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Hooman Hooshangi et al.
signi cant difference detected in scleral using transconjuctival or transcutaneous operations after 4 months, however
only 2 (9%) scleral was observed using transcutaneous approach (P<0.8). The same results observed after 6 months
follow-up period (P<0.8).Despite insigni cant differences between 2 lower eyelid blepharoplasty approaches regard-
ing the scleral show incidence, using transconjunctival technique was recommended for the lower eyelid blepharo-
plasty in order to decrease the incidence of the scleral show.
KEY WORDS: LOWER EYELID BLEPHAROPLASTY, TRANSCUTANEOUS, TRANSCONJUNCTIVAL, SCLERAL SHOW
INTRODUCTION
Blepharoplasty remains one of the most common con-
temporary facial surgical procedures performed. While
in oculo-facial plastic surgery functional upper eye-
lid blepharoplasty still encompasses the majority of
the specialties procedures, cosmetic upper and lower
blepharoplasty are rapidly increasing in number.The
skin-muscle ap approach to lower blepharoplasty was
popularized in the 1970s. It remained the most gener-
ally used method because of e fast, effective and widely
applicable (Hidalgo, 2011; Massry and Hartstein, 2012).
Post blepharoplasty treatment of lower eyelid retraction
is challenging (Yoo et al. 2013). Several methods intro-
duced to improve lower eyelid blepharoplasty outcome
(Schwarcz et al. 2016, Kossler et al. 2017).
Transcutaneous lower eyelid blepharoplasty with fat
excision has been the paradigm for addressing the un-
desirable sequelae of the aging eye (Grif n et al. 2014).
This is eyelid contour and no changes in eyelid position
when performed in a conservative fashion. Transcutane-
ous is a time-tested method that achieves satisfactory
cosmetic results (Garcia and McCollough, 2006). The lat-
est evolution of the transcutaneous lower eyelid blepha-
roplasty is a skin ap or skin muscle ap method in
which the incision is placed inferiorly to the tarsal mar-
gin (Freeman, 2000). The transconjunctival approach
was primary described in 1924 to the lower orbital fat
and the inferior orbital surface (Korchia et al. 2003).
Transconjunctival lower eyelid blepharoplasty is most
acceptable as a safe and effective method to eliminate
herniated orbital fat from the lower eyelid and avoid-
ing the complications of a cutaneous incision (Belinsky
et al. 2015).
The transconjunctival approach avoids numer-
ous complications of the classic transcutaneous lower
blepharoplasty (Kossler et al. 2017). It is reported
the limitations of the transcutaneous approach was
improved by the transconjunctival approach (LoPiccolo
et al. 2013). The transconjunctival approach has gained
popularity over the transcutaneous approaches because
of its inconspicuous scar and decreased risk of postop-
erative ectropion and scleral show (Salhi and Cordoba,
2015).
Scleral show is one of the main complications of
lower blepharoplasty which may result to manifest as
lack of de nition of the lateral part of the eyes and eye-
lid retraction (Pascali et al. 2015). Lower eyelid retraction
is known for the existence of scleral show (which each
patient stated (Grif n et al. 2014). Scleral show is one of
the most feared complications of lower blepharoplasty
surgery. The attendant scleral show and rounding of the
eye are poorly tolerated by patients from a cosmetic and
often functional stand-point (Grif n et al. 2014). The
surgical correction of postsurgical eyelid retraction can
be challenging as well as frustrating (Yoo et al. 2014).
Despite its effectiveness for the facial rejuvenation,
blepharoplasty has been associated with several adverse
effects. One of the most common side effects of this sur-
gery is eyelid malposition and scleral show which is not
suitable from esthetic point of view. Although some tech-
niques have been used for the blepharoplasty of the lower
eyelid, the effect of these techniques has not been de -
nitely identi ed in the incidence of scleral show. So, the
current study was compared the effects of lower eyelid
blepharoplasty with transconjunctival and transcutaneous
approaches in the incidence of scleral show in patients.
MATERIAL AND METHODS
In a prospective randomized clinical trial, 22 candidates
of the lower eyelid blepharoplasty in patients referred
to two private clinics and Bu Ali hospital at 2015. The
patients had no history of systemic disease, previous
lower eyelid blepharoplasty, trauma or dry eye syn-
drome. The patients were randomly assigned in 2 meth-
ods of transconjunctival and transcutaneous approaches.
The surgeries were perform on 2 eyelids of the left and
right sides and in total, 44 eyelids were subjected to
blepharoplasty surgery in both sides of the patients in
2 approaches. The incidence of scleral show in both
modalities was studied using standard photographs of
patients taken before the surgery and 2, 4 and 6 months
post-surgery. The frequency of the scleral show was sta-
tistically analyzed by exact sher test in two approaches
in different time intervals.
RESULTS
In this study, 22 patients were included for eyelid blepha-
roplasty (44 eyelids). In the transconjuctival approach, 4
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS COMPARISON OF TWO TRANSCONJUNCTIVAL AND TRANSCUTANEOUS APPROACHES 103