Had a lower blepharoplasty consultation, the doctor said he would put in "bolsters" on the outside of my face. Is that typical?

Question

This surgery would be done internally so that there is no external scar. I have had many consultations for lower blepharoplasty and no one has ever suggested anything like this. The doctor I am seeing is an ophthalmic plastic surgeon, as I felt it was best to see a specialist. I just wonder if this is normal and why is this done? I also wanted to know the possible complications from using this technique. I want to try to avoid any potential external scaring from sutures. Thank you.

Vito C. Quatela, MD · Answer

Thanks for your question. There is a type of lower lid blepharoplasty that involves fat transposition or fat re-positioning to improve the look of your tear trough area. There are different ways of performing this particular procedure, but one of the ways involves using the bolsters that are sewn to the outside of your face. Depending on your exam, there are many techniques that do not involve bolsters as well. But, this is quite typical and I do this frequently in my practice. Rest assured that this does not cause any external scarring. The only downside is having the bolsters on your face for about 5 days (give or take, depending on your surgeon).

David W. Rodwell III, MD · Answer

This is a normal thing. As others have mentioned bolsters are like a small padding for sutures that are temporarily tied outside of the skin.Certain techniques of transconjunctival lower lid surgery that include fat repositioning (also called fat transposition) will use sutures to help secure the repositioned fat, and those are temporarily tied outside the skin even though the work can all be done through an incision hidden within the eyelid.

Elizabeth Whitaker, MD, FACS · Answer

Hello DT3519, Thank you for sharing your concerns and your question.  Blepharoplasty can be performed in different ways, but if fat repositioning is being performed then the fat may be secured with internal or external fixation.  With external fixation, the sutures are brought out through the skin, and a bolster can be used as a cushion for the sutures against the skin.  These sutures are temporary and typically removed after around a week.  I hope you have found this helpful.All my best!Dr. Elizabeth

Thomas J. Walker, MD, FACS · Answer

There is nothing wrong with a bolster after your lower blepharoplasty. Bolsters are placed by some surgeons in case of fat transposition where your own excess fat is "flipped down" or transposed to fill the tear trough deformity. The fat that gets "flipped down" can be secured with sutures through the skin and temporary bolsters are often used as a cushion for these sutures. Best wishes,Thomas Walker, MD, FACS

Rohit Seth, MD, MRCS(Ed), PhD · Answer

Thank you for questionThere are a number of ways to carry out surgical procedures. I do not do it this way but that doesnt mean it is wrong. Normally I use blosters if I need to secure a graft underneath but I dont feel this is required for a standard blepharoplasty. I would contact your surgeon and ask for his reasons why he does this and that should help you understand why he uses them. If you have looked at his before and after pictures and are happy with his results then how he achieves those results shouldnt be what worries you. I hope this is of help to youBW

John J. Martin, Jr., MD · Answer

If your surgeon is doing a fat repositioning,  the fat is often held in place with sutures that pass from the fat, through the overlying tissue to exit on top of the skin.  These sutures are sometimes tied over a cotton bolster so that they don't make a crease in the skin, or retract under the skin.

Matthew Bridges, MD, FACS · Answer

He may be referring to the use of small pieces of nonstick gauze or otherwise that sutures are  tied over.  This is commonly done when fat repositioning is performed as part of the blepharoplasty.  They typically are kept in place about 1 week.  I'm sure your surgeon could clarify this for you.

Robert W. Sheffield, MD · Answer

Thanks for the question. A lower eyelid blepharoplasty procedure usually includes relocating or trans-positioning of fat tissue to enhance the look of your under eye region. A certain type of blepharoplasty utilizes the bolsters that are stitched to the outside of your face. These are small padding for sutures that are only temporarily attached outside of the skin for securing the repositioned fat tissue. This is fairly typical and is done frequently by some surgeons. There are some techniques that do not involve bolsters. If it is of particular concern to you, you can ask your surgeon to offer you alternative techniques and see if your physical examination allows an alternative procedure. It does not cause any scarring and can be removed after about 5 days post-surgery.I hope it helps

Ivan Vrcek, MD, FACS · Answer

It sounds like your surgeon is planning to transpose some fat to help with the Contours of the lower eyelid and cheek. I do this commonly as do many oculoplastic surgeons. Best of luck!

David Cheung, MBChB, Bsc(Hons), FRCOphth · Answer

Hi greetings from the UK. Yes I would agree with everyone else. It sounds like your surgeon is recommending fat draping where some of the inferior orbital fat is draped over the orbital rim and secured in place temporarily using sutures. Some surgeons secure these sutures through the skin going through a bolster which can often be various materials including cotton wool, plastic tubing, etc. Essentially they act a bit like washers underneath a nut allowing safer more diffuse force distribution for when sutures are tied tighter without fear of causing the suture to pull through the tissue. Quite safe and pretty standard practice so don't worry. Best WishesDavid

Had a lower blepharoplasty consultation, the doctor said he would put in "bolsters" on the outside of my face. Is that typical?

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