Postoperative swelling is of course the rule after blepharoplasty. There is a phase when the eyes can appear "crepey". Waiting until swelling subsides, typically six months, is the standard answer.
The nature of the problem may depend on what was there before the surgery. If there was loose skin present below the eye and nothing was done about it, the loose skin will still be there. If a transconjunctival blepharoplasty was done, with strict fat removal, this can cause the appearance of crepiness to increase.
How to remove the extra skin below the eyes is a very difficult problem. I would respectfully disagree that removal of a pinch of skin is even an option. Removal of lower eyelid skin in my opinion, even if it is "just a pinch" performed with a transconjunctival blepharoplasty, has a high chance of changing eye shape. This change in eye shape typically takes two forms: pulling down of the corner of the eyes, and rounding of the eyes as the lower eyelid skin retracts postoperatively. The retraction is typically not apparent for several months postoperatively.
When a simple canthopexy in combination with a pinch of lower eyelid skin removal is performed to prevent this, another typical deformity can result: rounding of the eyes with a severe upturn at the corners where the canthopexy was performed.
In our practice, we perform midface elevation procedure to tackle the problem of loose skin of the lower eyelid. A superficial cheeklift (the latest version of this technique is called the LUSIC, or LiveFill graft ultrashort incision cheeklift. Here, the cheek is elevated slightly through an incision at the corner of the eye. Sutures are used to anchor the cheekpad higher, "giving" tissue to the lower eyes. Then, a small amount of skin can be removed without significant chance of eyelid shape aleteration.
If the lower eyes have already been done and the eye shape exhibits the typical post-blepharoplasty changes described above, a cheeklift is also helpful in reducing those. LiveFill grafts are used judiciously to restore volume at the same time.
These are all quite complex issues, but patients should be very aware of how their eye shape can be permanently altered with many lower eyelid procedures. The lower eyelid skin, the canthus, the lower eyelid itself, eye shape as a whole, the relationship between the upper and the lower eyelids are all important to consider preoperatively.
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