Overview of Lower Eyelid (Lower Blepharoplasty)

Eyes are the focal point of one’s face. They are the first thing people notice and are the key to facial expression. During the aging process, the region around the eyes shows the effects of aging much sooner than other areas. This is the main reason why so many people seek cosmetic eyelid surgery. Patients tell us over and over again that their eyes always look tired and old even when they feel wide awake. This is very profound because looking tired and old can make you feel the same way. How many times have you dressed up and prepared to go out feeling good about yourself only to look in the mirror to see that your eyes look older than you feel?

Aging affects the entire face but usually affects the eye region earliest. This is because early in life there is a large amount of fat surrounding the eyes. You can verify this yourself by looking at the cheeks of a newborn. They are round and full of fat. As we age, this fat can either descend on the face or go away completely. When this happens, it exposes the underlying facial skeleton and this results in the familiar gaunt appearance that we recognize as aging. Also, the fat and underlying muscles act as a filler creating the volume seen in the cheeks of youth. When this filler descends or goes away, we see wrinkling. This process is similar to a grape which turns into a raisin when the water is removed.

Muscles With Aging

In the past, eyelid rejuvenation was based on tightening the skin via skin excision. This has changed dramatically in the past decade. Today, well-trained plastic surgeons realize that skin excision is just a piece of the facial rejuvenation puzzle. In fact, there are four major components that make up the face: skin, fat, muscle, and bone.

When your Dr examines a lower eyelid during consultation he evaluates all four components. Drawing on his experience, he determines which component or components is/are causing the problem and what is the best way to correct it.

The increased understanding over the past 10 years of how the underlying fat and muscle contribute to the appearance of aging has been revolutionary in the field of plastic surgery. It is no longer acceptable to think of eyelid rejuvenation as merely a procedure to tighten the skin. This is why your Dr feels it is so important to correct the problem itself and not just the effects of the problem. He advocates repositioning fat to where it once was, not removing it. The repositioning of cheek fat is called a cheek lift, and it can be done at the same time as a lower blepharoplasty. Once again, not everyone needs a cheek lift. This is determined during your consultation.

Fat with Aging

Another contributing factor to the appearance of old age within the eye region is the fact that the lower eyelid, especially toward the temple region, begins to descend. This gives a depressed, sad appearance. This is much different than the appearance that one had when he/she was younger. The lower eyelid of youth has a bright, elegant appearance with the lateral aspect being higher than the nasal aspect often, he will elevate the lateral portion of the lower eyelid to recreate that youthful, almond-shape appearance. This is a powerful and very effective maneuver and is well worth the additional time.

Eyelid surgery alone will not correct crow’s feet. It will help but often a concurrent brow lift and/or face lift is necessary. However, is able to reduce crow’s feet significantly during his eyelid surgery by repositioning the underlying fat and muscle into a more youthful position.

It is often very useful to perform fat transplantation, as well as either chemical peeling or laser skin resurfacing, in addition to eyelid surgery. This allows to address all the components associated with aging around the eye. Remember, the aging eyelid is a result of problems within the skin, muscle, and fat.

Benefits of Lower Eyelid Surgery

There are many benefits to eyelid rejuvenation surgery. The key is to determine exactly what the problem is.

Upper eyelid surgery benefits

  • Removes excess fat and skin of the upper eyelid.
  • Creates a sculpted, more attractive upper eyelid.
  • Creates a double lid and removes excess eyelid fat in Asians.
  • Elevates the upper eyelid to give a brighter, and more youthful expression.
  • Repositions upper eyelid fat into more youthful position.
  • A temporal browlift or formal brow lift can can be performed at the same time.

Lower eyelid surgery benefits

  • Tightens and smoothes out bags underneath the eyes.
  • Repositions lower eyelids into a more elegant, almond-shaped appearance.
  • Repositions underlying fat to get rid of the sunken, aged appearance.
  • Repositions skin and underlying muscles to smooth out wrinkles.
  • Markedly fills out the deep crease, known as the tear trough, between the eye and nose.
  • Eliminates circles underneath the eyes.
  • Improves dark discoloration within the lower eyelid.
  • Improves fine wrinkles.

Are you a good candidate for Lower Eyelid?

Most people, as they age, can obtain improvement from eyelid surgery. Specifically, good candidates include people with the following problems around the eyes.

  • Bags and loose skin.
  • Sad or tired appearance.
  • A deep crease circling underneath the eyes.
  • Excess skin and wrinkles.
  • Dark discoloration underneath the eyes.
  • Crow’s feet within the lateral eye area.
  • Sunken appearance to the eyes.
  • Sagging cheek fat.

Possible Complications of Blepharoplasty

The most common complication is inadequate correction of the problem. If this is the case, correction can usually be made with a minor additional procedure. Other complications include ectropion, or downward pulling of the lower lid, asymmetry, and dryness of the eyes. Complications that can occur with any surgery include infection, blood or fluid collection, and unfavorable scarring.