http://www.drhalaas.com/ Learn about Blepharoplasty techniques (from Asain Eyelid Surgery to Fat Transfer) from Dr. Yael Halaas.

1. Blepharoplasty
Techniques
Yael Halaas M.D.

2. Anatomy
• Lateral canthus
inclined 10-15 degrees
cephalad compared
to medial canthus
• Upper lid: midway
between the upper
pupil and limbus. Apex
medial to pupil
• Lower lid: 1-2mm over
the corneoscleral
junction. Central
lowest portion

3. The Beautiful Eye
• Brow- centrally on
rim, laterally above
rim
• Upper lid crease
<10mm above lid
margin
• Fuller sulcus below
the orbital rim
• Lateral lid free of
hooding

4. Fat pockets

5. The Signs of Aging
• Dermatochalasis- thin
loose skin secondary to
aging
• Blepharochalasishypertrophy & excess
draping of skin
secondary to recurrent
edema
o not age-related, found
in young women
o rare
• Pseudoherniation of fat
(Steatoblepharon)

6. •
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Lid Evaluation
Fat pads- identify where pseudoherniation exists
Lacrimal gland
Eyelid crease (7-9mm)
Epicanthal folds (Asian lid)
Orbicularis oculi
Lid ptosis- palpebral fissure symmetry
o Levator function: >12mm difference in lid aperture
between extreme up and down gaze
• Skin lesions- xanthomas, pigmentation,
blepharitis
• PHOTODOCUMENTATION
• Discuss findings with the patient

7. What’s the difference?

8. Ophthalmic exam
• Condition of corneal, sclera and conjunctiva
o Lack of injection, edema
• Basic visual acuity- Snellen card
• Baseline tear production- Schirmer test
o At 5 min, low (0-9mm), mod (10-20mm), high (21-30mm)
• Tests greater superficial petrosal nerve function
• Tear film breakup time
o Usually >20 seconds

9. Contradictions
• Thyroid disease- exopthalmos
• Dry Eye Syndrome- burning, tearing, use of artificial
tears, waking at night with stinging eye pain
• Sensitivity to lidocaine with epinephrine
• Anti-coagulation
o Nutritional supplements- gingko biloba, garlic, vitamin E, fish oil

10. The Asian Eyelid
• Small or absent
supratarsal crease
• Adipose fullness
• Epicanthal fold
• Narrow palpebral
fissure

11. Creation of the Double
Eyelid
• Suture
• Partial Incision
• Full Incision

12. Special techniques
• Transconjunctiva
l upper bleph
approach
o Only for medial
fat
o No levator
aponeurosis
between
conjunctiva &
subseptal fat
• Internal brow
elevation

13. Complications of Upper
Blepharoplasty
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Hematoma
Subconjunctival Ecchymosis
Chemosis
Lagophtalmos – incomplete eye closure
o Dry Eye Syndrome
• Poor Scars
o Milia
• Loss of Vision

15. Before & After

16. Preoperative Evaluationlower lid
•
Same as upper
blepharoplasty evaluation
o Dermatochalasis, etc.
o Double convexity
•
•
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•
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Lid position- extremely
important
Ectropion/entropion
Lid laxity
Tear trough deformity
Festoons
o Draping folds of orbicularis
+/- fat
•
Malar Bags
o Soft-tissue fullness

17. • Lid distraction (snap) test- movement of lid >
10mm is abnormal
• Lid retraction test- puncta movement > 3mm
from medial canthus is abnormal
o Slow return or requiring multiple blinks = poor lid
tone

18. Before and After

19. Lower Lid Blepharoplasty
Techniques
• Transconjunctival
• Subciliary
o Skin flap
o Skin Muscle flap
• With muscle suspension stitch
• "Canthoplasty" refers to a procedure designed to reinforce
lower eyelid support by detaching the lateral canthal tendon
from the orbital bone and constructing a replacement.
• "Canthopexy," on the other hand, refers to a less invasive
procedure designed to stabilize the existing tendon (as well as
surrounding structures) without removing it from its normal
attachment.
• Orbital Fat Repositioning (Repair)
• Orbital Fat Mobilization
• Ancillary procedures

20. Lower Lid Blepharoplasty Incisions

21. Technique

23. Skin-muscle flap
& Muscle suspension stitch

29. Complications of Lower Lid
Blepharoplasty
• Ectropion
o Subciliary- 20% lower lid retraction
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Hematoma
Blindness
Epiphora
Suture Line Complications
Wound Healing Complications
Skin Discoloration
Ocular Injury
Contour Irregularities

30. Which technique?

31. •
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Complimentary lower lid
procedures
SOOF lift
Composite Rhytidectomy
Endoscopic midface lift
Tear trough implant
Restylane and other fillers
o Excellent for malar festoons & bags
• Fat transfer
• Skin resurfacing

32. SOOF
• Fat pad between orbicularis oculi & periosteum
• Release arcus marginalis, lift fat, fixate SOOF to
periosteum at inferior orbital rim
• Contour irregularities, vertical lid retraction

33. Silicone

35. Fat transfer

36. For More Information
• Visit http://www.drhalaas.com/