Lower Eyelid Blepharoplasty

The youthful lower eyelid is smooth with no apparent bulges or color changes.  The skin of the lower eyelid and cheek are a continuum of smooth skin with no darkness.  As we age the lower eyelid develops bulges and wrinkles. The natural transition between the eyelid and cheek now become two separate units.  As in the upper eyelid, skin stretchs, fat bulges and gravity pulls skin downwards.

Lower eyelid blepharoplasty is most helpful in smoothing out the lower eyelid by removing fatty tissue and tightening of the underlying muscles in the eyelid skin.  Lower eyelid blepharoplasty is not useful for removal of wrinkles on the eyelids unless there is significant extra skin on the eyelid.

Dr. Ahmad is a superspecialist of the eyelid area.  He performs multiple different techniques to achieve the goal of surgery.  Some patients will require several different procedures to achieve the goals of surgery.  One of the risks of lower eyelid blepharoplasty is pulling down of the eyelid which is called lower eyelid retraction.  Lower eyelid retraction is pulling down of the lower eyelid below the colored part of the eye.  Lower eyelid retraction may be normal in some individuals depending on their own anatomy.  Lower eyelid retraction can occur after lower eyelid blepharoplasty if too much eyelid tissue is removed, or if the eyelid is loose or lax prior to surgery. Tightening of the lower eyelid at the time of surgery can be very helpful to prevent a postoperative lower eyelid retraction.  Medical insurance will never cover lower eyelid blepharoplasty but may cover the tightening procedures. The most common procedure to tighten the lower eyelid is called the tarsal strip procedure.

Lower eyelid blepharoplasty can be performed via two different approaches:

Transconjunctival (inside the eyelid approach)-This approach is chosen in people who have puffiness of the lower eyelids without excessive skin. By making a incision on the inside of the eyelid, Dr. Ahmad is able to remove eyelid fat that is causing the puffiness in the lid.  This procedure has multiple advantages including, no visible skin incision and minimal risk of pulling the eyelid down after the surgery (eyelid retraction).  This procedure can be performed in conjunction with other procedures like upper eyelid blepharoplasty (removal of skin on upper eyelids) or a pinch excision of skin on the lower eyelid.

Transcutaneous (incision on the skin of the eyelid below the lash line) – This approach is chosen in people who have considerable excess skin of the lower eyelids. The incision is placed under the lash line and is usually not visible 3-6 months after surgery. This incision has the advantage of allowing Dr.Ahmad to both remove fatty tissue, and excise skin on the lower eyelids. The lower eyelid can also be tightened and the cheek lifted with this approach. The main downside of this incision is the increased possibility of the lower eyelid being pulled down(eyelid retraction)after surgery. The risk of eyelid retraction after surgery can be minimized by meticulous surgery and conservative skin excision.