Lower Lids

As aging effects the lower eyelids, puffiness, skin wrinkles and dark circles develop. Lower blepharoplasty is performed to reduce excess fat and tighten skin of the under eye regions. Fatty tissue is normally present in within the eye socket. The eyeball (a.k.a. globe) normally “bathes” within fat which serves as a cushion against minor impacts for the delicate eye. The anatomic barrier which keeps this orbital fat behind the eye weakens with time, allowing fat to move forward and visible within the lower lids. This produces an aesthetically unpleasing fullness to the lower eyelids, frequently referred to as puffy eyelid or bags under the eyes.

Lower eyelid blepharoplasty may be performed through an incision right under the eyelashes (a.k.a. transcutaneous eyelid lift) or an incision on the inside of the eyelid (a.k.a. transconjunctival lower blepharoplasty). Excess fat can be removed to reduce puffiness from either type of incision. If the surgery is performed through a skin incision, excess skin can be removed as well, reducing lower eyelid wrinkles.

Cosmetic Lower Eyelid Surgery

The procedure can be performed by itself or as a part in the overall facial rejuvenation regimen. Because the eyelid region ages commonly as a unit, upper and lower lids are commonly addressed together with a “4-lid blepharoplasty”. For the lids alone, various anesthesia options are available ranging from local anesthesia or twilight sleep to general anesthesia. If other parts of the face deserve improvement for a balanced and natural look, lower eye lid lifts can be done together with a face and neck lift and a browlift.

Transcutaneous Lower Blepharoplasty – How is it Performed?

The lower lid region is easily anesthetized with a lidocaine and epinephrine solution. An incision is placed right below the lash line where the skin is the thinnest. The skin and muscle are raised (“skin-muscle flap” technique) and the underlying fat pockets are isolated. There are three fat pockets present in the lower lid region. Although they are adjoining each other, these bulging pockets need to be addressed separately. The cosmetic eyelid surgeon will either reduce the volume of these fat pockets or perform some advanced eyelid procedure to reposition the fat for softening of the dark circles (a.k.a. tear troughs). By many experts, fat preservation techniques are considered the standard of modern blepharoplasty. Conservative amounts of skin and muscle are removed. The incision is closed with a fine suture. The procedure may take between 45 minutes and 1 hour. In experienced hands, bleeding should be minimal.

Trans-conjunctival Lower Blepharoplasty – How is it Performed?

Anesthetizing the lower lid for trans-conjunctival lower eyelid lift concentrates on the inside lining of the lid. The eyeball is often covered by a protective shield. The lower lid is retracted off the globe to determine proper incision location. The incision is placed in the depth of the inside lining of the lower lid, often using electrocautery. The fat pockets are identified similar to trans-cutaneous lower blepharoplasty. Selective removal of fat is performed. Sometimes, fat is preserved and repositioned for sculpting purposes. The incision maybe closed with a fine absorbable suture. Sometimes, the incision is left without suture for spontaneous healing.

For reduction and tightening of excess skin, additional procedures are necessary. Sometimes, skin is removed using an incision in the same location as for trans-cutaneous blepharoplasty. Other options include the use of laser resurfacing or chemical peeling.

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