Blepharoplasty: Lower

I almost always avoid removing fat from the upper and lower eyelid during blepharoplasty to prevent these complications. Excessive fat removal from above or below the eyes can lead to a hollowed appearance.  Injection of a filler can be safely performed around the eyes to reintroduce a healthy appearing look.  I recommend autologous fat injection into the upper eyelid and brow region for hollowing in that area.  For the lower eyelid region, I try to avoid injecting fat because of the propensity for creating palpable and visible lumps over the orbital bony rim.  In selected patients, I sometimes inject a conservative amount of hyaluronic acid filler into the lower eyelid region for improvement in contour due to excess fat removal.

There is a distinct difference between the technique in which an Asian upper eyelid is performed compared to a non-Asian eyelid. Many Asians seeking blepharoplasty are unhappy with the puffiness and lack of upper eyelid (or pretarsal) crease, yet most patients want to maintain their ethnic appearance. In these cases, surgery is aimed at creating the pretarsal crease in eyes that are absent a fold. In general, a minimal amount of overhanging soft tissue is removed, and the skin is then attached to the tarsal plate of the upper lid to create the crease several millimeters above the eyelash line. Minimal fat is removed to avoid westernization of the eyelid. Eyelid symmetry is of utmost importance, and patients should choose a surgeon who routinely performs Asian blepharoplasty procedures.

First and foremost, knowledge and confidence in the surgeon that you choose is the most important step in achieving your desired goal. When combining upper eyelid surgery with brow lift, it is important to elevate the brows to the desired position and not to remove too much upper eyelid skin, which could impair eyelid closure and/or create a hollowed out look. I feel that a softly arched brow with lateral enhancement along with upper eyelid skin positioned several millimeters above the eyelashes looks the most pleasing. In my experience, I have not had a patient complain of their eyebrows pulled too high. As in any other cosmetic procedure you desire, ask your surgeon to show prior patient before and after pictures.

A brow lift is a procedure that elevates your eyebrows to create more distance between your brows and upper eyelids. There are several ways to perform this procedure (I almost always do endoscopic brow lifts). Blepharoplasty procedures are surgery of the eyelid, either upper or lower, in which unwanted skin and soft tissue is removed or repositioned to give a more rejuvenated appearance. Many times, patients are candidates for both brow lift and blepharoplasty to achieve the desired result.

Upper eyelid blepharoplasty is a very safe and effective surgery in patients your age. As long as you have no serious medical conditions that would preclude you from the procedure, such as requiring constant blood thinning medications, this procedure will benefit you immensely with minimal down time and virtually no postoperative pain.

Glasses can be worn immediately after your surgery, but not so for contact lenses. The soft tissue swelling of the upper eyelid can impart a minor change in the shape of your cornea. This sometimes creates a suction cup effect, inhibiting removal of the contact in the eager patient! I like to wait two weeks postoperative to allow contact wear, and I have the patient put them in and take them out while in clinic to ensure safety.

I would need to evaluate you before making a recommendation, but it sounds like you may have either a dehiscence of the muscle that elevates your eyelid, or excessive scar tissue that is impinging eyelid elevation. I perform repairs of both of these conditions, but I doubt simple blepharoplasty will fix your problem. Another possibility is that you sustained a bone fracture around your eye that may need to be addressed. The periorbital region is very complex and requires thorough evaluation.

You are a little young for eyelid surgery, unless you want to change your ethnicity, such as Asian eyelid surgery. It sounds like you have a heredity for heavy eyelids. In the next two decades of your life, you may notice aging changes of your face that may change immensely. I have seen individuals become very thinned out on their face after an early adulthood of fullness, and vice versa. My advice to you…do not have surgery on your eyes right now.

I ask my patients who wear contacts to avoid wearing them for 2-3 weeks after upper and/or lower blepharoplasty. I do not want any pulling or stretching of the upper or lower eyelids after surgery. Also, the temporary swelling of the conjunctiva of the eye interferes with proper fitting of the contact.

