Lower Blepharoplasty Eyelid Surgery
Ventura, Los Angeles, Santa Barbara

Transconjunctival

• The eyeball is protected by a plastic plate. The lower lid is retracted down and away from the eye. The initial incision is made by sweeping an electric current across the inside surface of the eyelid (conjunctiva).

• A step-wise conservative removal of fat is undertaken from one, two, or all three of the fat pads, thereby sculpting the lid into its new shape.

• Care is taken to leave some of the lid's fullness intact, as a hollowed eyelid suggests aging or illness rather than youth.

Several options for treating loose or damaged skin may be considered along with transconjunctival lower blepharoplasty:

• Wrinkles may be softened, skin quality improved, and the skin tightened slightly by the application of trichloroacetic acid (TCA chemical peel) immediately following the surgery.

• When indicated, a tiny strip of skin may be pinched and then excised from the area just below the lashes without disturbing the deeper eyelid structure (pinch blepharoplasty).

• When indicated, thinned or sagging tissues supporting the lower eyelid may be tightened (canthopexy) by attaching them to the lining or the bone or fascia surrounding the socket.

Tissue-Sparing

Approached through a skin incision, bulging orbital fat is returned to its normal anatomic compartment, making fat removal unnecessary. There are both advantages and disadvantages to tissue-sparing lower blepharoplasty, which is a much newer technique that is still developmental and not without its own set of risks.

Transcutaneous

Transcutaneous lower blepharoplasty (skin and fat removal undertaken through a skin incision) had not been employed in our practice for over fifteen years. Not only is the aesthetic outcome sub-optimal, but the risk of significant immediate and late complications is unacceptably high.

Although still popular, we refrain from lower eyelid fat repositioning into the tear trough in the vast majority of patients. Less invasive, safer, and more effective approaches are available for filling upper cheek hollows. Moving substantial amounts of fat out of the orbit simply to camouflage a cheek depression introduces the possibility of causing eyelid hollowness.

Details QuickNotes Photos Operations Asian Risks From the Insider's Guide to Blepharoplasty More on lower eyelid surgery technique, options, pros, and cons... • Chapter 17: Lower Blepharoplasty • Chapter 19: Canthopexy and Lateral Canthal Tightening • Chapter 20: Lower Eyelid Fat Repositioning • Chapter 21: Cheek, Midface, and SOOF Lift • Chapter 22: Skin Resurfacing: Chemical and Laser Peels From Eyelid Surgery QuickNotes Short discussions that cut to the point... • Three Different Approaches to Lower Blepharoplasty • Should Skin Be Removed From the Lower Eyelid? • Skin Pinch Lower Blepharoplasty Also, • KISS Blepharoplasty: A Sensible Approach to Surgery From Eyelid Surgery Photos Actual patients before and after lower lid surgery ... • Patient Photos From Operations Step-by-Step Lower eyelid surgery shown start to finish... • Lower Tranconjunctival Blepharoplasty • Lower Transcutaneous Blepharoplasty • Canthopexy with Skin Excision Actual surgery photos From the Asian Eyelid Surgery Resource Special considerations in the Asian lower lid... • Lower Eyelid Asian Blepharoplasty From the Insider's Guide to Blepharoplasty What can be done if something goes wrong... • Chapter 30: Treatment of Lower Blepharoplasty Complications