| Abstract [eng] |
This thesis reviews lower eyelid blepharoplasty, with a focus on how anatomical findings such as orbital fat pseudoherniation, lower eyelid skin excess, eyelid laxity, orbital vector, and lid-cheek con-tour influence the choice between transconjunctival and transcutaneous lower eyelid blepharoplasty. In addition, the review examined the role of fat excision, fat repositioning, and arcus marginalis release in contemporary lower eyelid rejuvenation. Because severe complications such as ectropion or lower eyelid retraction may require reconstructive correction, selected reconstructive techniques were includ-ed as a supporting part of the review. This thesis was conducted as a structured non-systematic literature review. The literature search was performed between August and November 2025 and updated in March 2026. A total of 40 sources were included in the final qualitative review, comprising clinical studies, anatomical studies, review articles, reconstructive surgery literature, and epidemiological reports. The PRISMA 2020 statement was cited separately as a methodological reporting reference and was not counted among the 40 sources included in the qualitative synthesis. Original clinical studies were prioritized when discussing surgical outcomes, while anatomical and review articles were used to support background and surgical planning sections. The available evidence does not indicate that either the transconjunctival or transcutaneous approach is universally superior. Instead, the choice should be guided by the dominant anatomical problem. Trans-conjunctival access is most appropriate when orbital fat prominence is the main finding and lower eyelid skin quality is relatively preserved. In contrast, a transcutaneous approach remains necessary when skin redundancy, orbicularis laxity, or direct anterior lamellar correction are clinically relevant. Rather than supporting one universally superior technique, current evidence suggests that surgical planning should be individualized according to anatomical findings, eyelid support, tissue quality, and patient-specific risk factors. Contemporary lower eyelid blepharoplasty increasingly emphasizes conservative and volume-preserving strategies. Fat repositioning with arcus marginalis release appears most relevant in patients in whom prominent orbital fat is accompanied by infraorbital hollowing or loss of a smooth eyelid-cheek transition. A clear comparison is difficult, however, because the studies use different patient groups, surgical modifications, follow-up periods, and outcome definitions. Therefore, the superiority of fat repositioning over conservative fat excision cannot be concluded definitively. Complications remain a central concern in lower eyelid blepharoplasty. Lower eyelid malposition, ec-tropion, retraction, chemosis, asymmetry, dry eye symptoms, diplopia, and retrobulbar hemorrhage are described in the literature, although their reported frequency varies considerably between studies. Pre-vention depends less on the surgical approach alone and more on careful preoperative assessment, conservative tissue handling, appropriate fat management, and the use of canthal support procedures in patients with increased anatomical risk. Reconstructive principles, including local flaps and graft-based techniques, are relevant for understanding lamellar support and for managing severe tissue defi-ciency or postoperative malposition. The reviewed literature supports an individualized, anatomically guided approach to lower eyelid ble-pharoplasty. While many studies report favorable aesthetic outcomes and high patient satisfaction, these findings must be interpreted cautiously because outcome assessment is often subjective and non-standardized. Future studies should include longer follow-up, clearer reporting of complications, and validated patient-reported outcome measures. |
