Subtarsal Capsulopalpebral Fascia Incision: A New Paradigm for Ectropion-Free Transcutaneous Lower Blepharoplasty.

[BACKGROUND] Lower-eyelid surgery by means of the transcutaneous approach is challenging because of common complications such as ectropion and scleral show.

[METHODS] The authors devised a transcutaneous lower-eyelid technique that incorporates 4 modifications that greatly reduce these complications-namely, tension-reducing incision of the capsulopalpebral fascia to prevent ectropion and preserve the pretarsal fullness; selective omission of lateral canthoplasty; universal application of arcuate expansion cuts to prevent lateral compartment bulging; and reattachment of the tear-trough and orbital-retaining ligaments to the orbital septum. A prospective cohort study was conducted on all consecutive patients who underwent the technique in January of 2020 to March of 2023. All complications were reviewed. The 50 most recent patients were assessed objectively by 3 independent plastic surgeons with regard to patient preoperative and 3- and 6-month postoperative tear trough, lid-cheek groove, eye bag, and fine lines. Each variable was scored on a 5-point scale.

[RESULTS] In total, 340 patients underwent the procedure. No major complications, including ectropion, were observed. All 4 aesthetic variables improved significantly at 3 and 6 months relative to preoperative baseline.

[CONCLUSIONS] This new approach significantly mitigates common complications of transcutaneous lower-eyelid operations, including persistent postoperative ectropion. Thus, it may be a promising advance in surgical correction of lower-eyelid aesthetics.