Is it possible to have both lids done at the same time? I feel that my lower lid needs filling up, can this be done from my own fat? What is the best way to go about this? Thank you.
What is Good for Droopy Eyelids and Sunken Lower Lid?
Doctor Answers 6
Addressing sunken and droopy eyelids
Upper Eyelid Drooping can be the result of:
1- Sagging eyebrows
2- Sagging lacrimal glands (tear producing glands)
3- Too much fat and skin in the upper eyelids
4- Stretched or injured muscle that lifts the upper eyelid
Treatment for the Eyebrow sagging is one of the many types of browlifts. Treatment for the sagging lacrimal glands, excess fat and skin is the upper blepharoplasty. Treatment for the injured or stretched muscle is repair of the muscle by several different approaches depending on the degree of droop.
Lower eyelid problems:
1- Excess Fat and skin
2- Sagging eyelid
3- Depression below the bags
Treatment for the excess skin and fat is a lower lid blepharoplasty. The correction of the depression below the bags is usually performed with a filler or fat. My preference is fat bacause it is natural, blends in well and there is ample volume to make an adequate correction.
Treatment for the sagging eyelid is a technique to tighten the eyelid called a canthoplasty or canthopexy.
Robert M. Freund, MD, FACS
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Droopy eyelids and sunken lower lids
I prefer to do upper and lower eyelids at the same time. Usually for the upper eyelid, I remove the excess skin that's creating the "hooding" effect. For the lower eyelids, the sunken appearance may be a result of aging, weight loss or less than ideal health. This can sometimes be improved by the cheek lift procedure which does restore volume in the area. I occasionally use filler like Juvederm or, less frequently, fat grafting, but the distinction between which procedure will work best for you has to be determined by your surgeon who can examine you and discuss with you your goals and desired results.
Fat injections best for hollowed lower lids.
You have come up with your own very good plan. We usually do upper and lower blepharoplasty together. The droopy upper lids are corrected, and fat injections fill out and smooth the lower lids.
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Transconjunctival blepharoplasty with open fat grafting best for sunkenlower eyelid
The transconjunctival lower eyelid blepharoplasty with open composit fat grafting is the best approach to correcting the hollowmor sunken lower eyelid. I do not use fat injection or injection of soft tissue fillers to correct the hollow or sunken eye because these injection techniques often produce lumps in the eyelid and often need to be repeated, creating additional trauma to the lower eyelid-a very delicate structure.
The drropy upper eyelid can be corrected with an upper blepharoplasty at the same operation.
Droopy eyelid surgery
There are multiple reasons for droopy eyelids. The procedure to correct droopy eyelids varies depending on the cause. Make sure you seek an oculoplastic surgeon with expertise in ptosis (droopy eyelid) surgery. If your lower eyelids are drooping as well they can be repositioned and operated at the same time you are having your upper eyelids done.
Eyelid Surgery A Conservative Approach Yields a More Natural Result
My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.
Surgery of the lower eyelids is, in most cases, more anatomically and surgically complex than surgery of the upper lids. While skin excess or redundancy may be an issue, as it is with the upper lids, there are the added issues of lower lid position and support, protruding lower lid fat pads or 'bags', soft tissue atrophy in the 'tear trough' area, and the relationship of the lower lid to the midface (cheek area)
it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.