can significantly enhance periorbital and midface aesthetics by improving the tired appearance of even young patients, and is an important tool for facial rejuvenation.

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