Lower eyelid surgery, or lower blepharoplasty, can help freshen and revitalise your face by reducing the appearance of heavy and sagging eyelids, wrinkles, puffiness, bags and hollowness under the eyes.
There are several options for lower eyelid surgery. The ‘Inside’ approach involves no external scars and is useful for removing excess fat from the lower eyelid. Alternatively, the ‘Outside’ approach involves a well-hidden incision just below the eyelash margin and is useful when there is also excess skin involved. Sometimes, a mid-face lift is also an alternative for those who want to rejuvenate the appearance of the lower eyelid and cheek area. Dr Miroshnik will help you decide which procedure is best for you during your consultation.
For more information on each of these individual procedures, please click on one of the subheadings above.
Over time, the eyes undergo changes that often make people feel as if they appear sad or tired. The aging process can cause the eyelids to sag and droop, which in combination with bags and puffiness can make you look tired and older than you really are. Lower eyelid surgery, or lower blepharoplasty, can help freshen and revitalise your face by reducing the appearance of heavy and sagging eyelids, wrinkles, puffiness, bags and hollowness under the eyes. For lower eyelid rejuvenation, the role of the mid face is also important. Due to its proximity, an aging mid face will compound the aging effect of the lower eyelid and may also need to be addressed. This can be done via the same incision in the 'concentric' mid facelift.
What Causes the Eyelids to Change?
Before you understand how eyelid surgery works, it is important to understand the underlying structure of the eyelids. Like the rest of the face, eyelids are composed of layers of skin, muscle, and fat. With time, age and environmental factors like sun damage, cause the skin's support network in the dermis to break down. As a result, the skin loses its structure and elasticity and becomes lax.
The muscle layers also weaken, which with the skin's loss of elasticity and the effects of gravity, cause the eyelids to droop and sag. Fat deposits normally give eyelids a full appearance. However, fat too is depleted over time and shifts in response to weakened, sagging muscles, which results in puffiness and bags around the eyes.
How Does Outside Lower Eyelid Surgery Work?
While there are several different techniques that Dr Miroshnik can use to alter the appearance of the eyes, the standard surgical technique usually involves removing or redistributing fat deposits, as well as removing excess skin and muscle. Bags and puffiness in the lower eyelid most often result from protruding orbital fat deposits. Normally, the orbital septum holds the fat deposits in place.
However, over time the orbital septum loses some of its structural integrity and weakens, which allows the fat deposits to slide forward, creating bags and puffiness. The 'outside' or 'transcutaneous' approach works by redistributing or sculpting excess orbital fat through an incision on the outside of the lower eyelid. Unlike the transconjunctival approach, excess skin is also typically removed to correct laxity in the lower eyelid.
An eyelid surgery procedure may last approximately one to two hours, depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anaesthesia will be administered. The procedure may be performed under local anesthesia with sedation, in which the eyelids and surrounding areas are numb and you are in a relaxed state. Alternatively, a general anaesthetic may be used, in which you are asleep.
Prior to making the incision, Dr Miroshnik may choose to place a suture in your lower eyelid to help keep your eye closed during the procedure. He will then draw incision guidelines along the fold of the lower eyelid to ensure that the resulting scar is hidden in the natural contours of your face. A small incision is then made in the skin exposing the underlying muscle.
Exposing the Orbital Septum
To gain access to the orbital fat, Dr Miroshnik makes a small incision in the muscle layer. Through this incision, he dissects the skin and muscle away from the underlying orbital septum. This allows Dr Miroshnik to pull the skin and muscle layers away from the orbital septum and subsequently expose the orbital fat in the lower eyelid.
Fat Repositioning or Sculpting
Once the orbital septum is exposed there are quite a number of procedures that can be performed. These can be divided into fat-conserving and fat-removing procedures. The orbital septum may be carefully opened to expose the three orbital fat deposits of the lower eyelid. This animation shows each of these fat deposits being trimmed, however the fat deposits will often be conserved and simply redistributed and sutured to areas of hollowness in the surrounding area. In an alternative fat-conserving procedure, the orbital septum may be left completely intact and plicated or strengthened with a series of sutures to stop it bulging. Dr Miroshnik will help you decide during your consultation, which of these procedures is best for you.
Excess Skin Removal
If you have excess skin in the lower eyelid, a small amount will likely be removed. This will remove with it any wrinkles caused by its redundancy. This animation shows it being removed with the use of surgical scissors.
At this stage, after making sure there is no bleeding, Dr Miroshnik closes the incision with sutures. This is often done with a fine, running, non-absorbable suture that is simply pulled out in the office after five to seven days.
As with any surgical procedure, you will likely experience some discomfort, swelling, and bruising which can be alleviated with cold compresses and pain medication. You will begin to notice an improvement in the bruising around your eyes in seven to ten days. Although you will feel well enough to return to work in approximately a week, you should continue to avoid strenuous activity such as heavy lifting or exercise for at least two weeks following the procedure.
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You will start to notice the results from your procedure within a few weeks as the bruising and swelling continue to fade. The scar will fade to an inconspicuous line hidden along the contours of your lower eyelids. While the results of an eyelid surgery are long-lasting, it is important to realise that your face will continue to age. However, eyelid surgery can successfully restore a youthful, revitalised appearance to your eyes for years to come.