title: Transcutaneous lower eyelid blepharoplasty with fat excision: a shift-resisting paradigm.
abstract: OBJECTIVE
  To prove through our experience that the use of transcutaneous lower eyelid blepharoplasty results in negligible incidence of unacceptable scar and eyelid malposition and that the overall lower eyelid contour is acceptable. A detailed overview of the lower eyelid anatomy and a discussion of the "aging" eyelid are further discussed.
  
  
  METHODS
  Retrospective, observational study. The study population comprised 50 patients (100 eyes) seen at the McCollough Plastic Surgery Clinic, Gulf Shores, Ala, between 2002 and 2003 (45 women and 5 men), who had undergone transcutaneous lower eyelid blepharoplasty with fat excision. Lower eyelid blepharoplasty was performed by the senior surgeon (E.G.M.), and the surgical technique was identical in all cases. The patients were followed up for a minimum of 6 months and a maximum of 2 years. Patients were selected on the basis of return visits to record the findings, documented by consecutive digital photos. By comparing standard blepharoplasty digital views, the patients were assessed by 3 independent unbiased plastic surgeons. This study was performed in a private practice setting. The main outcome measure was mean score for the presence of unacceptable scarring, the presence of lower eyelid malposition, and the overall appearance of the eyelid after transcutaneous lower eyelid blepharoplasty, as assessed with the Garcia-McCollough Scale for Lower Eyelid Appearance.
  
  
  RESULTS
  The 50 patients were retrospectively reviewed and analyzed by a group of 3 unbiased plastic surgeons, and there was negligible evidence of lower eyelid contour abnormality, lower eyelid malposition, or easily visible scars.
  
  
  CONCLUSIONS
  Transcutaneous lower eyelid blepharoplasty with fat excision is a time-tested method of correcting the undesirable sequelae of the aging eye. This technique not only is a safe and effective manner to rejuvenate the lower eyelid but also results in virtually nonexistent ill effects.
authors.affiliation: Garcia Facial Plastic Surgery Institute, Neptune Beach, FL, USA.
authors.forename: Roberto Eloy
authors.initials: RE
authors.lastname: Garcia
authors.forename: E Gaylon
authors.initials: EG
authors.lastname: McCollough
mesh_terms: D000273:Adipose Tissue / Q000601:surgery; D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology; D019882:Blepharoplasty / Q000379:methods*; D005143:Eyelids / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome