what are the risks of lower eyelid surgery cosmetic lower eyelid surgery or
lower eyelid blepharoplasty is amongst the most popular cosmetic surgical
procedures performed throughout the world the appearance of puffy eye bags
that are present all the time is due to bulging fat and is commonly genetic in
origin as well as being associated with facial aging the genetic aspect of this
condition is why many younger people have under-eye bags the most effective
and longest lasting procedure for puffy eye bags is lower eyelid surgery to
sculpt the fat responsible for the under eye bags
the popularity of lower eyelid surgery can make it appear to be a generic
procedure in actuality it's anything but generic many surgeons performing this
category of surgery use a one method fits all approach resulting in many
people needing corrective procedures by specialists like myself the lower eyelid
is a complex structure and the art is in creating the optimal strategy to get the
most satisfactory result with minimal risk for complications I'll discuss how
I assess my patients and how I customized the procedure to minimize the
risks related to lower eyelid surgery I'm Dr. Amiya Prasad I'm a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I've been in practice in Manhattan and Long Island
for over 20 years as an oculoplastic surgeon who specializes in cosmetic
eyelid surgery I routinely perform lower eyelid blepharoplasty as well as eyelid
revision surgery for complications after surgery originally performed by other
doctors I've observed throughout my career that a lot of complications after lower eyelid surgery occur because the surgeons performing
this procedure are not fully aware of the ways to avoid compromising the
support structures intrinsic to the lower eyelid anatomy one of the more
common risks of lower eyelid blepharoplasty is lower eyelid
retraction the degree of eyelid retraction can be such that the eyes
look rounded after surgery and the patient loses the characteristic shape
of their eyes I've seen patients who had this problem after surgery and their
original surgeon denied that the patient had a rounded appearance of their lower
eyelids it seems that there's been a normalization of rounded lower eyelids
similar to the normalization of high arched eyebrows and overfilled lips this
is why during consultations patients will often express their disdain for the
look of some famous people who they feel look like they're a deer in headlights
so what is the cause for this eyelid retraction problem well the most
commonly performed surgical technique to address fat under the eyes which causes
puffy eye bags is called transcutaneous blepharoplasty this technique involves
making an incision in the lower eyelid right below the eyelashes to access the
fat pockets responsible for puffiness the transcutaneous blepharoplasty
technique is often performed by general plastic surgeons this approach has the
potential to compromise the strength of the eyelid structure by separating the
layers which are stronger when intact in addition there is potential compromising
of the function of the orbicularis oculi muscle which works like a belt
supporting the lower eyelid this can lead to the lower eyelids sagging or
pulling downward making the eyes look rounded instead of
retaining their original shape and it's referred to as lower eyelid retraction
the lower eyelids may also rotate inward causing irritation from the eyelashes
known as entropion or avert outward causing irritation from exposure known
as ectropion further worsening this compromise of the integrity of the lower
eyelids is caused by the common practice of eyelid skin removal as a strategy to
improve the appearance of fine lines and wrinkles
a common misconception held by many surgeons and the general public is that
the fine lines and wrinkles are the result of excess lower eyelid skin so
many surgeons excise skin when performing transcutaneous bluffing this
removal of skin often leads to the lower eyelids retracting even further and can
lead to a more rounded look and worse a skin shortage where the eye is not
adequately protected this can cause the tears to not be evenly distributed over
the eyes to maintain proper eye health in some situations there can even be a
limitation in high closure when sleeping I approach lower eyelid retraction
ectropion and aunt ro beam with one guiding principle restoration of anatomy
eyelids that look good function well this means for eyelid retraction in
order to restore anatomy I have to use tissue grafts such as dermis cellular
matrix graft and even skin grafts to reconstruct and provide vertical support
I also have to repair the anatomic structural connection to the bone called
the lateral canthal tendon each patient situation is unique and requires proper
evaluation I use advanced wound healing technology such as PRP or platelet-rich
plasma and a cellular matrix to improve my patient
tissue healing and consequently their outcomes it's often the case that lower
eyelid fat prolapse is associated with the deficiency in the projection of the
cheek bone and bone structure under the eyes the paradox is that there is excess
fat pushing forward while deficient bone is not projecting forward enough I
usually recommend placement of hyaluronic acid filler at the bone level
to address bone volume deficiency some doctors advise fat repositioning with
lower eyelid surgery where a small extension of fat still connected to the
eye is stretched and bent over the bone to try to address this deficiency this
pedicle of fat is usually too small to address hollowing and the blood supply
is kinked over the bony orbital rim resulting in prolonged swelling
irregularities or the fat just dying from the blood vessels being bent and
compressed to provide adequate volume as well as a more predictable result I use
hyaluronic acid fillers such as Restylane and Juvederm to address
hollowness in the lower eye area as well as the cheek bones I bring to my
patients attention the relationship between the bone structure around the
eyes and the eyes themselves so they can look their best it is of course much
better to completely avoid lower eyelid retraction of other complications than
it is to need extensive and expensive revision surgery so many people opt for
cheaper lower eyelid surgery to save money without understanding why the
surgery is being done so cheaply quality and cheap simply don't go together so
opting for cheaper lower eyelid surgery can be much more expensive to fix not to
mention the cost of time off work and the expenses of travel
so how do I minimize the risk of lower eyelid retraction I start with the
approach of preserving the lower eyelid support structures such as the lower
eyelid skin and the orbicularis oculi muscle I preserve lower eyelid Anatomy
by using a specialized technique called transconjunctival blepharoplasty
transconjunctival blepharoplasty involves no external incision because
the fat pockets responsible for under eye bags are sculpted from behind the
eyelid the lower eyelid skin and the orbicularis oculi muscle are completely
preserved and the results look natural since there is no scar from an external
incision and there is no compromise in the support structure I also avoid skin
removal because under eye wrinkles and fine lines are an issue of skin quality
not excess skin quantity for under eye wrinkles I improve the quality of the
skin by stimulating collagen production and resurfacing the skin collagen can be
stimulated using a laser or radiofrequency device to induce collagen
production collagen is the protein that gives skin its strength in addition the
application of heat also makes the skin contract and tighten to further
stimulate collagen production and blood supply in the lower eyelid skin without
heat I use platelet-rich plasma platelet-rich plasma also called PRP is
a concentration of wound healing and growth factors present in the blood
which are activated when you have a cut if there is redundant lower eyelid skin
or a fold I'll perform a skin pinch excision I still focus on maintaining
the natural shape and the character of the lower eyelids I perform lower eyelid
surgery under local anesthesia with Lite IV sedation
so patients don't have to deal with the stress of general anesthesia as well as
the side effects of general anesthesia patients are comfortable throughout the
surgery and what is generally referred to as a twilight state of consciousness
they walk out of our office alert and happy soon after surgery most of our
patients have little to no bruising and return to work in about a week like any
surgery there are always risks risks can be minimized through the experience
expertise and techniques used by the surgeon coming from an ophthalmology
background and having an understanding of how to maintain the shape and retain
the healthy function of the eyelids has been invaluable for my ability to help
my patients undergoing lower eyelid surgery I hope you found this
information helpful thank you for your question