Lower Eyelid Surgery

What is Lower eyelid surgery or lower blepharoplasty?

Lower eyelid surgery or lower blepharoplasty is a broad term to describe surgical procedures that specifically address ageing changes in the lower eyelid with surgical precision and finesse.

What are the features in the eyelid that make patients seek lower eyelid surgery? 

Patients seek surgery to address the following conditions

• Eyelid skin – loose, crepey and wrinkly
• Eyebags - bulging
• Muscle – saggy and loose and bulging
• Eyelid margin – sagging with the ‘white’ of the eyeball on show
• Eyelid margin can be turned inwards (entropion) or outwards (ectropion)
• Deep grooves in the under-eye area such as a prominent ‘tear trough’
• Combination of the above as a part of the ageing process.

What is involved in a Lower blepharoplasty? ?

What are the benefits of Lower eyelid surgery or lower blepharoplasty?

Lower eyelid surgery or lower blepharoplasty can remove loose, excess and crepey skin, remove eyebags, tighten the lower eyelid, fix the deep under eye grooves and restore youthful contours of the lower eyelid and cheek. It can reduce puffiness and eyebags in the area of your Lower Eyelids. 

Is lower eyelid surgery worth it?

According to www.realself.com 95% said eyelid surgery was worth it. Realself.com based this on 1200 ratings and this information was last updated on 23 May 2020.

Can men undergo lower eyelid surgery?

Yes, men and women commonly undergo lower eyelid surgery.

In fact, men undergo lower eyelid surgery to correct bulging eye bags more than correcting loose skin or wrinkles

At what age does eyelid puffiness and eyebags appear?

Most people end up with sagging eyelid skin after the ages of 40 and 50.

Sometimes people experience eyelid puffiness and skin sagging at even earlier ages, due to genetic traits they inherited from parents or grandparents. Eye bags that are small puffy looking fat bulges under your lower eyelids are often seen in older people and is a well-known feature of the ageing eyelid. So, it is naturally concerning for younger people when they notice eyebags.

Eyebags impact on facial appearance and the effective treatment using lower eyelid surgery

One of the biggest detractors from a younger looking face are eye bags and deep under eye grooves. Eye bags that are small puffy looking fat bulges under your lower eyelids are often seen in older people and is a well-known feature of the ageing eyelid. So, it is naturally concerning for younger people when they notice eyebags.

The appearance of eyebags together with other changes in the under-eye area that occur over time, can leave your eyelids looking swollen, tired or aged. 

Eyebags primarily occurs when the under-eye cheek bone shrinks a natural feature of age. As a result, the skin and muscles around the eye region becomes lax, loose and the fat starts to bulge. The primary question people ask, however, is how to remedy the condition of eyebags.

Creams won’t help eyebags, and cosmetic injections in the eyelid area can only go so far; under eye bags typically require a surgical approach 

Plastic Surgery of the eyelids involves re-tightening the muscles and redistributing the fat under the eyes (between the eyes and cheekbone) 

The result is smoother, firmer looking skin versus puffy eye bags or tired-looking eyes

Lower eyelid surgery can help puffy looking skin bulges. What causes puffy-looking skin bulges under your eyes?

Three (3) key contributors to eyelid area laxity Eyebags and puffy eyelids are typically caused by multiple factors. 

• A general weakening of the support structures and skin around the eyelids (leading to laxity, droopiness, puffiness and fat pad redistribution)
• Repeated facial expressions 

• Bone changes around the eyes (ageing-related skeletal atrophy)

This can occur all around the eyes, when atrophy occurs beneath the eyes, eye bags often form; and lower eyelid surgery may be indicated.

Fortunately, lower eyelid surgery can reduce the appearance of puffiness and ‘eye bags’ beneath your eye area.

• Lower eyelid blepharoplasty of the eyelids can help correct droopy, puffy eyelid skin beneath the eyes
• Lower Blepharoplasty leads to a refreshed appearance that leaves the eyes looking brighter and less sleepy or closed.

Lower eyelid surgery to reduce puffy eyes and eyebags is one of the top requested cosmetic facial surgery procedures in Sydney. Lower eyelid surgery is one of the eyelid surgery procedures that expert Plastic Surgeon, Dr Naveen Somia, provides through his Sydney eyelid surgery and facial rejuvenation clinic.

