Subciliary Approach to Lower Eyelids
Video transcript: A subciliary approach to the lower lid requires a small incision that goes just underneath the lash line. The advantage of this approach is that this is more useful in patients who have more substantial age related changes, and we usually see this in patients over the age of 40. So with the incision it allows us to remove extra skin and tighten the lower lid’s skin, as well we can tighten the lower lid muscles.
The surgery is performed by making a small incision just underneath the lash line. This allows for access to the underlying structure I can remove extra skin, I can remove some of the extra fat that sits in the orbit. I can also elevate or soften the nasal juval groove tear trough. Once this is performed I can take fat from the lower lid and implant it into this nasal groove or tear trough to elevate it permanently. This is an area where we will often inject synthetic fillers to soften the tear trough. I find it very helpful when I’m doing a blepharoplasty to use a patient’s own fat to augment that area and I can see the area directly through the subciliary approach blepharoplasty, so I find it very helpful for that.
In addition to tightening the skin I can also tighten the lower lid itself as well as the orbicularis muscle which forms much better the structure of the lower lid, and this helps to elevate the areas lateral to the area in particular malar bag can be elevated with this technique. The subciliary approach really affords lots of access to the lower lid to modify many of the structures much more so than through the transconjunctival approach, which is really limited to removal of fat.
This is the before and after of a patient we did a subciliary approach lower blepharoplasty. So we’ve removed extra skin by making a small incision and tightening the lower lid. By elevating the muscle underneath the skin, the orbicularis muscle, we suspend it upwards and this elevates and flattens the malar bag, or the malar mound. I’ve also removed orbital fat which decreases the swelling and puffiness of the lower lid. And finally, the vision of the orbicularis retaining ligaments allows for softening of the nasal juval groove and what I do is I go through the lid incision and I elevate the attachments of the orbicularis muscle to the cheekbone. And the markation line is then softened by allowing that skin and muscle to float in an upward direction.
Here’s another example of a before and after photo of a patient who we did subciliary approach. Often in people with darker colored skin we often worry about scar formation. Fortunately the lower lid skin is extremely soft, extremely thin and supple and we rarely ever get visible scars, even in this patient with fairly dark skin.