Assessment of Eyelid Positioning with the Transcutaneous Lower Blepharoplasty Surgical Approach: A Single-Surgeon Experience

Background: Transcutaneous lower blepharoplasty has been associated with scleral show and lid malposition. Objective: To evaluate postoperative eyelid position (marginal reflex distance, canthal tilt), complication rates, and patient satisfaction, as measured by standardized photographic analysis and patient-reported outcomes. Methods: A retrospective review of 78 patients undergoing transcutaneous lower eyelid blepharoplasty with orbicularis suspension between 2022 and 2024 was conducted. Minimum follow-up was 12 months. Clinical photographs were assessed using PicPick software (version 7.2.8), and follow-up data were analyzed for aesthetic outcomes, complications, and satisfaction. Results: Of 78 patients (62% female, mean age = 47.5 years), the mean follow-up was 14.2 months (range = 12–25). Comorbidities included hypertension (18%) and diabetes (9%). Postoperative eyelid malposition (29.5%) and scleral show (28.2%) were unchanged from preoperative values. No cases of frank ectropion occurred, and one revision surgery (1.3%) was required. Negative preoperative canthal tilt was significantly associated with scleral show ( p < 0.001). Overall, 98.7% of patients reported satisfaction. Conclusions: Transcutaneous lower blepharoplasty with orbicularis suspension maintains eyelid position and contour, with low complication rates and high patient satisfaction.