A well designed and precisely executed lower Blepharoplasty Surgery by a specialist plastic surgeon with expertise in eyelid surgery can help

• Correct skin laxity, structural weaknesses and reduce eyebags. Expertly performed, lower eyelid surgery leads to a more youthful and refreshed appearance. The eyes appear fresher, brighter and/or more naturally open. It does not leave you with a startled expression; instead, it gives you a rested and refreshed expression that is subtle and natural
• Redistribute fat precisely to provide a smoother contoured appearance by blending the lower eyelid and cheekbone. This rejuvenates the mid-face in a subtle and natural way.
• This surgery should only be done by an expert. Otherwise, in the hands of a less trained Surgeon, problems could lead to serious consequences such as malfunctioning tear ducts, the inability to close your eyes fully, a very uneven appearance, and more.

What are the 4 main types of lower eyelid surgery?

The 4 types of lower eyelid surgery are

1. Pinch lower eyelid blepharoplasty
2. Transconjunctival lower eyelid blepharoplasty
3. Transcutaneous lower eyelid blepharoplasty
4. Transcutaneous lower eyelid blepharoplasty +Midface lift

Pinch lower blepharoplasty

As the name suggests a very small amount ‘a pinch’ of skin is excised from the lower eyelid. Suitable for younger patients who have only a small amount of excess skin.

Transconjunctival lower eyelid surgery or blepharoplasty

In this approach the cut is made on the inner surface of the lower eyelid and there is no visible scar. It is useful to treat younger patients whose main complaint is eyebags and is a very effective way to reduce the bulging eyebags

If the skin needs to be removed a pinch lower blepharoplasty technique can be used to remove small amount of skin.

This method is not suitable for older patients who have excessive amount of loose skin.

Transcutaneous Lower eyelid surgery or blepharoplasty

Here the cut is made 2 mm below the eyelid margin and extends past the outer corner for about 5-10 mm.

Using this method, you can effectively address loose and excess skin, tighten muscle and reduce the eyebags. A canthoplasty or canthopexy can be performed at the same time to tighten the eyelid margin. Suitable for patients over 45 who have significant ageing changes.

Transcutaneous Lower blepharoplasty + cheek lift or midface lift

In addition to the above, this approach allows one to address excess skin and muscle, address eyebags and comprehensively correct the deep grooves under the eyelid like tear trough and naso jugal groove. It also allows to reposition the cheek or malar mound thereby restoring the contours of the face. This approach can effectively treat festoons.

Can eyebags and festoons be treated with lower eyelid blepharoplasty + midface lift?

Eyebags and festoons are not one and the same. Eyebags occur directly under the eye, between the eye and the cheek bone. Festoons or malar bags occur ON the cheek bone. 

Festoons are formed due to the ageing process of the cheek bone (not the part immediately under the eye) together with the laxity of the skin and muscle.

Festoons in my opinion is the most difficult lower eyelid condition to treat. It is difficult because of many reasons. The anatomy is complex and not well understood, the results following any treatment be it dermal fillers, laser or surgery is unpredictable at best.

I have found that the best way to treat malar festoons is by Transcutaneous lower eyelid blepharoplasty + midface lift using multiple techniques. Wide undermining of lower eyelid and cheek skin, release of tough ligaments like arcus marginalis, tear trough, orbito malar ligament, zygomatico facial ligament or midface ligament, fat transposition, canthopexy with midface lift and malar fat pad elevation, tightening of lower eyelid with a skin muscle flap followed by redraping of skin.

Direct excision of festoons is an option that is reserved for very severe cases and for recurrence of festoons following surgery. The downside to this direct excision is a scar on the cheek that surprisingly settles well in 12 months.

Cost of Lower Eyelid Surgery (Blepharoplasty) surgery price ranges will depend on several factors.

Unless medically indicated to correct lower eyelid conditions like ectropion, entropion, eyelid skin cancer or traumatic injuries, it is fair to assume that all lower eyelid surgeries are considered as cosmetic and hence you will not be able to get medicare or health fund cover.

Procedures commonly performed with Lower Eyelid surgery 

• Upper Eyelid Surgery / Upper Blepharoplasty
• Facelift and/or cosmetic injections
• Epicanthal (over-hanging fold in the corner of the eye)
• Skin Resurfacing/Pigmentation Reduction
• Brow Lift Surgery

Secondary facial surgery procedures that patients may consider when rejuvenating their eyelids:

• Cheek Augmentation 
• Lip Augmentation

How long does the lower eyelid operation take?

