TRANSCONJUNCTIVAL VERSUS TRANSCUTANEOUS LOWER EYELID BLEPHAROPLASTY -A PROSPECTIVE-STUDY

Debate continues over the relative merits of transconjunctival and the more customary subciliary transcutaneous approaches for lower lid ble pharoplasty. Tell consecutive patients presented for blepharoplasty, a nd in all patients the transcutaneous subciliary musculocutaneous flap approach was used on the left lower eyelid and the transconjunctival preseptal approach was used on the right. Patients served as their own controls. Followup was evaluated clinically by patient questionnaire and by standardized photographs preoperatively and at 5 days, 1 month, 3 months, and 6 months postoperatively. Photographs were graded indep endently by four blinded examiners.No statistical difference was ident ified in measured fornix depth between preoperative patients and posto peratively on each side. Average fat removed from each side was the sa me, and no patient had an identified ''missed fat compartment.'' Three patients had mild bilateral scleral show postoperatively, and a fourt h developed it on the left (transcutaneous) side. However, overall gra ding on both sides was universally very good with no significant diffe rence on the two sides-0.68 on the right and 0.60 on the left (maximum worst grade could be 5.0 and best grade 0). The potential for externa l scarring was never a perceived problem in the transcutaneous techniq ue.