Should Skin Ever Be Removed From the Lower Eyelid?

There are a few cosmetic surgeons who state categorically that they never remove skin from the lower eyelids of a female (why just on females is beyond us). Adhering to inflexible policies is almost never a good idea.

• Excess is Not the Same as Wrinkling

Think of a piece of paper. If it somehow becomes elongated, that's a matter of "excess." If it gets crumpled into a ball and then opened back up, that's a matter of "wrinkling."

Skin excess is simply that--too much tissue, the result of lost elasticity and stretching.

Wrinkling is different and caused by loss of dermal collagen and subcutaneous fat.

• If It's Elongated, You Trim It Back to Size

Sticking with the paper analogy, if a sheet of paper becomes elongated, you take out a pair of scissors and trim it back to its proper dimensions.

If, on the other hand, the paper is only crumpled, cutting off a few inches doesn't help. What's left behind is too short to perform its function but still crumpled into folds.

• If It's Wrinkled, You Smooth It Out

Still with the analogy, if a sheet of paper gets crumpled up and creased, you first moisten it and then use an iron to smooth it out.

If the paper is merely elongated, then ironing it for an hour won't make it any shorter (that is, unless you burn it up).

• An Iron is Not the Same as a Pair of Scissors

If skin on the lower eyelid becomes stretched, the proper way to resize it is to surgically trim away the excess.

If skin on the lower eyelids becomes wrinkled, what works is a resurfacing procedure such as a chemical peel or laser resurfacing.

The two approaches are not interchangeable and will not achieve equivalent results.

Conclusion

So, should skin ever be removed during lower blepharoplasty?

Unless you find sagging skin attractive, the answer seems fairly clear.