# Extended Lower Blepharoplasty: How Much Skin Can We Resect?

## TL;DR

Extended lower blepharoplasty safely removes large amounts of eyelid skin while maintaining stability and minimizing complications.

## Contribution

The study demonstrates the safety and efficacy of extended lower blepharoplasty for significant skin excision and midface rejuvenation.

## Key findings

- Skin excision ranged from 6 to 16 mm with an average of 10 mm.
- The extended technique had a low complication rate and satisfactory outcomes.
- It is effective for skin laxity and midface aging without major functional issues.

## Abstract

Lower eyelid blepharoplasty is a widely performed procedure to address periorbital aging. While traditional techniques primarily focus on the lower eyelid, extended lower blepharoplasty provides a more comprehensive approach by incorporating midface rejuvenation. This study evaluates the safety and efficacy of extended lower blepharoplasty, with a particular focus on its ability to allow the excision of large amounts of excess skin while maintaining eyelid stability and minimizing complications. Consequently, we selected cases in which the primary concern was skin elastosis, characterized by significant skin redundancy and sagging. In contrast, patients whose midfacial aging was predominantly due to progressive adipose or bony atrophy were excluded from the study.

A retrospective analysis was conducted on patients who underwent extended lower blepharoplasty over a 10 year period (2013–2023). Surgical technique involved a transcutaneous approach with subcutaneous and sub-orbicularis dissection, meticulous tissue repositioning, and deep and superficial canthoplasty for structural support. The study assessed the amount of skin excised and the incidence of postoperative complications, including scleral show and ectropion.

Among the patients included, the amount of skin excised ranged from 6 to 16 mm, with an average of 10 mm. The extended technique demonstrated a low complication rate, with satisfactory aesthetic and functional outcomes in most patients.

Extended lower blepharoplasty is a safe and effective technique for addressing extensive lower eyelid skin laxity and midface aging. The ability to excise substantial amounts of skin while maintaining eyelid stability makes it a valuable alternative to traditional approaches.

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The online version contains supplementary material available at 10.1007/s00266-025-05405-7.