Lower Eyelid SurgeryAuthor: Dr. Gordon Sasaki
Skin looseness, drooping of facial fat pad (malar cheek fat pad), and muscle slackening constitute the major changes that occur in the aging lower lid and face. You may be self-conscious about your lower lid bulges and skin folds, deepening crescent-shaped hollowness at the lid-cheek junction, swelling on your lateral cheek (malar bag), irregularity from your tear-trough downward, fullness of the nasolabial fold along with deepening of the nasolabial line, jowliness above and below your jawline, and downward fold at the corner of your mouth (marionette fold). These interdependent transformations are determined not only by your genetic background but also by your age and lifestyle.
Rejuvenation of lower eyelid fat protrusions, skin folds and lid laxity may be accomplished by two different approaches to the lower lid. Either a transconjunctival (inside the lid) or infraciliary (outside the lid) approach permits removal and/or transposition of fat. The infraciliary procedure is able to remove excess skin because of the incision beneath the lash line. Surgical correction of lower lid laxity (determined by measurements, symptoms of dryness of eyes, and scleral show/lateral lid bowing) is more easily addressed by the infraciliary approach because the exposed orbicularis muscle may be tightened at the outside corner of the lower lid (lateral orbiculopexy). On the other hand, crepy skin to the primary lower lid frequently accompanies visible skin laxity, fat bulging and lid laxity. Although skin separation from the underlying orbicularis oculi muscle may precede the removal of a conservative strip of excess skin, this maneuver does not ensure improvement of this troublesome finding. Since crepy skin is a result of progressive thinning from aging/sun damage and the attachments of the underlying orbicularis muscle, excision of damaged crepy skin will not resolve this aesthetic concern. The use of fractional resurfacing laser or intermediate chemical peels is a more consistent method to improve this aged sign. Please click on fractional laser resurfacing, chemical peels, microneedling, BOTOX® Cosmetic, Utherapy tissue tightening for more information.
Dr. Gordon H. Sasaki
Triple Board-Certified Plastic Surgeon
Few plastic surgeons can match Dr. Sasaki's combination of expertise, compassion, and experience. He's a distinguished educator and a renowned innovator whose work and research have influenced a generation of plastic surgeons. Dr. Sasaki will work with you to make the improvements you desire.
For the majority of aging patients, however, a more complete rejuvenation is optimally achieved by blending the lower lid to the facial procedure. Based on your findings and goals, Dr. Sasaki will explain his reasoning for redistributing your lower lid fat downward to fill in the hollow at the lid-cheek junction, simultaneously elevating the large triangulated cheek fat pad upward to meet the lower lid fat and produce a smoother, fuller, a more youthful appearance in both areas. The doctor may also suggest fat grafting to your lower lid-cheek hollow for optimal results. To obtain a desired natural and longer-lasting rejuvenation in mature patients, however, a facelift procedure oftentimes requires not only fat repositioning, but also tightening of a deeper layer (submuscular aponeurotic system) whose laxity contributes to the formation of jowls and marionette folds, and a gentle skin adjustment. In younger patients who do not yet exhibit skin laxity, Dr. Sasaki may suggest an endoscopic facelift through small incisions to elevate the drooping facial structures without skin removal.
A well-designed lower lid blepharoplasty is performed either through an incision within the lid or through the skin immediately below the lash line. Dr. Sasaki uses both approaches to expose the fat bulges. The doctor will then determine the amount of fat removal or fat relocation to smooth out the lower lid region for an optimal outcome. A transconjunctival approach is used when there is no need to remove skin. An infraciliary approach permits an opportunity to remove excess skin and to tighten the underlying muscle for lid support.
Lower lid blepharoplasties may take about an hour to perform and may be done safely under local anesthesia in our office surgical suite. You may shower and get the incisions wet the day after surgery. Medicated eye drops will be prescribed to reduce irritation and infection. Skin sutures will be removed ten days after surgery. If a transconjunctival blepharoplasty is performed, the single absorbable suture inside the lower lid is not removed.
Are you ready to discover all the ways Sasaki Advanced Aesthetic Medical Center in Pasadena can enhance your appearance and confidence? Request a consultation using our online form or call (626) 796-3373 for an appointment.Back to Top