Lower eyelid blepharoplasty involves the removal or repositioning of lower eyelid fat pads, support of the middle portion of the eyelid, and tightening or removal of the outer portion (skin and muscle). Dr. Walrath develops a customized plan for each patient, taking into account these distinct anatomical structures.
In younger patients, the personalized approach to the lower eyelids may involve a surgical incision on the inside of the eyelid to remove and redistribute the fat pads (“lowering the mountain”), or it may involve the nonsurgical placement of injectable filler in the region adjacent to the fat pads (“raising the valley”), both with the goal of smoothing out the transition zone from the lid to the cheek and the transition zone from the inner aspect of the lower eyelid to the nasal side wall (the “nasojugal fold” or “tear trough”). The skin may be pinched and a small segment removed, or a gentle chemical peel may be utilized to remove fine wrinkles and create mild tightening. The eyelid itself is usually anchored to the eye socket rim for additional support if surgery is performed.In patients with skin excess and eyelid laxity, the usual approach is to perform an incision beneath the eyelashes. This incision preserves the eyelash follicles. Lower eyelid fat pads can then be removed or repositioned, tailored to the patient’s cosmetic needs. Customized treatment of the middle anatomic layers of the eyelid is critical. This layer is often released surgically, and spacer materials, usually composed of processed collagen, are often used to provide vertical support to the eyelid within this middle layer, to ensure proper eyelid position and function. Excess skin is then redraped and conservatively removed, so as to avoid a “skin shortage” and the attendant problems with eyelid closure and protection of the ocular surface.
A detailed discussion of the decision making process in lower lid cosmetic surgery can be found here.
Dr. Walrath has recently been invited to lecture on the topic of blepharoplasty.
If you would like to learn about lower eyelid surgeries that are occasionally covered by insurance, look here.
Cosmetic lower eyelid surgery can make patients look refreshed by eliminating the “bags” and softening the transition zone between the eyelid and the cheek, two features of the midface that we all associate with aging. When done properly, it can be very rewarding for the patient. The important element for surgeons to understand when performing lower eyelid surgery is that the eye socket volume, bony facial structure, and eyelid shapes are unique for each patient. It really is true that no two patients get the exact same surgery. Some patients with prominent eyes require the advanced techinques that oculoplastic surgeons can provide. One thing I’ve learned is that the best chance for a great result is on the first surgery. When a patient is referred in from elsewhere for revision, the chance to success in a single surgery is somewhat diminished.