Contemporary literature on upper and lower aesthetic blepharoplasty, evaluating the evolution of surgical techniques, anatomical considerations, and strategies for complication management. Methods: A literature review was conducted based on selected articles regarding surgical techniques (transconjunctival approaches, pinch technique, tarsal fixation), preoperative evaluation, and management of eyelid retraction. Studies focusing on tissue preservation and risk reduction were prioritized. Results: The current surgical paradigm has transitioned from aggressive tissue resection to the preservation and repositioning of fat and the orbicularis oculi muscle. In upper blepharoplasty, the emphasis is on avoiding the "operated look" through precise incisions and volume preservation. In lower blepharoplasty, the transconjunctival approach combined with fat repositioning and lateral canthopexy proves superior in preventing eyelid malposition. The management of post-blepharoplasty lower eyelid retraction (PBLER) requires complex reconstructive approaches that avoid conventional skin grafts.
Acosta et al. (Mon,) studied this question.