title: Quantified Incision Placement for Postseptal Approach Transconjunctival Blepharoplasty.
abstract: OBJECTIVE
  This study quantifies the incision location in transconjunctival lower eyelid blepharoplasty to optimize postspetal (direct) access to the eyelid/orbital fat.
  
  
  METHODS
  A retrospective chart review of patients undergoing transconjunctival blepharoplasty by one surgeon (GGM) from January 2013 to January 2014 was performed. Simultaneous globe retropulsion and lower eyelid inferior displacement was used to balloon the conjunctiva forward to maximally visualize the transconjunctival surface anatomical landmarks of importance. A caliper was used to measure the distance in millimeters from the inferior tarsus to the most superior projection of visible fat. The conjunctival incision was made 0.5 mm posterior to this measured distance. For each procedure it was noted whether the preseptal or postseptal plane was entered.
  
  
  RESULTS
  Sixty-six patients were assessed. Fifty patients were women, and the mean patient age was 54 years (range 36-71 years). The mean distance from the inferior tarsus to the visualized superior tip of fat was 6.03 mm (range 5-7 mm) and the mean incision placement was 6.53 mm (range 5.5-7.5 mm). The postseptal space (direct access to fat) was entered in 54 cases (82%). The inferior vascular arcade was identified in 23 cases (35%) cases. In this instance, the incision was placed below this landmark in 16 cases (70%). There were 5 cases (7.6%) of postoperative chemosis which all resolved within 2 months with conservative measures. There were no other complications related to the conjunctival incision.
  
  
  CONCLUSIONS
  Placing the conjunctival incision for postseptal approach transconjunctival blepharoplasty 0.5 mm posterior to the most superior projection of clinically visible fat (with adjunctive globe retropulsion and lower eyelid infraplacement) accesses the postspetal space directly in 82% of cases. Previously suggested incision placements: between 2 and 5 mm below the tarsus, at the fornix, or at the inferior vascular arcade are subjective/anecdotal at best and without similar quantitative validation.
authors.affiliation: *Facial Plastic and Reconstructive Surgery, Head and Neck Associates, Havertown, Pennsylvania; †Eye Plastic, Orbital and Facial Cosmetic Surgery Service, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; ‡Clinical Professor of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; and §Beverly Hills Ophthalmic Plastic and Reconstructive Surgery, Beverly Hills, California, U.S.A.
authors.forename: Satyen
authors.initials: S
authors.lastname: Undavia
authors.forename: César A
authors.initials: CA
authors.lastname: Briceño
authors.forename: Guy G
authors.initials: GG
authors.lastname: Massry
mesh_terms: D000273:Adipose Tissue / Q000601:surgery; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D003228:Conjunctiva / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome