Product Description

Modern lower lid blepharoplasty requires a thorough understanding of periorbital anatomy, age-related changes of the lid-cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion. The patient with isolated lower lid bags may be treated by transconjunctival fat resection alone. Additional mild skin laxity can be improved with skin pinch or skin-only undermining. Skin resurfacing using chemical peeling or laser can further address fine lines. In these patients with an abnormality of the lid-cheek junction, release of the medial orbicularis oculi muscle and variable amounts of the orbicularis retaining ligament is essential. This is combined with orbital fat resection or repositioning through a transconjunctival or transcutaneous skin-muscle flap. The transcutaneous approach most often necessitates lateral canthal tightening to optimize lid margin control. Generally, the degree of laxity dictates whether a canthopexy or a canthoplasty is most appropriate. Lateral canthal procedures can be applied to patients displaying clinical signs predictive of lid malposition and to those presenting with varying degrees of established lid descent.  

Learning Objectives

After viewing this course, the participant should be able to:

1. Define the anatomy of the lower eyelid tarsoligamentous framework and the related periorbital retaining ligaments, and cite their surgical relevance.
2. Perform a systematic functional and aesthetic evaluation of the lower eyelid focusing on the lid-cheek junction, and clinical tests that predict the need for lateral canthal tightening.
3. Enumerate the different approaches to lower eyelid rejuvenation and discuss their merits/limitations.
4. Describe surgical strategies to blend the lid-cheek junction and tighten the lateral canthal retinaculum.

Faculty

 Ahmed M. Hashem MD; Rafael A. Couto MD; Joshua T. Waltzman MD MBA; Richard L. Drake MD; James E. Zins MD

Plastic and Reconstruction Surgery® Editors:

Editor-in-Chief: Rod J. Rohrich, MD 

Co-Editor: James M. Stuzin, MD 

Section Editor: Donald H. Lalonde, MD

Accreditation Information

Patient Safety Credit: 0.5 

Media: Journal Article, Video 

Publish Date: 12/28/2016

Estimated time to complete this course: 1.0 hour 

Directly provided by the American Society of Plastic Surgeons^® (ASPS^®)

Accreditation Statement

The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Intended Audience

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

Disclosures

Dr. Rohrich, MD is the Principal/Co-Principal Investigator of research grants awarded to the University of Texas Southwestern Medical Center, Dallas, from Medicis, Mentor, and Contura Pharmaceutical. All research funds are provided directly to UT Southwestern. Dr. Stuzin has no relevant financial relationships or affiliations to disclose. Dr. Lalonde is a consultant for ASSI Instruments. None of the authors have any relevant financial relationships or affiliations to disclose. All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.

Product Code: 20908