Lower Eyelid Surgery, Specialized Blepharoplasty to Remove Circles (lid-cheek junction deformities; tear trough) and Eyelid Puff

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Patient concerns: This 40-year-old woman expressed concerns about the puffiness and “bags” under her eyes. She was especially bothered by the “circles” under her eyes. The patient reported that people often commented that she looked “tired” and had a “sad” appearance. She also explained that even as a younger woman she had puffiness under her eyes, but said that this had become worse with age. This is often an inherited problem and characteristically shows up early in life. Procedure notes: The eyelid/blepharoplasty surgery was done using intravenous sedation anesthesia rather than general anesthesia. The goal was to keep this patient’s eyelid/blepharoplasty surgery pain free and also to keep her comfortable after her eyelid/blepharoplasty surgery. This specialized eyelid/blepharoplasty procedure is done via an incision hidden internally (transconjunctival). This is followed by release of the retaining ligaments and the patient’s own fat which is redraped into the areas where the circles are apparent (lid-cheek junction abnormality). The vascularized fat is sutured into the exact position where it is needed to correct the tear trough deformity or wherever “circles” are a problem. This eyelid/blepharoplasty treatment is designed specifically to treat each patient’s individual deformity on each eyelid. (The eyelids are almost always asymmetric.) This unique eyelid/blepharoplasty surgery gives a much smoother appearance in the lower lid and cheek and can give a fresher and more rested appearance to the whole face. Experience with 330 consecutive eyelid surgery patients with similar deformities was presented at the 2011 meeting of the American Society of Aesthetic Plastic Surgeons. Patients from their 20s to their 70s were included. Results showed a very high success rate with very few complications. Emphasis is always placed on artistically designing each surgery to give every patient a very natural appearance without having them appear “surgical.”

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