Would I benefit from a blepharoplasty procedure? I have been very concerned about the lower lid. (Photo)
Doctor Answers 16
Less is more..
The importance of lower eyelid support structures during under eye surgery, & addressing skin & volume in the eyelid-cheek area
At 46-years-old, you probably noticed that there’s been some volume loss under your eyes. In my practice, most patients are confused between a filler versus surgical procedures to address this area.
A few years ago, I wrote a book, “The Fine Art of Looking Younger” where I explained the issues of facial aging. Facial aging has two essential principles: first is volume loss where we lose bone, muscle and fat as we get older; second is laxity. For example, the lower eyelid tendon becomes looser and the orbicularis muscle gets a little more lax. Overall, there’s a support issue that may be part of the whole lower eyelid rejuvenation process for you.
When I do an evaluation for lower eyelid blepharoplasty, I look at the tone of the lower eyelid. I do a snap test by pulling the eyelid down and see how well it comes back up. In addition, I think it is important to address the fat pockets as well as lifting or tightening the lateral canthal tendon. Looking from different perspectives, we also have to asses if there’s a relative prominence of the eye to deal with any type of support structure in the lower eyelid.
I also wrote an article many years ago called “Ethnic Considerations in Eyelid Surgery” to cater patients who were not Caucasians and were embracing and exploring cosmetic surgery procedures. Unfortunately, traditional cosmetic procedures like an external incision lower eyelid blepharoplasty where the lower eyelid is opened up, and fat and skin removed was problematic for patients of African origin. It resulted in the eyelid being pulled down. Someone with dark skin color has to be mindful of the techniques applied to lower eyelid blepharoplasty. At the same time, addressing volume loss can be the second part of the equation. By adding volume in the cheek area with fillers, cheek implants, or through face lifting, it can have a tremendous impact in the context of how the eyes look.
The last part of this equation is skin quality. People often mistake lower eyelid surgery as a way to reduce wrinkles and dark circles. To address the skin quality issue in our practice, we routinely use platelet-rich plasma for lower eyelid rejuvenation. We draw your own blood, then spin it to concentrate the platelets and growth factors necessary for healing. We place it under the skin of the eyelids and see a qualitative improvement in the skin, which includes improvements in wrinkles and skin color. There is an overall healthier glow to the skin.
I think you should meet with cosmetic surgeons who have a lot of experience with different skin types. Once you find someone who resonates with you, you can move on with the procedures. I hope that was helpful, I wish you the best of luck, and thank you for your question.
First both lower lids are with laxity, excess skin and a bit droopy, with significant hollowness of the nasojugal area (deep tear trough hollow), depression which occurs at the infero-medial aspect of the lower lid.
Your face have a substantial deflation and descent of the mid face malar fat (cheeks), and in your lower eyelids there is too an infra-orbital flattening (volumen deficit) which is caused by descent of the mid face malar fat and periorbital tissues.
You need to have a full blepharoplasty on both upper and lower eyelids. For lower periorbital rejuvenation you need to have an orbicularis oculi muscle lifting, this procedure elevate the lower lid, correct muscle weakness, the periorbital hollows, and the tear troughs; creating a smooth plane then soften the orbital line or the transition from your eyelid to your cheek.
With this procedure you can achieve a more rested look. After surgery your lower eyelid is just smooth with no bags, no wrinkles and black circles; the scar is in the lower lash line, heal well and it’s invisible.
Orlando Figueroa Cerpa M.D.
Tijuana, Mexico Plastic Surgeon