It’s possible to completely recontour and rejuvenate the lower eyelid, without making a subciliary or transconjunctival incision. And, except for in the most advanced cases, it’s unnecessary to remove skin, according to Birmingham, Ala.-based plastic surgeon Grady B. Core, M.D.
Dr. Core talked about his approach to lower eyelid rejuvenation yesterday, during his presentation “Minimally Invasive Rejuvenation of the Lower Eyelids,” at the Global Aesthetics Conference, in Miami Beach, Fla.
Dr. Core tells Cosmetic Surgery Times that he makes a 1.5 cm incision at the subciliary line below the lateral canthus and enters the suborbicularis avascular space from the side.
“This prevents any need for cutting skin or orbicularis muscle in front of the lid. And it preserves lid function after surgery, which also greatly reduces any risk for postoperative scleral show,” Dr. Core says. “Thus far, the incidence of permanent scleral show in the series of patients since 2007 is still zero.”
Best candidates for the approach, according to the plastic surgeon, are patients with early- to mid-stage aging of the lower lids.
The approach meets all criteria outlined by plastic surgeon Rod J. Rohrich, M.D., which are necessary for successful lower lid rejuvenation, without the need for incisions in the central lid area, according to Dr. Core.
NEXT: Dr. Core’s 4 Tips
Dr. Core’s 4 Tips
- The surgeon should be experienced in the Loeb technique of lower lid fat repositioning, as well as the muscle lifting support methods described by Hinderer.
- Special instruments are necessary and include 4.5 power loupes with an Aufricht Retractor (Sklar Instruments), long tenotomy scissors and long, slender forceps.
- Transcutaneous sutures are used to hold the transposed fat in place for a week.
- There is learning curve but no longer than most new procedures.
Variations, according to Dr. Core, include removal of fat pads and muscle lifting, along with canthal support, as indicated. Surgeons can add laser, although not of the patients in Dr. Core’s presentation had laser treatment.
Read more from Global Aesthetics Conference 2015.