Dynamic analysis of modified transcutaneous lower blepharoplasty based on biochemical and biophysical principles

Chuh Kai Liao, Feng-Chou Tsai, Tsorng Harn Fong, Chin Ju Huang, Yi Chin Shen, Yuan Hao Ku, Ching-Hua Su

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


In this study, we analyzed the key parameters of modified transcutaneous lower blepharoplasty based on multidisciplinary principles (biochemical findings and biophysical wrinkling theory). A total of 408 female patients received our subciliary lower blepharoplasty between March 2002 and January 2010. The severity of the eyebags (dynamic wrinkle numbers and prolapse) was evaluated through preoperative and postoperative photography, whereas the excised lower eyelid skin specimens from 56 patients were investigated with hematoxylin and eosin staining. The modified techniques produced significant improvements in the severity of eyebags in all age groups (P <0.001). Poor surgical outcome was found to correlate significantly with preoperative dynamic wrinkle numbers (P <0.001). Age, dynamic wrinkle numbers, and prolapse correlated significantly with dermal fiber density (P = 0.004, 0.000, and 0.000, respectively) but not epidermal, rete ridge, and dermal thickness or the number of rete ridges. In conclusion, modified transcutaneous lower blepharoplasty provides significant improvement to dynamic wrinkles and prolapse in the eyebags. Periorbital aging progressively disturbs the dermal compactness (fiber density) until the structure can no longer hold its integrity at the critical age (around the age of 40).

Original languageEnglish
Pages (from-to)634-638
Number of pages5
JournalAnnals of plastic surgery
Issue number6
Publication statusPublished - Dec 2013


  • aging
  • buckling
  • epidermal thickness
  • eyebags
  • lower blepharoplasty

ASJC Scopus subject areas

  • Surgery


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