Blepharoplasty. Avoiding plastic eyelids.

The goal of a facial plastic surgeon should be to correct the undesirable conditions for which he has been consulted and to avoid leaving his mark on the patient. By embracing the concept that prevention is better than cure, it is generally possible to avoid the "operated-on look" following cosmetic surgery. We describe a number of safeguards we use to preserve natural-looking eyes following lower lid blepharoplasty in men and women. The most common, permanent complication described following conventional lower lid blepharoplasty is the round eye. The condition is readily identified by an increase in scleral show between the limbus and lower lash margin. Closer evaluation will reveal inferomedial displacement of the lateral commissure, increased slope of the lateral third of each eyelid, a flattened, unanimated, pretarsal component, and an unnatural infralash crease produced by the healed incisional scar. These findings are one step short of ectropion; therefore, the methods herein described should help reduce the incidence of this more dreaded and serious complication of blepharoplasty.