Most patients who seek a repeat blepharoplasty procedure will have had prior blepharoplasty approximately 10-15 years prior. Sometimes, if there is a return of excess skin, or sagging around the eye, this can represent a soft tissue depletion that can be improved with volumetric enhancement in the form of an absorbable filler or autologous fat.

After blepharoplasty procedure, I usually allow makeup wear to resume about 10 days after surgery. The sutures are removed after one week, and the topical ointment is discontinued. Makeup can be resumed several days after this.

If you are excessively concerned about your mole, the small thin scar is almost always less visible then the mole after healing.  Sometimes patients opt out of having the mole removed when they begin to see it as a personal unique trait of their face.  I always have them consider it that way…..like Marilyn Monroe!

If your puffiness is from excessive fat, no.  This is a surgical matter.  However, I have seen lower eyelid puffiness as a result of untreated allergies, fluid retention, and other medical conditions which has responded to treatment from your primary care physician.

I almost exclusively use injectable hyaluronic acid (HA) fillers in the face.  There are several products available which work well.  This is composed of a naturally occurring substance found in the skin and is not made from animal products.  Although mentioned as a potential risk, I have never seen an allergic reaction to this product after injection.  There are studies which suggest that this type of filler stimulates collagen formation which is desirable in long-term reduction of wrinkles.  This is an absorbable filler that lasts approximately 10 months.  I know of no long term deleterious effects after injection of HA fillers.

Upper eyelid surgery remains one of the most common facial cosmetic surgeries performed in the United States every year.  The vast majority of patients report exactly what you are saying.  Removal of the extra eyelid skin that you are unhappy with will restore visibility of your eyelid platform for successful application of eye liner and eye shadow.  Patients who consult with me will have their digital photos taken and will be shown their simulated results on computer.  This greatly helps in patients understanding the expected results.

As one ages, the soft tissue of the face starts to sag and also lose its thickness of the layer of fat under the skin.  With the lower eyelid and cheek, there can develop a separation between the cheek fat due to sagging, and prominence of the lower eyelid fat, leaving a groove between the eyelid and cheek.  A non-surgical way of addressing this is with an injectable filler that can fill in the gap between your lower lid and cheek.  This can work very well in experienced hands.  A more definitive way is with lower eyelid surgery and/or a mid-face lift.

Of course.  That is the goal of upper eyelid surgery, or blepharoplasty.  Removal of the excessive upper eyelid skin results in improved visibility of the eyelid platform which would better show your eye shadow and lash lines.  Care is always taken to not remove too much skin and soft tissue which could result in a hollowed appearance of the upper eyelids.

I have performed upper eyelid blepharoplasty in patients in their 30’s.  It is not very common, but if you have a familial trait that bothers you, it is a very easy procedure to have done.  In my view, the sooner you do it, the more years you will enjoy the results.

I often inject Botox into the crows feet area in both younger and older patients.  However, if you have a lot of excessive skin around your eyes in this area, you may be a better candidate for upper and/or lower blepharoplasty surgery.  For prominent crows feet, Botox will lessen but probably not eliminate the lines present.

Darkening of the skin under the eyes can be due to shadowing from overlying fat, or pigmentation of the skin from a variety of causes.  Often, addressing the fat during surgery to smooth out the bags will eliminate the shadowing effect, providing an acceptable appearance.  However, in patients who have persistent darkening under the eyes, I will offer phototherapy treatments to treat the pigment problem.

The aging process continues in everyone.  After upper eyelid surgery to remove extra skin, eventually the skin redundancy will recur.  Patients who seek another blepharoplasty surgery will usually have had their initial procedure around 10 years prior.

I have performed blepharoplasty in patients undergoing Mohs reconstruction of the lid.  These are usually smaller defects that need reconstruction.  Larger defects may need reconstruction followed by possible blepharoplasty later.  If you are desiring upper blepharoplasty, this can be performed at the same time.