Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience

Overview

The question was how well a direct approach through a lower eyelid incision works for correcting aging of the lower lid and midface, and what goes wrong with it. The authors retrospectively reviewed 757 patients treated for midfacial aging over 5 years. They also used the approach in a smaller group of difficult reconstructive cases.

Findings

• 757 patients treated over 5 years with a direct trans-lower lid blepharoplasty subperiosteal approach for midfacial aging.
• A smaller group had the approach for difficult reconstructive problems; the abstract calls it valuable there.
• The paper gives a retrospective evaluation of the technique.
• It discusses the pitfalls and complications associated with the technique.
• It describes technical modifications that may lower the rate of morbidity.
• The abstract does not report complication rates or outcome numbers.

What it means for a patient

• A midface lift can be done through the same lower eyelid incision used for lower blepharoplasty.
• The approach carries complications, and the authors changed their technique over 5 years to reduce them.
• Ask a surgeon who offers this approach which complications they see and how they prevent them.
• Limits: a retrospective review of one group's experience. The abstract gives no rates of complications or measured results.

Why this paper matters

It reports a 757-patient series of this approach and pairs the technique with a discussion of its complications and fixes. The abstract supports only that the authors used the approach widely and refined it over time. Cited 128 times (NIH iCite, 2026-09-25).

Terms

• Blepharoplasty: eyelid surgery that removes or repositions skin, muscle or fat.
• Transblepharoplasty approach: reaching deeper structures through the eyelid surgery incision.
• Midface: the cheek area between the lower eyelid and the upper lip.
• Subperiosteal: beneath the periosteum, the thin tissue layer that covers bone.
• Morbidity: complications or unwanted effects of a treatment.
• Retrospective evaluation: a review of past cases from records.