Lower Blepharoplasty by Wave Plastic Surgery & Aesthetic Laser Center

Lower lid is one of the first places that change as part of our aging process. It is probably the most common surgery that is performed in both men and women. Usually in men, the condition is more severe and noticeable. Patients usually complain of:

“Bags” under the eyelid (protruding fatty bags)

Wrinkles

Deep dark circles

Depression of the lower lid border (tear trough)

Rounded contour of the lower lid margin

Lack of the lower lid orbicularis muscle protrusion

Protruding fat:

There are three separate compartments where the orbital fat resides. As we age, the tissues holding the orbital fat in becomes attenuated and as a result, the fat becomes more visible because it protrudes out more. Depending on the severity and whether there is a depression in the lower portion of the lower lid rim, the treatment is different. In younger patients, if fat is the only issue, it is to remove by a transconjuctival approach ( inside the eyelid). This prevents unnecessary external scar, and less chance of disrupting the tissues that can cause evertion of the lower eyelid. The removal of the fat must be conservative to prevent unwanted hollowing. If the fat is not too significant, but does exist, the tissues holding the orbital fat can be simply tightened. This is called septal reset. If there is hollowness in the lower lid rim, called tear trough, the fat can be mobilized and repositioned to the bony rim margin. This helps with both removal of the protruding fat and filling in the defect of the tear trough.

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+Wrinkles / Depression of the lower lid margin (tear trough):

This is another condition that appears in older patients. The tear trough is an area just beneath the margin of the lower orbital rim becomes depressed. Factors that cause this condition are:

The skin in the lower lid becomes thinner

The attachment of the undersurface of the skin with the bone becomes tighter

The fat in the cheek descends, leaving hollow area

The orbital fat above becomes more pronounced

If only the orbital fat is removed, it may cause even more pronouncement of this depression. Instead, usually it is best to transfer the orbital fat to the lower lid rim and fill in this area. I found at times, fat is not enough and therefore another procedure is needed to lift the malar soft tissue called endo midface lift using endotyne.

Lower lid margin shape:

Aesthetically pleasing shape of the lower lid margin should have relatively a straight horizontal direction with a slightly upward tilt towards the end. However, as we age, the lower lid margin tension becomes weak and stretched. This results in a very loose margin giving a rounded contour appearance. A method of making the margin tighter and straighter can have a dramatic appearance in giving a more youthful appearance of the eyes.

To achieve this desired outcome, the technique used is called a lateral canthopexy, where the lateral tendon of the eyes is fixed to the orbital bone. Depending on the method, this provides better shape to the eyes and protection against post surgical ectropion( margin of the eyelid being pulled down), which can occur after removing excess skin.

Sculpting the orbital muscle in the lower lid:

One of the prominent features of beautiful younger lower eyelid is the prominence of the orbital muscle just under the lower eyelashes. As we age, this can appear less pronounced giving an aged appearance. There are several methods to treat this area. Alloderm dermal matrix or fat transfer can be done to restore the youthful appearance.

What is an Eyelid Surgery?

Also known as blepharoplasty, eyelid surgery improves the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

Treatable conditions:

Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.

Bags under the eyes can be corrected by blepharoplasty.

Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).

Is it right for me?

A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

You should undergo blepharoplasty surgery for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.