Various forms and degrees of morphological changes in the lower eyelid are presented in this study. A comprehensive, individualized clinical approach based on sound anatomical principles and lower lid stability is needed. We evaluated morphological outcomes of lower blepharoplasty by measuring lower eyelid position.

One hundred sixty-eight eyes underwent lower blepharoplasty between August 2009 and August 2014. The mean patient age was 62.1 ± 13 years and mean follow-up period was 6.0 ± 10.2 months. Lower eyelid position of 84 consecutive primary lower blepharoplasty patients (52 females and 32 males) was analyzed using digital images and measured with standardized data points using the Image J Program.

Of the 168 individualized lower eyelid blepharoplasties analyzed, margin reflex distance 2 (MRD₂) decreased from 5.4 ± 1.1 mm to 4.9 ± 0.8 mm ( p = 0.005) and marginal nose distance (MND) increased from 59.2 ± 18.3 mm to 61.9 ± 17.6 mm ( p < 0.001). Complications after lower blepharoplasty were not observed.

The position of the lower eyelid improved after individualized lower blepharoplasty that addressed all the anatomical lower eyelid findings was performed.