Avoidance of complications in lower lid blepharoplasty

The most common complication of lower lid blepharoplasty is lower lid malposition either lower lid retraction or frank ectropion. This is caused by the vertical pull of skin shortage or shrinkage on a lax tarso-ligamentous sling. A method of tightening the tarso-ligamentous sling combined with a lower lid blepharoplasty is presented. An alternate method of lower lid fat removal through the fornix without skin incision is presented to be used in patients with taut lower lid skin.