Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye

Marco Klinger, MD* Valeriano Vinci, MD†‡ Maria Angela Romeo, MD† Andrea Battistini, MD* Francesco Klinger, MD§ Valeria Bandi, MD* Luca Maione, MD* Paolo Vinciguerra, MD†¶ Alessandra Di Maria, MD†¶

This paper was published in the Plastic and Reconstructive Surgery journal in 2023.

🎯 Lower Eyelid Surgery: How to Achieve Natural Beauty Without ‘Round Eye’

How to Avoid 'Round Eye' and Achieve Natural Beauty with Lower Eyelid Surgery

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👁️ What Is a ‘Round Eye’?

What Is a “Round Eye”?

One of the most common complications after lower blepharoplasty is ‘round eye,’ a condition where the lower eyelid is pulled downward, exposing excessive sclera (the white part of the eye).

This not only leads to an unnatural appearance but also causes eye discomfort, such as tearing (epiphora) and dry eye.

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🧠 What Causes These Complications?

What Causes These Complications?

Excessive skin removal

Damage to the orbicularis oculi muscle

Over-resection of fat or muscle

Scar contracture pulling the eyelid downward

These factors contribute to the descent of the lower lid and rounding of the lateral canthus.

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✅ Solution Proposed by a European Surgical Team

Solution Proposed by a European Surgical Team

A surgical team at Humanitas Hospital in Italy proposed a technique that prevents round eye without using muscle flaps, based on 280 successful cases.

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🔍 Key Principles of the Technique

Key Principles of the Technique

1. Inducing Muscle Tension According to Skin Excision Direction

By suturing the skin in an oblique vector, horizontal tension is applied to the underlying muscle, resulting in a stable outcome with reduced operative time.

2. Removing Only the Necessary Amount of Skin

Only the necessary amount of skin is excised vertically, avoiding anterior lamellar shortening and ensuring a natural eyelid contour.

3. Fat Removal: Carefully, Only When Necessary

Fat is conservatively removed only if it is herniated, to avoid a hollow or aged appearance.

4. Nerve Protection and Prevention of Thermal Damage

Cold blade dissection and bipolar cautery are used to protect nerve branches and reduce collateral tissue damage.

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📊 What Were the Outcomes?

What Were the Outcomes?

Only 4 complications in 280 patients (3 cases of ectropion, 1 infection)

Patient satisfaction score: 8.4 out of 10

Surgeon’s evaluation score: 4.5 out of 5

Natural, symmetric lower lid line with minimal scleral show

Fast recovery with minimal swelling or bruising

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✨ Final Thoughts

Final Thoughts

This technique allows for natural and stable lower eyelid rejuvenation without muscle flaps.

It’s ideal for those seeking a smooth, youthful lower lid line without the risks of round eye or ectropion.

Frequently Asked Questions

What is ‘round eye’?

‘Round eye’ is a condition that can occur after lower eyelid surgery, where the lower eyelid is pulled downward, exposing an excessive amount of the white part of the eye (sclera). This can make the eyes look unnatural and cause discomfort such as tearing or dry eyes.

What causes ‘round eye’ after lower eyelid surgery?

‘Round eye’ can be caused by a combination of factors, including excessive skin removal, damage to the orbicularis oculi muscle, over-resection of fat or muscle, or scar contracture pulling the eyelid downward. These factors can lead to the lower eyelid drooping and the eye appearing rounded.

What are the key principles of the new surgical technique to prevent ‘round eye’?

The key principles of the new surgical technique involve suturing the skin in an oblique direction to induce muscle tension, and removing only the minimal necessary amount of skin and fat. Additionally, using cold blade dissection and bipolar cautery is crucial for protecting nerves and reducing tissue damage.

Does this surgical technique avoid touching the muscle?

Yes, this surgical technique is designed to prevent ‘round eye’ without directly manipulating the muscle. By controlling the direction of skin excision, it indirectly applies horizontal tension to the muscle, leading to stable results.

What are the results of the new surgical technique?

This surgical technique resulted in complications in only 4 out of 280 patients, with an average patient satisfaction score of 8.4 out of 10 and a surgeon’s evaluation score of 4.5 out of 5. It achieves a natural and symmetrical lower eyelid line without ‘round eye’ or ectropion, and offers fast recovery.

Who is this surgical technique suitable for?

This surgical technique is suitable for individuals who wish to achieve a natural and smooth lower eyelid line without concerns about ‘round eye’ or ectropion. Since it avoids direct muscle manipulation, stable results can be expected.