Blending of the eyelid–cheek junction and removal of protruding fat: an intraoral approach to blepharoplasty of the lower eyelid

Blepharoplasty is one of the most common aesthetic procedures done today. The protruding fat and lid–cheek junction are the most conspicuous signs of aging that need attention. During zygomatic reduction by an intraoral approach we found occasionally that the orbital fat can be exposed through the perforated periosteum at the inferior obital rim. We therefore developed a new blepharoplasty procedure using an oral approach.Seventeen patients aged from 26 to 38 years, of whom six had had a previous unsuccessful blepharoplasty and one had a history of injury to the lower lid, were studied. The operation was done under an infraorbital nerve block and local anaesthesia through an intraoral incision at the upper vestibular groove. The periosteum was raised on the surface of the maxilla to the infraorbital rim, and the infraorbital nerve preserved. The periosteum and the orbital septum were incised along the whole length of the infraorbital rim. The fat that was exposed through the incision was either removed or preserved and fixed to the outer soft tissue with sutures.Cosmetic results were good and the oral incision healed without infection. Six patients developed numbness in the infraorbital region, five of whom recovered within 3 months; the other recovered by 6 months postoperatively.