First, we measure the skin in the upper lid. Then, the area is marked after a thorough cleaning. Next, we inject local anesthesia to numb the area while limiting bleeding. Fourthly, we remove skin and a strip of the eyelid muscle. Though, for some patients, the muscle stays for a more natural look. Next, we dissect fat pockets and take away extra fat. If the eyelid droops, a repair happens at this time. After three days, we remove the sutures. After a few weeks, you can’t see scars. Complications are rare and can include over-tightening of the lid skin, bleeding, and incomplete removal of fat.
A pre-operative evaluation includes the amount of skin and fat as well as evaluating the elasticity of the lower lid by performing a “snap back” test. For laxity of the lower lid, we may perform one or two procedures. Next, we clean the area with an antiseptic and inject anesthesia. Then we make a 2-3 mm incision from the lash line, developing a flap. This allows the surgeon to remove fat from multiple pockets. Sometimes fat is preserved and rolled under the nasojugal groove. After surgery, keep your head elevated. Also, ice the lower lids for the first day. After 2-3 days, your surgeon removes the sutures. You can expect a fast recovery.
Transpalpebral lower blepharoplasty
For patients with fatty lower eyelids and minimal skin, a lower eyelid lift with an incision inside the eyelid may be used. This has the advantage of no external scar but may require a peel of the lower lid skin.
Eye droopiness of the upper eyelid occurs when the eyelid drops down toward the pupil. This happens for many reasons, including age. The repair involves suturing the levator aponeurosis (a ligament) which elevates the lid to a more normal position. Additionally, insurance may cover the procedure.
Chemical peeling improves wrinkling eyelid skin. Chemical peeling requires 2-5 days of recovery and has minimal complications.
Some patients need an orbicularis lift. If you have lax lower lids or festoons, this will help. Essentially, this involves pulling the muscle of the lower lid upward. From there, the lid sutures into place. Suspension of this muscle supports the lower lid leading to a more youthful look.
These procedures tighten the lax lower lid by repositioning the corner of the eye or by shortening the lower lid. Laxity of the lower lid can lead to ectropion (outward bowing of the lower lid) which causes dry eyes. Bowing also leads to an aged appearance. A snap-back test helps determine lower lid elasticity. The eyelid is pulled down by the surgeon and the degree of “snap back” is measured. If your eye doesn’t return to its normal position, you may need one of these procedures. Ultimately, your surgeon decides which procedure you need to get a normal appearance.