title: Lower blepharoplasty with direct excision of skin excess: a five-year experience.
abstract: BACKGROUND
  Many patients present for aesthetic treatment of their lower eyelid region. Although traditional lower blepharopasty can successfully correct prominent lower eyelid bags, tissue excesses in the lower periorbital region (such as crepe-like skin and festoons) can cause distress for patients both aesthetically and physically, as they may cause discomfort. The skin that can be removed from this area (below the eyelashes) with a traditional incision is limited since tension on the lower eyelid must be avoided.
  
  
  OBJECTIVE
  The authors report the results of their five-year experience performing lower blepharoplasty with a direct skin excision in the lower periorbital region.
  
  
  METHODS
  Fifty-five patients were treated with the authors' method of blepharoplasty between Ferbruary 2004 and February 2009. After precise preoperative marking, each patient was placed under local anesthesia and the excess of tissue in the lower periorbital region was removed. When necessary, removal of fat bags was performed. When the tissue in excess was significant, this kind of direct incision allowed the removal of more skin than the traditional method, without tension on the lower eyelid.
  
  
  RESULTS
  No major complications-or even temporary scleral show-was observed in any of the patients in this series. In addition, no patients complained of any exaggerated visibility of postoperative scarring. The high rate of patient satisfaction with this procedure has led the authors to apply this type of incision with increasing frequency in their blepharoplasty patients.
  
  
  CONCLUSIONS
  The authors' direct incision technique for lower blepharoplasty, when selected with the appropriate indications, can provide a successful and safe alternative to traditional methods. Options for treatment of the lower lid are few since the area is a very challenging one to treat and the authors believe that this additional alternative will be helpful to both surgeons and patients alike.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bellinvia
authors.forename: Francesco
authors.initials: F
authors.lastname: Klinger
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellinvia
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000209:etiology; D062109:Dermatologic Surgical Procedures; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D016896:Treatment Outcome