Single access upper blepharoplasty and lower lid lateral fat pad removal: A proven technique with low recurrence rate

Background: The transconjunctival approach is commonly performed in lower lid blepharoplasty so as not to violate the orbicularis oculi muscle integrity and avoid additional scars. This technique does not, however, permit easy access to the lateral fat pad (LFP). As upper and lower blepharoplasty are frequently combined in our clinical practice, the removal of LFP via upper blepharoplasty is a surgical approach that we found most applicable with good outcomes. Methods: A prospective review of 47 consecutive bilateral combined upper and lower blepharoplasty cases using a single access technique was conducted; patient outcomes and the occurrence of any complications were recorded, in addition to preoperative and postoperative measurements between standardized anatomical landmarks. Results: Forty-seven patients were included in our study. Postoperative measurements showed a decrease of both lateral cantus to inferior orbital border distance and horizontal width of LFP. Good esthetic outcomes and patient satisfaction with surgical results were achieved in the majority of patients. Conclusion: The single access upper blepharoplasty and lower lid LFP removal technique can improve esthetic outcomes in lower blepharoplasty. The advantages are many; a low risk of missing the lateral pad, ease of achieving a uniform contour of lower eyelid; short lower transconjunctival incision, minimizing complications associated with an intra-conjunctival scar. This technique, based on cadaveric anatomical studies, has been found to be safe and is of great utility to those patients requiring upper and lower lid blepharoplasties.