Lower Blepharoplasty / Lower Eyelid Tuck
Montgomery AL

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 long term 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/redundancy of skin in this area, and loss of volume under the eye from cheek sagging. Some people have a congenital disposition to these factors due to specific anatomical differences such as lack of bone support below the eye and protruding eyes (negative vector eyelid). This also can be from a natural progression of the aging process. During your consultation 3 major areas will be evaluated by Dr. Nizam to rejuvenate the region.

1. Volume

         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 and/or re draped 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.

2. Skin

          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 is used to tighten the skin. For individuals with a large amount of excess skin this skin is typically surgically removed and lasered.

3. Support

         Of paramount importance is an examination of support for the lower eyelid. Some patients require extra support of the lower eyelid be added during surgery. If the lower eyelid is surgically manipulated and poor support exists, the lower eyelid may pull down, become everted, or even become inverted. This lack of support can be from cheek sagging, lack of bone support, or a loose eyelid itself. 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.

Surgical Approaches

Dr. Nizam uses two basics surgical approaches for the lower eyelid. Patients with mild/moderate aging will have an incision placed behind the eyelid. This approach allows access to all necessary structures mentioned above, has less downtime, and less chance of eyelid mal positioning. For patients with severe bags, excess skin and/or malar mounds or festoons a subciliary approach is utilized. This places a fine incision just under the lower eyelid lashes that extends out laterally. From this approach excess skin can be removed and a small midface lift can be performed to address drooping tissue and smooth a festoon/malar mound. This approach results in more downtime, however a more profound rejuvenation can be achieved.

Regardless of approach the same basic steps are taken and tailored to your specific anatomy. Access is gained to the fat bulge under the eye. Excess fat is removed and a portion of it is freed. The retaining ligament that forms the crease below is released. Excess fat that was freed is then pulled inferiorly to assure this ligament does not reattach. If any eyelid tightening is needed is performed at this point.  Fat transfer is then undertaken. Then, for the subciliary approach skin is removed and lightly lasered to thicken and contract it. For the transconjunctival approach the laser alone is used to tighten and thicken the tissue. Lower blepharoplasty is performed under general anesthesia and takes 1-2 hours.

Recovery

Social downtime (the time it takes to look presentable in public) is typically 7-14 days depending on approach taken. As mentioned prior the transconjunctival approach is less recovery time and subciliary approach more.  Mild blurry vision can be expected over the first 24-48 hours. If non-dissolving sutures are placed 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. Complications are typically minimal and if they do occur are typically amenable to repair.

Longevity

As with all cosmetic procedures the goal is reset the anatomy to 10-15 years prior. The changes that are made are in a sense permanent, however you still age from that point on. How quickly the aging process occurs depends on a multitude of factors including age, genetics, skin care, sun exposure, etc.

Click here for Lower Blepharoplasty Before and After pictures