Eyelid Plastic Surgery (Lower)

Are your eyes still one of the most striking features on your face? Do they convey your actual emotions and inner vitality, or do they make you appear fatigued, sad, or older than you feel? Eyelid surgery, also known as blepharoplasty, may be performed on the upper eyelids, the lower eyelids, or both. This animation describes lower eyelid blepharoplasty, which reduces the appearance of puffiness and bags underneath the eyes.

Eyelid Plastic Surgery Video

Before and After Photos

Click on photos below to see more before and after photos

What Causes Eyelids to Change?

The skin on your lower eyelid is very thin, especially toward the center of your eye. A layer of muscle is located just beneath the eyelid skin and is separated from the fat by a thin tissue membrane, called the orbital septum. Muscle layers and the orbital septum weaken and sag with age and fat deposits shift in response to weakened tissues, causing puffiness and bags under the eyes. In addition, changes occur in the skin itself. The collagen and elastin that provide support to the skin break down over time, causing the skin to lose elasticity and become lax.

Eyelid Surgery - Lower - Change

Procedure Variations

There are two variations of the procedure for removing or repositioning fat deposits from beneath the eyes: outside and inside lower eyelid surgery. For those who have excess skin beneath the eyes, the outside lower eyelift, also called transcutaneous lower blepharoplasty, is appropriate. This variation is performed with incisions on the outside of the lower eyelid and removes excess skin and sometimes muscle tissue in addition to fat deposits beneath the eyes. An inside lower eyelid lift, also called transconjunctival blepharoplasty, involves a single incision inside the eyelid in the thin membrane that lines the inside of the eyelid, called the conjunctiva. This procedure is appropriate for patients with fatty deposits and little or no excess skin in the lower eyelids.

Procedure Variations Eyelid Surgery - Lower

Preparation

Lower eyelid surgery is most commonly performed under general anesthesia, which causes you to sleep during the procedure. Alternatively, you may be given local anesthesia with sedation, in which the eyelids and surrounding areas are numb and you are relaxed but may not be asleep. Protective, plastic shields, similar to contact lenses, may be applied to your eyes.

Preparation Eyelid Surgery - Lower

Outside Lower Eyelid Procedure

During an outside lower eyelid procedure, incision guidelines may be drawn just beneath the eyelashes of the lower eyelid to ensure that the resulting scar will be as inconspicuous as possible. Your surgeon will make an incision and expose the underlying muscle. Another small incision will be made in the muscle layer and the skin and muscle will be separated from the underlying orbital septum. Your surgeon will carefully open the orbital septum to expose the three orbital fat deposits of the lower eyelid. These fat deposits will be removed or repositioned to reduce puffiness under the eyes. Finally, excess skin and, if needed, small portions of muscle are removed from the outer eyelid to eliminate bags under the eyes, and the incisions are closed with either absorbable or non-absorbable sutures.

Outside Eyelid Surgery - Lower

Inside Lower Eyelid Procedure

The inside lower eyelid procedure consists of an incision inside the lining of the lower eyelid. Your surgeon will gently pull the lower eyelid away from the eye and make a small incision in the conjunctiva, exposing the three orbital fat deposits. Each fat deposit will be removed to reduce puffiness under the eyes. Your surgeon may choose to close the incision with sutures, but sutures may not always be necessary.

Inside Eyelid Surgery - Lower

Recovery and Results

You can expect to experience some pain, bruising, and swelling after the procedure, and your physician will likely recommend cold compresses or pain medication to help make you as comfortable as possible. You should avoid strenuous activity, such as heavy lifting or exercise, as recommended by your doctor, to allow your body sufficient time to heal. If absorbable sutures were used, they do not need to be removed and will dissolve on their own. Any non-absorbable sutures are typically removed in five to seven days, and you will begin to notice an improvement in the bruising around your eyes in seven to ten days. Lower eyelid surgery will not stop your eyes from aging, but will reduce puffiness and bags from beneath your eyes. The results are usually very long-lasting and will brighten your eyes to the rested, youthful appearance you desire.

Recovery and Results Eyelid Surgery - Lower

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