Lower Eyelid Surgery
There are two basic approaches used for an eye lift involving the lower lids:
- A transconjunctival procedure which involves an incision made along the inner surface of the lower eyelid.
- A transcutaneous procedure which involves an incision made just beneath the eyelashes on the lower lid.
Despite the fact that transconjunctival lower blepharoplasty is associated with certain advantages, the procedure is not appropriate for everyone. The advantages of having a transconjunctival eye lift include:
- A lack of a visible scar following the procedure
- Diminished risk of reddening or bruising
- The orbital septum incision isn’t necessary
- Denervation of the orbicularis oculi muscle can be avoided
Transconjunctival lower blepharoplasty is unfortunately associated with a swelling of the conjunctiva and scarring on the inner eyelid. The procedure is not appropriate for patients with excess skin in their lower eyelid and must be modified for patients whose lids are sagging or drooping. Mid-face descent is also contraindicated for transconjunctival eye lift. It is best for young patients without mid-face descent who don’t have problems yet with eyelid laxity.
As with an eye lift involving the upper eyelids, evaluating a patient requires a skillful examination and testing. Patients should have reasonable expectations about what an eye lift can accomplish and they should also be in reasonably good health. Patients taking blood thinning medications or who have issues with blood clots or thin blood may not be good candidates for the procedure. It may not be safe or prudent to discontinue anti-coagulant use just to have an eye lift performed. Talk with your doctor about your options.
Hypertension or high blood pressure is another issue of concern when patients are considering an eye lift surgery. Blood pressure should be mostly under control before the patient can be considered for the procedure.
An eye lift may be appropriately performed at the doctor’s office or in a hospital with a licensed anesthesiologist. Typically local anesthesia is recommended because general anesthesia is associated with problems like dilation of the blood vessels and increased risk of bleeding. Some patients with severe anxiety about the procedure, however, may require the use of general anesthesia.
The doctor should evaluate the anatomical eye features prior to surgery to come up with a plan of action during the procedure. Specifically, the amount of extra fat in the lower three eyelid fat pads should be considered. It may be necessary to reduce the amount of fat in any one or all of these fat pads to achieve the most aesthetically pleasing effects.
Lower Eye Lift (Transconjunctival Incision Approach)
Lower blepharoplasty can be performed by placing the incision inside the lower eyelid in the transconjunctival incision approach (which is also known as the posterior eye lift approach). The conjunctiva is a clear membrane that covers the inner surface of the lower eyelid and a small portion of the white of the eye as well. Incisions in the inner eyelid cut through this membrane by necessity in order to accomplish certain aesthetic goals.
Typically, bulging fat is a primary issue that is resolved using this particular eye lift procedure. The patient’s lower eyelids are pulled away from the eye and a plastic shield is used to protect the eyeball itself during the procedure. An electrocautery tool, scalpel, or a laser is used to make the incision through the conjunctiva along the entire length near the eyeball. The fat that needs to be removed becomes easily accessible. This fat is clamped, cut, and then cauterized to stop the bleeding.
The orbicularis muscle and canthal tendon may be optionally tightened during a lower transconjunctival eye lift procedure. Fat that is removed may also be used to fill in and volumize the upper cheek area, creating a more youthful appearance. The surgeon may occasionally stop the procedure and return the eyelid to its normal position to look at the results of his or her work, thereby accomplishing greater precision using this technique. At the end of the procedure, the plastic surgeon may use several sutures to close the incision or the incision may not be suture-closed.
Typically, patients recover quickly from the procedure with less swelling than what’s common with the transcutaneous approach. However, some swelling is to be expected and many patients report that the swelling that does occur using this approach can persist for several months following the procedure. Patients may see some blistering or temporary swelling of the conjunctiva of the eye after this procedure. This can persist for several weeks. The lower eyelid may also look somewhat hollowed after the surgery.
There are limitations associated with transconjunctival eye lift. Talk with your doctor about issues relating to excess skin in the lower lid. Using a skin pinch procedure, excess skin can be removed. However, in patients who don’t have excess skin, removal of extra fat can help the lower lid skin return to a more normal position.
The advantages of using transconjunctival eye lift include the fact that no visible scars remain after the procedure. The middle layers of the eyelid are not opened up during the procedure making it slightly less invasive. The lower eyelid is less likely to pull away from the eye using this procedure and the precision with which doctors can sculpt fat is enhanced through the location of the incision. Patients who use this procedure report less bruising and swelling and fewer complications associated with repeat surgical procedures performed on the lower lids.
Lower Eye Lift (Transcutaneous Incision Approach)
The transcutaneous incision approach is also known as the anterior approach or the lower eye lift surgery. The goals associated with the transcutaneous approach differ somewhat from the goals of the transconjunctival eye lift. Using the transcutaneous approach, doctors can easily remove excess skin and fat from the lower eyelid and correct droopiness of the orbicularis muscle. Other procedures may be implemented at the same time to complement a transcutaneous incision blepharoplasty. In fact, it is rare for transcutaneous blepharoplasty to be performed without adjunctive procedures to help offset the potentially undesirable “surgical” look that some patients have reported in the past.
Patients are given local anesthesia and a sedative to numb the pain and help them relax during the procedure. By using local anesthesia, many of the risks and complications associated with general anesthesia can be bypassed.
During transcutaneous blepharoplasty, the eyelid is incised just below the eyelashes to expose the orbicularis muscle. The exposed muscle is also incised. Fat pockets are then exposed such that it can be clamped and removed with scissors. The fat is cauterized to prevent bleeding before it is allowed to retract back to its original position. Excess skin is removed and then the surgeon uses sutures to close up the wound.
Some doctors will use a slightly different placement of the incision to achieve desirable effects, or won’t penetrate as far into the various layers of the skin. The eye lift surgery can be varied somewhat from patient to patient in order to achieve the most aesthetically pleasing effects.
After the procedure is complete, the patients are moved into a recovery area. Recovery from transcutaneous blepharoplasty is usually swift. There is some risk that the skin will be positioned improperly creating an unnatural look following the procedure. Bruising and swelling should be expected and patients sometimes lose eyelashes as a result of the procedure. This procedure can alter the position of the eye opening and create a lot of scar tissue due to its invasive nature, unfortunately. Some adjunctive procedures can be used to offset some of these limitations, but patients are urged to carefully consider the validity of the procedure before going under the knife.
One of the advantages of transcutaneous blepharoplasty is the surgeon’s ability to remove and reposition fat and remove skin and muscle tissue at the same time.