Lower Eyelid Surgery
Lower eyelid blepharoplasty is a broad term used to describe a “lower eyelid lift”. The goal of a lower blepharoplasty is to rejuvenate and refresh the lower lids. This may involve removing lower eyelid “bags”, smoothing or removing excess lower eyelid skin, filling in a hollow tear trough (hollowing below the eyes), reforming the eyelid angles, or a combination of these. Since everyone’s anatomy and aging process is unique, a lower blepharoplasty should really be a procedure that is individualized for each particular patient. While most patients believe that lower blepharoplasty is a relatively simple procedure, it is actually a very intricate eyelid surgery. Meticulous pre operative planning and attention to detail are vital to a great result.
Commonly asked questions about lower eyelid blepharoplasty:
My lower eyelids are puffy, would a lower eyelid blepharoplasty help me?
Mostly likely, yes. Lower eyelid bags are due to excess fat that has fallen forward from the orbit (eye socket). A thin membrane called the orbital septum holds the fat inside the orbit (it acts as a shock absorber for the eye). As we age, the orbital septum weakens and fat can pooch forward causing lower eyelid bags. A lower blepharoplasty can remove the excess fat and deflate the puffiness. In addition, if a tear trough is present, the excess fat can be either repositioned (moved) or trimmed into small pieces and replaced (transferred) in order to soften it.
My lower eyelids have extra skin and wrinkles, would a lower blepharoplasty help me?
Again, most likely yes. As we age, the lower lid skin loses its elasticity (ability to spring back into shape) and we develop lower eyelid wrinkles and sagging skin. The excess skin can be addressed by a lower blepharoplasty. Depending on the amount of wrinkling or excess skin, either a small incision can be made just under the lashes to remove the skin, or a CO2 (carbon dioxide) laser can be used to resurface the lower eyelid.
My eyelids are hollow or have both bags and hollowing, am I a candidate for lower blepharoplasty?
Once again, most likely yes. Lower lid hollowing occurs due to many factors, but often it is from loss of volume at the lid-cheek junction (sometimes called the tear trough). This can be addressed either by using the fat that is already present in the lower eyelid and repositioning it into the hollowed areas. Or, it can be addressed by grafting fat (from the lower eyelid or elsewhere) into the hollowing. Implants can be used as well. In addition, a “SOOF lift”, which basically involves a mini cheek lift, can be performed to help smooth the tear trough.
How long does a lower eyelid blepharoplasty take?
Ever patient is different, and because there are so many different options for lower eyelid surgery, the average operating time varies considerably. However, most lower eyelid blepharoplasty procedures take anywhere from 1 1/2 hours to 2 1/2 hours to perform.
Where is lower eyelid blepharoplasty performed and what type of anesthesia is used?
Lower eyelid blepharoplasty can be performed in the office under local anesthesia. However, most lower eyelid blepharoplasty is performed in the outpatient surgery center under a twilight (MAC) anesthesia. Given the length and nature of the procedure, MAC anesthesia is usually more comfortable for the patient. If necessary, general anesthesia can be used as well.
Where is the incision for lower eyelid blepharoplasty?
That depends on what issues are being addressed. One was the incision is commonly made is on the inside of the lower eyelid. This approach is called a trans-conjunctival blepharoplasty. It is used to address problems with bulging lower lid fat or hollowing. There are no visible incisions when a trans-conjunctival blepharoplasty is performed.
If excess skin needs to be addressed, then there are two options. For small amounts of lower eyelid skin or wrinkling, laser resurfacing can be performed (“laser blepharoplasty”). While the skin is treated and tightened, a laser blepharoplasty creates no actual incisions on the lower eyelid. If more skin is present, then a small incision is made just below the eyelashes (subciliary incision). This incision is usually not noticeable once it has healed. The subciliary approach allows for access to address all potential issues for lower eyelid blepharoplasty.
What is the recovery like after lower eyelid blepharoplasty?
Most patients have very little if any pain after lower eyelid blepharoplasty. There is typically some swelling and occasional bruising, but this typically subsides within 1-2 weeks. Many patients can return to light activity within a few days. If a skin incision is made, the sutures are usually removed in a week. Sometimes, a canthopexy or canthoplasty (tightening the eyelid tendon) will be performed at the same time as a lower eyelid blepharoplasty. In these cases, the lower eyelid will seem a bit over tightened for a week or so, but it is temporary. Antibiotic eye ointment is used post operatively. The ointment is thick, and some patients have blurry vision when the apply it.
What type of anesthesia is used for lower lid blepharoplasty and where is the surgery performed?
Lower eyelid blepharoplasty is usually performed as an outpatient procedure. Typically, this type of eyelid surgery is performed under twilight (monitored anesthesia care or MAC) anesthesia. Occasionally, lower lid blepharoplasty can be performed under local anesthesia in the office. Dr. Vidor will discuss all of your options during your consultation.
I have already had lower eyelid blepharoplasty at another facility at another facility and my lower eyelids appear low or turned out. Do I need a revision lower blepharoplasty?
Possibly. There are many reasons that the lower eyelids can appear to sag or low after lower blepharoplasty. If the lower lids develop scarring or there is not enough eyelid tendon support, then the lower eyelids may drop or turn out. This can often be improved with revision lower eyelid surgery. As an oculoplastic surgeon, Dr. Vidor specializes in eyelid reconstruction and is an expert at revision eyelid surgery. During your consultation, Dr. Vidor will discuss all of your options for eyelid surgery.