Lower Blepharoplasty 2017-04-04T06:03:41+00:00

Lower Blepharoplasty

What is lower eyelid 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. 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 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 eyelid blepharoplasty?

You may be an appropriate candidate for an lower eyelid 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 eyelid blepharoplasty surgery done?

There are presently two main surgical approaches to the lower eyelid; the anterior transcutaneous approach (external) which involves an incision just under your lower eyelid margin and the posterior transconjunctival approach (internal) which involves an incision on the inside of your lower eyelid. Both procedures 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 infraciliary skin incision just under the lower eyelid margin. After the desired amount of skin and fat are removed skin incisions are closed with sutures. To support the lower eyelid, additional sutures may be used to re-suspend the lower eyelid margin.

The internal 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 usually not neccessary for closure.


How do I find a surgeon right for me?

An excellent result in a happy patient of course speaks for a good surgeon and you may rely on word of mouth advertisement. In addition, you should discuss your wishes in great detail and explicitly ask the surgeon about the chances of precisely obtaining the desired outcome. Your surgeon should be able to show you pre- and postoperative photographs of results e has obtained himself.

You will have found the right surgeon, if all your questions have been answered in a pleasant atmosphere of mutual understanding, if the surgeon precisely knows what you expect and you are well informed about the chances of getting the result you want. EAFPS.org will help you to find a European Academy of Facial Plastic Surgery member near you.


Can I see what I will look like after the operation?

The best way to learn what blepharoplasty accomplishes, and therefore what an individual patient might expect, is by examining preoperative and postoperative  photographs of blepharoplasty patients .Also computer imaging can give you an idea of what you will look like after surgery. Some doctors offer computer imaging and others don’t.

Those who are in favor of imaging find that it helps to precisely plan the operation and it is greatly appreciated by the patients. Those who dislike imaging are worried about raising undue expectations. Remember that the result will almost always differ somewhat from the computer generated outcome, regardless of the surgeon’s expertise.


What can I expect before surgery?

Your surgeon will also talk to you about additional procedures that are available if he/she finds it necessary. These include upper eyelid blepharoplasty, brow or mid-face lift, injection of the crows feet with botox ,CO2 laser resurfacing , application of fillers to smoothen lines or chemical  skin peelings.
Your surgeon will ask you about your past medical history, including medications you are taking, allergies, smoking habits, previous surgery and more. At least 2 weeks prior to the surgery, any patients who are taking aspirin or warfarin sodium (coumadin) are instructed to discontinue these medications.

Your surgeon may also question you about any dryness or watering of your eyes you may have, he/she may ask for some extra tests if you state a problem to eliminate any problems with your tear functions.
The main goal of lower eyelid blepharoplasty is aesthetic improvement. Your physician will discuss with you the reasonable expectations from surgery and ascertain whether or not your goals are realistic.

Your surgeon will also talk to you about the risks, benefits and possible complications of lower eyelid blepharoplasty procedure. The discussion includes the type of anesthesia you will undergo. Local anesthesia is more frequently performed; sedation or general anesthesia may also be utilized.The operation may be performed as an outpatient procedure or you may be admitted to the hospital for observation and dressing changes.


What can I expect after surgery?

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 surgery?

A bandage is usually 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?

In the external approach non-absorbableskin sutures are removed 5 to 7 days, Absorbable sutures dissolve within 1-3 weeks. Both types of sutures have advantages and draw backs and your surgeon should explain to you which suture material she / he recommends. For the internal approach, absorbable sutures are usually utilized

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.

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 4 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 a certain time after the surgery.


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.


How do I find a surgeon that performs lower eyelid blepharoplasty?

Members of the EAFPS that perform lower eyelid blepharoplasty can be found through the find a member link.