A minimally invasive approach to lower lid blepharoplasty

Background: The lower eyelid anatomy is very complex and variable. Many operative and non-operative interventions have been described and to improve the aesthetic properties of the lower eyelid. In general, the more invasive the procedure, the higher the risks and complications. As our knowledge of orbital soft tissue and bony aging deepens, our focus in minimizing invasive surgical interventions has accelerated.Methods: In the current study, we initially evaluated patients who planned to undergo lower eyelid blepharoplasty at our medical institution .our study is a pilot study and until now we studied on 4 patients were divided in two group of blepharoplasty with phenol peeling and without it.and inclusion criteria is:Fitzpatrick I-III skin typeAge of > 40 yearslower eyelids herniated fat padsPatients consent for participation in the studyWe offer a minimally invasive approach to removing the lower eyelid herniated fat pads, allowing better aesthetic results while avoiding the risk of serious complications. We call this procedure the triple L lift (lower eyelid lipo Lift), as it helps remove the lower eyelid fat while hiding the incisions as one does in liposuction. The patient is marked in a sitting position while gazing upward (this allows for a better visualization of the degree of the herniated fat pads). A thin line is drawn with surgical marker over the fat pad at a length of not greater than 6 mm.The person is then laid in a supine position, and the incision as well as the fat pad are then carefully infiltrated with lidocaine 1% with epinephrine 1:100,000 .The area is then sterilized with betadine. An incision is carried out with a #11 blade along the marked area down through the skin and muscle, and the fat is gently teased out using a bishop forceps and a curved hemostat . After the appropriate amount of fat is removed, it is excised and its base is cauterized before the fat is allowed to retract back into its pocket. The process is repeated in a similar fashion for all the marked fat pads. A single interrupted 5.0 Ethilon suture is then used to close the incision. The patient is given erythromycin ointment and repairing cream to apply at home and told to sleep elevated and intermittently apply ice to the surgical site. The sutures are removed in 3 to 5 days and a Steri-strip is applied over the incision site. In other group we apply peeling with 89% phenol before the fat pad removal specially in patient who had loosing of the skin in the lower lid and the skin type fitzpatrick I-III. Result: Patients satisfaction about criteria such as pain, symmetry, scar and appearance was significantly high but in phenol peeling group dark circle and wrinkles were much better. We are going to expand our study in a bigger scale and in a comparative study in a near future.Conclusion:Our study shows that this method is safe and effective for lower lid fat pad.we will try to show our study in a power point and video clip.