The conjunctival vascular arcades and the position of the postseptal incision in lower eyelid transconjunctival blepharoplasty

Abstract

There are two general approaches to accessing orbital fat in transconjunctival lower blepharoplasty: preseptal and postseptal. The postseptal approach allows entry to fat pads without involving the orbital septum. Some authors consider the position of the second vascular arcade the ideal placement of the postseptal incision in transconjunctival blepharoplasty. The purpose of the present study was to investigate if the ideal position of the postseptal incision is over the second arcade of the inferior eyelid conjunctiva. A retrospective review of patients undergoing lower transconjunctival blepharoplasty from july 2015 to july 2017 was performed. All measures of the second vascular arcades were performed by the senior author. The distance in millimeters from the inferior tarsal edge to the second arcade was documented. A total of 82 patients met the inclusion criteriosa for review. In 34 cases (42%), the inferior arcade was visualized surgically at the right and left conjunctiva of lower eyelid. 26 patients (76,4%) were females and the mean patient age was 56,6 years old (range 47–68 years). The measure distance from inferior edge of tarsus to the second arcade was 4,6 mm (range 3,9–5,2 mm). The second vascular arcade visualized in the surface of the conjunctiva of the lower eyelid cannot be a landmark of the position of the postseptal incision in transconjunctival blepharoplasty. The optimal location of the postseptal incision is 6,5 mm inferior to the inferior tarsal edge, below the fusion point of the orbital septum and lower eyelid retractors. Level of evidence: Level IV, therapeutic study.