Transconjunctival lower lid blepharoplasty with fat resection
This is Richard Allen at the University of Iowa. This video demonstrates a lower eyelid blepharoplasty with conservative fat excision through a transconjunctival incision.
A 4-0 silk suture is placed through the lower lids at the level of the meibomian gland orifices.
A transconjunctival incision is then made with the needle tip cautery extending from the punctum medially to the lateral canthus laterally.
Dissection is then carried out between the orbital septum and orbicularis muscle to the inferior orbital rim. A 4-0 silk suture is placed through the cut end of the conjunctiva to provide traction during the case.
The inferior orbital rim is identified and dissection is carried out inferior to the inferior orbital rim in a preperiosteal plane with a freer periosteal elevator. This is performed along the entire extent of the inferior orbital rim.
The orbital septum is then opened and the medial and central fat pads are identified and mobilized. In between these two fat pads runs the inferior oblique muscle.
The same dissection is then performed on the left side between the orbicularis muscle and the orbital septum to the inferior orbital rim.
Again, dissection is carried out inferior to the inferior orbital rim with a freer periosteal elevator in the preperiosteal plane.
The orbital septum is opened, and the fat pads are identified. The medial fat pad is then conservatively excised.
The main complaint with this patient was puffiness of the lower lids without a prominent tear trough. Each of the fat pads is conservatively excised.
During this, hemostasis can be obtained with monopolar or bipolar cautery.
The same resection is then performed on the other side.
It is important to resect symmetrical amounts of fat if the disease process is symmetrical. It is important to identify the lateral fat pad and excise it as this is a fat pad that is often neglected.
The transconjunctival incision is then closed with interrupted 7-0 vicryl sutures.
At the conclusion of the case, antibiotic ointment is place over the incision and in the eye. The patient returns in approximately one week for reevaluation.