Lower Blepharoplasty / Lower Eyelid Tuck
Many people wake up in the morning and notice dark circles or bags under their eyes and others walk into work Monday morning to be told by coworkers that they look “tired” even after a restful weekend. At Alabama Surgical Dr. Nizam hears these stories all too often and in fact it is one of the most requested procedures by younger patients. The lower eyelid is a complex structure that requires detailed anatomical knowledge to safely and repeatedly provide excellent results.
What contributes to dark circles and bags under the eye? Three main factors typically contribute to some extent. Shadowing from bulging fat (this is why your under-eye circles look worse if standing directly under a light vs. when light or flash is shining straight at your face), thinness of skin in this area, and pigmentary changes under the eye. Some people have a congenital disposition to these factors due to specific anatomical differences and/or it may be a natural progression of the aging process. During your consultation 3 major areas will be evaluated by Dr. Nizam to rejuvenate the region.
Different people at different ages have different volume distributions under their eye. One common finding as we age is excess bulging fat under the eyelid. This fat bulges forward as the tissue that holds it back in youth becomes lax. This extra fat is typically removed or redraped into the hollow area that typically lies inferior to it known as the “tear trough”. For a large majority of individuals additional fat is actually needed and harvested from the thigh or abdomen. This fat is utilized below where the initial bulge was to blend the eyelid with the surrounding cheek tissues. This provide a smooth harmonious contour from lid to cheek. If one looks at a picture of themselves in their 20’s they will typically note this smooth transition into a full cheek.
Dr. Nizam will examine the skin around the lower eyelid. Some individuals have no excess skin. Other individuals have a mild to moderate amounts of excess skin. For these individuals a laser or chemical peel is typically used to tighten the skin. For individuals with a large amount of excess skin this skin is typically surgicaly removed.
Of paramount importance is an examination of support for the lower eyelid. Some patients require extra support of the lower eyelid. If the lower eyelid is surgically manipulated and poor support exists, the lower eyelid may pull down/become everted/ or become inverted. Luckily as part of Dr. Nizam’s fellowship in cosmetic surgery he trained under the tutelage of an oculoplastic surgeon and as a result is able to offer procedures that increase support to the lower eyelid and lessen the chance for postoperative lower lid malposition.
Two basics surgical approaches are used for the lower eyelid. Patients with mild/moderate aging will have an incision placed behind the eyelid. The approach allows access to all necessary structures mentioned above and has less downtime. For patients with severe bags and excess skin a subciliary approach is utilized. This places a fine incision just under the lower eyelid lashes. From this approach excess skin can be removed and a small midface lift can be performed to address drooping tissue. This approach results in more downtime, however a more profound rejuvenation can be achieved. Lower blepharoplasty is performed under general anesthesia and takes 1-2 hours.
Social downtime is typically 5-10 days depending on approach taken and the amount of bruising. Mild blurry vision can be expected over the first 24-48 hours. If non-dissolving sutures are removed they are typically removed at 7 days. If a laser or chemical peel is performed for skin tightening slight redness may exist under the eyelid for 4-6 weeks. This however can be covered with makeup around 1 week.