Cosmetic eyelid surgery consistently ranks in the top 5 most commonly
performed cosmetic surgeries every year. Lower eyelid surgery for under eye bags
caused by prolapsed orbital fat affects a wide range of people of all ages.
Puffiness under the eyes is typically caused by genetics as well as aging. As an example of the
genetic aspect of under eye bags, I’ve personally treated 3 generations in the same family.
With so many people wanting to have this procedure, the law of supply and demand
results in more surgeons being willing to perform lower eyelid surgery.
In spite of patients seeking “board certified” plastic surgeons or other types of surgeons,
there are many people who end up having their eyes pulled downward after cosmetic eyelid surgery.
I’ll discuss the reasons why eyelids that are pulled down or retracted after eyelid
surgery occurs and how I avoid this issue when I perform surgery for under eye bags in patients.
I’m Dr. Amiya Prasad, I’m Board-certified cosmetic surgeon, and Fellowship-trained
oculofacial plastic and reconstructive surgeon. I’ve been in practice in New York,
and Long Island for over 25 years. As a cosmetic oculofacial plastic surgeon,I specialize in a
range of cosmetic eyelid surgeries, such as under eye bags, hooded upper eyelids, as well as eyelid
procedures typically not performed by general plastic surgeons, such as lacrimal gland prolapse,
and eyelid ptosis. I often perform revision eyelid surgeries to address surgical complications
originally performed by other doctors, including lower eyelid retraction, and ectropion.
In my opinion, the most common reason for eyelids being pulled down after cosmetic eyelid surgery is
in the way that most surgeons perform lower eyelid surgery. The most commonly performed technique
is called a transcutaneous blepharoplasty. This surgical technique involves making an incision
along the lower eyelid skin, usually right below the eyelashes, to access
the prolapsed orbital fat pockets that cause eye bags, so they can be sculpted, and removed.
This approach can compromise the orbicularis oculi muscle, as well as the lateral canthal tendon,
which are important for lower eyelid support. Loss of the integrity of these supporting structures
can cause the lower eyelid to collapse, leading to the rounding of the eyes known as lower eyelid
retraction. In addition, the lower eyelids can also evert outward, a condition called ectropion;
I perform lower eyelid surgery in my practice,
using a transconjunctival approach. Transconjunctival blepharoplasty involves
no external incision, allowing me to preserve the integrity of the eyelid support structures.
This method is considered a technically advanced procedure and allows my patients to preserve the
natural shape, and character of their eyes. In addition, since there is no external incision,
there is no chance of a visible scar on the lower eyelid that reveals they had surgery.
Another contributing factor to eyelid retraction and ectropion, is the removal of skin
to address skin wrinkling. Surgeons will often mistakenly think that under eye wrinkles are due
to redundant lower eyelid skin, just as hooded eyelids are due to stretched upper eyelid skin.
In my experience, wrinkles under the eyes are more due to diminished skin quality,
not excessive skin quantity. When a surgeon excises lower eyelid skin,
it can lead to a skin shortage, resulting in the lower eyelid rounding or retracting.
I routinely address eyelid ski wrinkling with lasers such as fractional CO2 laser
and fractional erbium laser as well as radio frequency thermal energy.
I like to enhance the benefits of laser and radio frequency treatment
with PRP or platelet rich plasma. Platelet-rich plasma is a concentration of the wound healing
and growth factors your blood to stimulate collagen production and improve skin quality.
As a specialist, I understand that general plastic surgeons and other non specialized surgeons
typically perform lower eyelid surgery as a small percentage of their practice, which more typically
is focused on more popular body procedures such as liposuction and tummy tucks. As a specialist with
an ophthalmology background, I can’t overstate the importance of having eyelids that look
good and function well. Preserving the characteristic shape of your eyes
and having the lower eyelids work to protect your eyes
is critical to your eye health and appearance. I hope you found this information from
my experience helpful. If you’re interested in recommendations for your individual situation,
you may contact us through our websites or call our offices to schedule a consultation. Thank you.