Effects of opening eye caused by modified lower blinking transconjuntival

A modified inferior blepharoplasty (TCLB) performed to treat the lower eyelid symptoms also benefits the upper eyelid with improved results,¹ According to Takayuki Kubo, MD, PhD, who is a plastic surgeon in a private practice in Tokyo.

Changes in aging affect both the upper and lower eyelids, such as dilution of the passenger skin resulting in upper eyelids or wrinkles. Lower eyelids can become wide (anterior hernia of the lower orbital part of fat [LOFC]), and tear deformations, Nasojugal grooves and black circles can be developed,^2-4 According to Kubo.

He explained that traditional cutting -edge surgeries were performed to treat aging points on the lower lids, making ophthalmoplasty surgery one of the most common procedures performed by aesthetic facial surgery.^5-7 However, TCLB becomes a high profile surgery because it is minimally invasive.⁸Specifically, scarring without scar is favored in Asian populations, because this skin type is more sensitive to postoperative scars.^9,10

Enophhalmia is a more complex symptom defined as an abnormality of the submerged sphere in the orbital reception caused by the weakening associated with the age of the supporting tissues inside the lower trajectory.¹¹ It not only shows a typical appearance of aging, but it is also believed to cause pseudo -platinum or dermatochane, Kubo said.

His goal in the discussion was to evaluate the impact of a modified TCLB process that added maneuvers for divergence and decompression on LOFC and its support structures to achieve better results for both the lower and upper lids.

Evaluation and results TCLB

Forty patients (36 women) with lower eyelid symptoms were treated using the modified TCLB followed by 12 months after surgery. The height of the malavic slit (PFH), defined as the distance between the upper and lower eyelids in vertical alignment with the central center, was pre -operatively measured and 12 months after three -dimensional photographs. Changes in the measurements were compared to the validation of the post -operative effect of eye opening and weighed the cut fat by each LOFC.

Kubo reported changes to the average preoperative right and left eye PFHS during surveillance examination. The average preoperative PFH for both the right and left eyes was 8.41 mm. Postoperatively, the corresponding measurements were 9.26 and 9.21 mm, the differences from the original value that reached the importance (p <0.01).

The total cut -off LOFC was 0.43 grams for the right and 0.42 grams for the left eyes. The largest amount of fat was cut bilaterally from the LOFC side.

Kubo concluded that “results after modified TCLB showed clearly increased eye opening capacity and marked analysis of observable symptoms. Back to the desired position.

Reports:

1. Kubo T. Activation of the eyes achieved by modified lower blepharoplasty. Aesthet Surg J. 2025;45: 126-135; https://doi.org/10.1093/asj/sjae205

2. Stutman RL, Mark A. Codner Tear Tear Creamory: Anatomy review and treatment options. Aesthet Surg J. 2012, 32: 426-440. DOI: 10.1177/1090820×12442372

3. Wong Ch, HSIEH MKH, Mendelson B. The tear link: Anatomical base for tear deformation. Plast Reconstr Surg. 2012, 129: 1392-1402. DOI: 10.1097/PRS.0B013E31824ecd77

4. VRCEK I, OZGUR O, NAKRA T. Hyperxi Black Circles: Review of pathogenicity, evaluation and treatment. J Cutan Aesthet Surg. 2016, 9: 65-72. DOI: 10.4103/0974-2077.184046

5. Atiyeh B, Hakim Cr, Oneisi A, GHIEH F, Chahine F. Surgical correction of tear deformation (TTD) with a release of a link that holds Orbicularis and an increase in volume for renewal of the bibliography: review of the bibliography. Aesthetic planet. 2023; 47: 199-214. DOI: 10.1007/S00266-022-03183-0

6. Majidian M, Kolli H, Moy Rl. Transconjuntival lower blepharoplasty with fat transport above the Orbicularis muscle to improve tear deformation. J Cosmet Dermatol. 2021, 20: 2911-2916. DOI: 10.1111/JOCD.13978

7. Akşam E, Karatan B. Periorbital Aesthetic Surgery: A simple algorithm for optimal youthful appearance. Plast Reconstr Surg Glob Open. 2019; 7: E2217. DOI: 10.1097/Gox.00000000002217

8. Baylis Hi, Long Ja, Groth MJ. Transconjuntival lower blepharoplasty. Technique and complications. Ophthalmology. 1989, 96: 1027-1032. DOI: 10.1016/S0161-6420 (89) 32787-4

9. Chike-Bobi CJ, Cole PD, Brissett SA. Spaining: Pathogenesis, clinical characteristics and management. Semin Plast Surg. 2009; 23: 178-184. DOI: 10.1055/S -0029-1224797

10. Huang C, Wu, Z du y, Ogawa R. The epidemiology of Keloids. In: Manual for Management of Tail: Art Management and emerging technologies [Internet]. Chapter 4.Springer, New York. 2020; 29: DOI: 10.1007/978-3-030-44766-3_4

11. Camirand A, Doucet J, Harris J. Anatomy, Pathophysiology and prevention of Gerontic Epiphany and the associated shells lower fat pillows. Plast Reconstr Surg. 1997, 100: 1535-1546. DOI: 10.1097/00006534-199711000-00026