What is lower blepharoplasty?

Lower blepharoplasty. The principal aesthetic goal of lower-eyelid blepharoplasty is to rejuvenate the appearance of the lower eyelids while preserving their shape, position, and function. The main goal of lower eyelid blepharoplasty is aesthetic improvement. Lower eyelid blepharoplasty may also be used in treating the sagging of the lower eyelid due to loss of facial nerve function. In this aspect it is performed to restore normal appearance and protect the eye from excessive dryness and more serious complications related to chronic dryness. It is not only about skin; it includes the skin, underlying structures such as orbicularis muscle and orbital fat.

Lower eyelid blepharoplasty can be performed for any of the following reasons ;

  • It can be cosmetic to afford a more youthful appearance to the eyes. The majority of patients seek this surgery because of age-related changes in the eyelid complex
  • It may be performed to improve the symmetry of asymmetric eyelids
  • It may be applied in conjunction with other techniques to tighten the lower eyelid.
  • To protect the eye from dryness and related complications in facial nerve paralysis.

Could I benefit from lower blepharoplasty?

You may be an appropriate candidate for an Lower Blepharoplasty if;

  • you are bothered by your ¨tired-looking eyes¨ which may include droopy eyelids, bagginess under the eyes, crow’s feet.
  • there is an asymmetric appearance between your lower eyelids.
  • you have some functional lower eyelid problems like horizontal or vertical eyelid laxity.
  • You have facial nerve paralysis and your eye is constantly dry, or you are experiencing problems related to the dryness of your eye.

How is lower blepharoplasty surgery done?

There are presently two main surgical approaches to the lower eyelid; the transcutaneous approach (external) which involves an incision just under your lower eyelid margin and the transconjunctival approach (internal) which involves an incision on the inside of your lower eyelid. The lower eyelid blepharoplasty may be performed as an outpatient procedure or you may be admitted to the hospital. The operation may be performed under local anesthesia, under sedation or general anesthesia.

Patients with significant skin excess or with puffed out lower eyelids are particularly good candidates for the external approach where excess skin, muscle, and orbital fat are removed through an subcilliary skin incision just under the lower eyelid margin. After the desired amount of skin and fat are removed, the skin incision is closed with sutures. To support the lower eyelid, additional sutures may be used to re-suspend the lower eyelid margin.

The transconjunctival approach may be used in patients that do not have a lot of saggy skin but have pronounced bags under the eye. An initial conjunctival incision is made on the inside of the eyelid. After the initial incision, protruding orbital (eye) fat can be easily visualized and removed. Sutures are not necessary for closure.

What can I expect after Lower Blepharoplasty?

You can typically get up and walk around the evening of the surgery or the following morning, initially with assistance. You should be prepared for moderate swelling and the ecchymosis of the skin. The degree of swelling and ecchymosis differs markedly from patient to patient. Either way the swelling and the ecchymosis both subside within 1-4 weeks, after which time it is typically hardly notable that you just underwent surgery.

Will I have a bandage or dressing after Lower Blepharoplasty?

A bandage is not used after the surgery. A steril strip may be used which is changed or removed after one to three days, and ointment is applied over the suture daily for approximately 1 week in patients with external approach. For the patients undergoing the internal approach eye-drop may be used for approximately 7 days. Artificial tear drops can be prescribed to prevent dryness during the  early postoperative period.

Cold compresses are frequently applied for the first 48 hours to reduce swelling and ecchymosis.

Do you need to remove the sutures?

Non-absorbable skin sutures are removed 5 to 7 days, Absorbable sutures dissolve within 1-3 weeks..

Will I be in pain after the surgery?

The lower eyelid blepharoplasty is a minimally invasive procedure. Pain after surgery is typically very mild and well controlled with pain medications. A mild analgesic (non-aspirin containing) is used to control the postoperative discomfort for one to five days.

If you have a severe pain it can be an important sign and you must visit your doctor as soon as you can.

What are possible risks and complications of lower eyelid blepharoplasty ?

Your lower eyelids may not be in the right position. This may be managed early after surgery conservatively with vertical massage and topical lubricants . If there is severe lower-eyelid malposition it may lead to the inability to close the eye and may require a secondary operation.

A perceived increase in skin wrinkling can also occur after fat removal. This is easily remedied with botox or laser treatment.

Is it possible that I will need revision surgery?

Although the result of lower eyelid blepharoplasty may be expected to last for years, aging will continue and drooping of the eye lids may recur. This should not be regarded as a complication of the procedure, but as a result of the continued aging process. A second procedure may be desired.

Other reasons to perform a revision procedure are residual excess skin, insufficient fat removal or lower eyelid malposition.

How long will I be off from work?

Generally speaking the recovery period after lower eyelid blepharoplasty is short and you may start doing your daily routines as soon as the first to third day. The swelling and ecchymosis persist  rarely longer than few weeks and almost never limits patient mobility.

Will I be able to use make-up after the surgery?

Your surgeon may ask you to refrain from applying make-up for 7-8 days after the surgery.

How long can I expect the outcome of surgery to last?

It depends on the age of the patient and the type of the patient’s skin. The aging process continues after surgery and relaxation of the skin and underlying structures is inevitable. This will lead to drooping of the eyelids. But it is generally accepted that this takes place 10 years after the surgery.