Lower eyelids

The problem

The lower eyelids are a major cosmetic focus for many people. They convey a message to others based on their appearance. For example, lower eyelid bags or dark circles make one appear tired. Lower eyelid wrinkles make one look older than their actual age. These false messages are bothersome and can affect how we feel about ourselves.

What happens to lower eyelids

Aging of the lower eyelids are accelerated by several factors, including tobacco use, excessive sun exposure, a history of allergies or swelling, repetitive eyelid rubbing, and other environmental influences. It may also have hereditary components, including lower eyelid bags that are often seen in the parents of patients with this concern. Fluid retention from excessive salt intake or other reasons can contribute to swelling of the lower eyelids. Episodes of allergy, inflammation, injury, or prominent veins can lead to dark circles under the eyes. These dark circles may represent the appearance of veins, the appearance of muscle through the thin lower eyelid skin, pigment within the skin, the remnants of blood cell products in the skin, or shadowing.

Before a lower eyelid lift

Before undergoing a corrective eyelid procedure, a medical history is performed. Dry eyes and previous laser vision correction are issues that must be discussed. Any history of allergies is also considered. An examination is an important part of the evaluation, including a measurement of visual acuity, the position of the eyelids, the appearance of the skin, and the eyelid characteristics. Photos are taken and a skin evaluation is performed.

In the case of a lower eyelid that has a low position or has poor support, a lower eyelid tightening procedure may be recommended to prevent further pulling-down of the eyelid after surgery. Lubrication drops or ointment may be recommended to prevent dryness of the eyes.

There are common medications and supplements that can promote bleeding. These are to be discontinued for a prescribed period of time before surgery, as directed by your physician. Lists are available which detail the types of substances that are associated with increased bleeding.

Certain supplements may reduce the risk of bruising and swelling, such as Arnica Montana, a homeopathic herbal preparation. This may be taken around the time of the procedure.

The procedure

A lower eyelid lift, or lower blepharoplasty, rejuvenates the lower eyelids. It is a term that encompasses a variety of surgical procedures. The specific procedure or combination of procedures performed is selected for each patient based on their specific concerns and the features of their eyelids and face.

The way in which lower eyelid rejuvenation is approached has dramatically changed in recent years. Before this paradigm shift, many oculoplastic surgeons would remove a significant amount of fat and/or skin from the lower eyelids, which removed undesirable pouches, but left the lower eyelids with a hollow, sunken appearance. It is now understood that a fat-preserving approach is often appropriate, resulting in more youthful contours and better, more natural improvements. In fact, surgery may not be required in many cases, and less-invasive options with injectable fillers and laser rejuvenation can be equally as restorative with less downtime.

However, there are patients that still require surgery for adequate rejuvenation of the lower eyelids. In these cases, incisions are performed with a laser, a radiofrequency device, an electrocautery device, or a scalpel. The incision is most often placed on the inside of the eyelid (on the conjunctiva) or just underneath the eyelashes in a natural lower eyelid crease.

Fat removal may be performed in cases where bulging fat pads are present. More commonly, fat is shifted from a bulging area to a hollow area, creating a more even and natural look. Fat transfer from another area of the body is sometimes performed to restore volume where it is needed. As previously mentioned, aggressive fat removal can create a hollowness which is often associated with an aged appearance.

If the lower eyelid muscle (orbicularis oculi) is sagging, it can be tightened, and this smoothes out the eyelid. Excess skin may also be modestly removed, although to a much lesser degree than the upper eyelid, as too much skin removal can cause the eyelid to pull down.

Extra procedures

When the cheek has sunken or descended with age, this may be lifted at the same time as a lower eyelid lift. There are two fat pads at the junction of the lower eyelid and the mid-face that can be lifted, the SOOF pad and the malar fat pad. This helps to restore a youthful fullness between the eyelid and the mid-face.

Commonly, the lower eyelid is tightened at the same time as a lower eyelid lift to add extra support, which can be crucial. This is termed canthoplasty or canthopexy. Another support procedure sometimes performed is called orbitomalar ligament resuspension, which can add longevity to a lower eyelid lift.

Other procedures may also be performed with lower blepharoplasty, such as laser resurfacing, fillers, botox, etc. to create facial harmony and restore youthfulness. Botox helps to eliminate crow's feet lines and the muscle roll that appears underneath the eyelashes. It can also widen the eyes for a more alert appearance. Laser resurfacing such as ActiveFX and DeepFX will tighten skin and reduce fine and deep wrinkles. For patients who desire thicker and longer eyelashes, a prescription medication may be prescribed for this purpose.

After the procedure

A topical antibiotic ointment which is safe for use around the eyes is applied to the incision area. Cold compresses are used for 48 hours after surgery to prevent swelling. It is advisable to avoid strenuous activity for the first week, but light activities and showering are permitted.

Complications

Bleeding or infection are serious complications of any surgical procedure, but are rare with lower blepharoplasty. Other rare complications include visible scars, dryness of the eyes requiring eye drops, and pulling-down of the lower eyelids. These conditions are treatable with scar therapies, dry eye therapies, and/or other procedures. Hollowing can occur if too much fat is removed. Too much or too little eyelid skin or fat removal can require further corrective procedures. These risks can be minimized by having your procedure performed by a trained oculoplastic surgeon.

At Allure Medical Spa, Dr. Charles Mok, and Dr. Brett Kotlus offer these and other cosmetic procedures. Allure Medical Spa was one of the first Medical Spas in the country, offering a variety of cosmetic surgical and non surgical procedures. We are located in Macomb County's Shelby Township, a suburb of Detroit, Michigan.

Call 800-610-7308 for your Free Consultation.