Nemiroff J, Baharestani S, Juthani VV, Klein KS, Zoumalan C. , Orbit. , 2014 Oct;33(5):372-4
Mega MS1, Dinov ID, Mazziotta JC, Manese M, Thompson PM, Lindshield C, Moussai J, Tran N, Olsen K, Zoumalan CI, Woods RP, Toga AW. , Neuroimage. , 2005 Jul 15;26(4):1009-18.
Cannon TD1, Thompson PM, van Erp TG, Toga AW, Poutanen VP, Huttunen M, Lonnqvist J, Standerskjold-Nordenstam CG, Narr KL, Khaledy M, Zoumalan CI, Dail R, Kaprio J. , Proceedings of the National Academy of Sciences of the United States of America. , 2002 Mar 5;99(5):3228-33. Epub 2002 Feb 26
Lower blepharoplasty is a procedure that is also known as eyelid surgery or an eye lift. The surgery addresses the skin or both the muscle and the skin below the eye. Lower blepharoplasty repositions “bags” under the eye, or the fat that protrudes, and places them in a better position. Lower1
Ectropions and entropions are two types of eyelid malpositions where the eyelid is positioned abnormally on a patient. In general, the eyelid should naturally be resting along the eyeball. When a patient has an ectropion, the eyelid is everted out which leaves the eyelashes turned out as well.1
This patient had a medial portion (closest to the nose) of her eye everted outward so the puncta (the opening of the tear duct) is not facing the eye. This needed to be corrected otherwise the patient will complain of tearing, discomfort, and may be at risk for an ocular infection. The lower lid was resuspended by Dr. Zoumalan; in addition, the medial portion of the lower lid (closest to the nose) had an additional procedure to help better invert the puncta (opening of the tear duct) in order to face the eye. The patient had resolution of his tearing symptoms and ocular irritation.
This patient suffered a left lower lid ectropion from prior eyelid skin cancer (basal cell carcinoma) resection. The removal of the skin cancer resulted in skin contracture and lid retraction near the eyelid. As a result, the patient complained of a malpositioned lid, tearing, and ocular (eye) irritation. Note that the retraction is worsened when the patient looks up (and with his mouth opened); this suggests a cicatricial (scar or shortening of the thin eyelid skin) component. In order to appropriately reposition his lower eyelid, a skin graft was required. He had already lost skin from him prior skin cancer resection, and procedures that would not require a skin graft (ie mid face lift with a canthal suspension) may end up working but only a short amount of time. This photo was taken 8 months after undergoing skin graft with Dr. Zoumalan to resurface the lower eyelid with an ectropion repair. The skin graft was taken from behind his ear (preauricular skin graft).
This patient had bilateral lower lid ectropions resulting in tearing. Note that the left is more severe than the right.This patient received a bilateral lower lid ectropion repair and a left lower lid midface resuspension (midface lift) from Dr. Zoumalan. The midface resuspension allows for better support for her lower lid position and to help prevent it from recurring months or years after surgical repair.
This patient suffered an inward turning of the right lower lid (entropion). He also has constant irritation and tearing. The right lower lid underwent an entropion repair by Dr Zoumalan to help “turn” the lid back to a more normal position.
This patient’s lower lid malpositions were resulting in constant tearing and ocular irritation. She had a “loose” right lower lid that was turned out, which was resulting in an early ectropion. An ectropion repair was performed to reposition the right lower lid to normal position. Her left lower lid had the opposite problem; the lid was turned inward and resulting in constant rubbing of her lashes onto her eye. This is called an entropion. Entropion repair was performed by Dr. Zoumalan to reposition the lid out to a more normal position. Her symptoms were resolved after surgery and healed very well.
This patient has moderate infraorbital rim hollowing and volume loss along her midface. There is no true prominence of orbital fat. She underwent injectable treatment of hyaluronic acid along her infraorbital rim and midface.
Side view on the left demonstrates both prominent orbital fat along with infraorbital rim hollowing and midface volume loss. The patient underwent lower lid transconjunctival blepharoplasty with fat grafting to the midface.
Preoperative photograph demonstrating significant lower lid fat pockets and infraorbital and midface volume loss. Mild excess lower lid skin is also present. Upper lid ptosis (droopy eyelids) is also noted. The patient underwent lower lid transconjunctival blepharoplasty with fat repositioning to the infraorbital rim. He also underwent and upper lid ptosis repair at the same time. Notice the natural looking appearance to his lower lids.
Preoperative photograph demonstrating moderate lower lid fat pockets and fairly moderate infraorbital and midface volume loss. Mild excess lower lid skin is also present. Upper lid excess skin is also noted. The patient underwent upper lid blepharoplasty and lower lid transconjunctival blepharoplasty with fat repositioning to the infraorbital rim and a chemical peel to improve her skin tone. Notice the natural looking appearance to her lower lids.
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