• The surgery usually takes from 1.25 to 2.5 hours. 
• This can vary from patient to patient and depends on the specific procedure required to address your eyelid concerns and whether additional procedures are performed.

Do I have to stay in hospital overnight for lower eyelid surgery?

• Lower Eyelid surgery is a complex plastic surgery procedure that must be performed precisely to reduce the risks of complications. 

• Lower Eyelid Surgery should be performed in a licensed facility. This is typically a Day Surgery centre or hospital setting.
• It is best performed by an expert Plastic Surgeon with extensive experience in lower eyelid procedures, due to the high risk of complications if you choose a less-trained, less qualified surgeon.
• The surgery can be done in a day surgery centre or hospital 
• It may require an overnight stay; however, it depends on the type of surgery, how many surgeries are being performed in one theatre session, and the patient’s health and anaesthetic preferences or requirements.
• Complications may require longer hospitalisation periods.

How long is the healing process?

• Healing and recovery after eyelid surgery can vary from patient to patient.
• On average, the healing process tends to take two (2) weeks or more; sometime longer depending on what you’re having performed; and how your body responds.
• Please ensure you allow adequate healing and resting time after your eyelid surgery.
• Check with Dr Somia for some helpful healing instructions and don’t try to do too much too soon; you will need to rest your eyes a lot during those 2 or more weeks of healing.

Tips for a better outcome: Before, During and After Eyelid Surgery

BEFORE Blepharoplasty Surgery:

• Book a consultation with Sydney’s top eyelid surgeon, Dr Naveen Somia
• Read the materials provided and discuss your surgery objectives, desired outcomes and facial anatomy including surgery costs, surgery schedules, time frames, recovery care, healing times and risks
• Consider the PROS and CONS of the surgery and what you want accomplished
• Ask any and all questions you have about eyelid surgery including risks and your ideal eyelid appearance after surgery
• Determine your preferences for anaesthetic and which day surgery or hospital option you prefer for your Surgeon
• After doing your research into lower blepharoplasty, decide to proceed 
• Schedule your surgery, work out your payment options and attend pre-consultations
• Follow Dr Naveen’s recommendations for pre-surgery preparation
• Stay healthy to enhance your healing period and help prevent healing delays

DURING Lower Blepharoplasty Surgery:

• Avoid wearing contacts for the designated time (ask Dr Naveen for specific information on stopping wearing contacts before your eyelid surgery)
• Before surgery, read and re-read your post-op instructions
• Have the post-operative eyelid care instructions laminated and place them by your bedside, using very large font sizes, for when you get home after surgery
• Have numbing injections in the area for improving procedure comfort
• Have anaesthetic (local or general and local, depending on what you’ve chosen or what your Surgeon feels is best for your procedure)
• Have the Lower Blepharoplasty procedure?
• When you’re cleared by Dr Naveen or released from the Surgery Centre, make sure you have someone to drive you home 
• Have someone available to assist you for several days post-surgery 
• If you’re having multiple procedures, you may stay a night or two in hospital (e.g. eyelids and a facelift, or both upper and lower eyelids)

After Blepharoplasty Surgery:

• Stay out of the sun for the designated period of time
• Make sure you’re choosing good nutrition and drinking plenty of water 
• Rest your eyes and do not drive until you are cleared by your Surgeon
• Care for your eyes and sutures as instructed by Dr Naveen
• You may be asked to sleep in an elevated position 
• You may be able to use gently applied cool packs to minimise swelling, but check with Dr Naveen as these must be used only according to instructions
• You may feel your eyes appear swollen or your eyelids ‘tight-feeling’; you may have some bruising or discolouration around the eyes after surgery 
• Some sutures are dissolvable; if any non-dissolvable sutures are used, these will be removed at a follow-up consultation with your Surgeon (around 8 days)
• Report any concerns or questions 
• Attend follow up appointments and have your sutures removed at about 8 days (this can vary slightly and frequently doesn’t hurt)
• In approximately two (2) weeks’ time, your eyelids should be mostly healed, however, the scar may take up to 12 months to fully mature
• Follow Dr Naveen’s scar minimisation instructions