Blepharoplasty: Lower

Aging changes of the eyes occur in the lower eyelids as well as the upper eyelids. Over time, the soft tissues beneath the eyes relax and fat protrudes, resulting in excessive skin and sagging beneath the eyes. Additionally, the cheek fat may descend, creating a groove between the eyelid and cheek. Lower blepharoplasty, also known as lower eyelid surgery, is a plastic surgery procedure which improves the fat bags and excess skin beneath the lower eyelids. The procedure corrects drooping and puffiness associated with the lower eyelids and helps to blend the lower eyelid and cheek junction for a more youthful and rejuvenated appearance.

LOWER BLEPHAROPLASTY PROCEDURE

Lower blepharoplasty in TX is an ideal procedure for individuals with excess fat and skin of the lower eyelids resulting in a tired appearance. As with all forms of surgery, patients should also be in good physical health and have realistic expectations for improvement. While often performed on its own, lower blepharoplasty may also be combined with a cheek lift, or midface lift, for additional improvement of drooping in this area. Lower blepharoplasty is also commonly combined with upper blepharoplasty for individuals looking to brighten up and refresh the overall appearance of the eyes.

WHAT TO EXPECT

Dr. O’Mara performs the lower eyelid surgery at an outpatient surgery center using either IV sedation or general anesthesia. Surgical times will vary but generally average one hour in length. Excess fat is typically addressed through an incision located on the inside of the lower eyelid. If excess skin must be removed, the incision is sometimes made under the eyelashes. Working through the incision, Dr. O’Mara may remove excess fat responsible for bags or reposition the fat to a lower point in order to smooth the junction between the lower eyelid and cheek. Any excess skin beneath the eyelashes is also removed.

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LOWER BLEPHAROPLASTY RECOVERY

The recovery after lower blepharoplasty takes approximately one to two weeks. Some degree of swelling, bruising and minor discomfort may result. Most of the swelling and bruising subsides within one week. Sutures are removed after one week and shortly thereafter patients are typically able to wear eye makeup to conceal the remaining bruising. Many patients find that they can return to work as early as three to four days following their lower blepharoplasty surgery, though more strenuous activities will need to be postponed for three weeks.

Lower blepharoplasty can dramatically improve a puffy, tired or sagging appearance of the lower eyelids, creating a more youthful, rejuvenated and rested look.

FAQ

What can be done when too much fat was taken out above the eyes and below the eyes?

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.

I am an Asian male and would like to know if there is a difference between how a Blepharoplasty is performed on an Asian vs. Caucasian?

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.

I am a 56 year old female and would like to have a forehead/brow lift and a Blepharoplasty done. I don’t want to have that “scared” or surprised look after surgery. How do I know this won’t happen?

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.

What is the difference between a brow lift and blepharoplasty?

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.

I am a 72 year old lady and my eyes are sagging. My eyelids basically cover my eyes. Can Blepharoplasty help an old lady like me?

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.

I am both near sighted and far sighted and have poor vision. I am getting eyelid surgery on my top eyelids. How long after having Blepharoplasty, can I wear my contact lenses and glasses?

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.

When I was 22 I was in a punk rock band and I got smashed in the face with a guitar. Ever since my eye hasn’t been the same and has looked droopy. I’s only gotten worse with age. Is there a way that Blepharoplasty can fix my eye?

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.

I did some research on Blepharoplasty. It says that you can modify an eye lid and that excess tissues and fat can be removed. Can you do that for anyone at any age? I’m only 27 but I’ve always felt like my eyelids looks puffy and unattractive.

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.

Will my eyes be bothered by contacts after I have eyelid surgery?

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.

Four years ago I had a blepharoplasty procedure and I loved the results. Within the last couple of months, however, I’ve noticed that the area around my eyes has begun to look like it did pre-surgery. Would you recommend a second eyelid lift?

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.

I wear a lot of heavy make up for my job as a cocktail waitress. How long after my eyelid surgery will I be able to wear my eye makeup again?

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.

I am 30 and I’ve always been embarrassed by my “Marilyn Monroe” mole on my upper lip. Can this be removed without extensive scaring?

If you are excessively concerned about your mole, the small thin scar is almost always less visible that them 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!

Is there any permanent non-surgical procedure for under eye puffiness?

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 have deep frown lines between my eyebrows that I’d like to fix, but I am worried about the toxicity of the chemical fillers. What are the long terms effects on health and skin after using these injectable fillers?

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.

I just turned 50 and my upper eyelids droop so much that I cannot wear eye shadow and other makeup looks silly. I’m interested in eyelid surgery but I don’t want to have permanent scarring. What results can I expect?

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 I’ve hit my 40s, I’m starting to notice bags under my eyes that makes it look like I’ve got dark shadows there. What can be done about it?

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.

Would an eyelid lift change the amount of upper lid showing when my eyes are open?

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 know most who get eyelid surgery have it performed when they’re older. I’m only in my 30s but I’ve already got a hooded, puffy appearance to my upper eyelids. Should I wait?

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.

Would Botox take care of the really bad crows feet around my eyes?

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.

I’m 54 years old and I’ve had dark bags under my eyes for a long time now. Will a blepharoplasty help to completely remove the bags?

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.

Is it possible for my eyelids to droop back to their original position after an upper eyelid blepharoplasty surgery?

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’m having Mohs surgery for a spot beneath my eye. After my reconstruction will I still be a candidate for a blepharoplasty?

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.