Lower Blepharoplasty - is there a reason a doctor would not remove skin under eye and only do a transconjunctival fat removal?

Question

61 year old doing upper/lower eyelids. First doctor I met with (not RealSelf member) said not to remove under eye skin and only do transconjunctival fat removal and that it would not totally remove wrinkles below thicker sagginess right below eye and said something about that being water. My concern is that I have very little body fat, especially in face and that if skin is not removed below eye, then it would leave even more sagginess. Right? Thoughts?

John Michael Thomassen, MD · Answer

In your case, I would recommend a transconjunctival fat removal with skin removal along the lash line.  This will correct some of the deep wrinkles in the lower lid.   Adding a TCA peel may also help tighten the skin there.

Zoran Potparic, MD · Answer

Skin does not have to be removed with every lower blepharoplasty. Primary goal of transconjunctival blepharoplasty is to correct and improve fat bags in lower eyelid and correct the groove (tear trough); excision of the skin is done as necessary, based on surgeon's evaluation. Skin removal, however, will not necessary eliminate the wrinkles. Based on these photos, you are a candidate for upper and lower blepharoplasty, with skin excision. Hope this helps.

Steven C. Dresner, MD · Answer

The upper eyelid skin can be removed. A lower blepharoplasty can be perform and skin can be removed, however if you have laxity of the lower eyelid, a lid tightening needs to be performed at the same time. This is best performed by an eye plastic surgeon.

Robert Singer, MD · Answer

I would suggest that you get a consult from another surgeon. Following the advice of anyone who would presume to tell you what to do based on a limited photo and more importantly without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD FACS

La Jolla, California

William Portuese, MD · Answer

From the one limited photo, you appear to be a great candidate for both upper and lower eyelid surgery. The primary goal of upper eyelid surgery is to remove the Hooded and excess skin and a small amount of fat on the inner corners. The primary goal of lower eyelid surgery is to remove the fat bags creating the puffy look. The fat is removed through a trans-conjunctival approach on the inside of the lower lids. At age 61, you'll most likely need some conservative tightening of excess skin at your age. In our practice, that incision is placed directly below the lower eye lash line, and we close that incision with tissue glue. No stitches are required for the lower lids.

Robert T. Buchanan, MD (retired) · Answer

You are basically correct in your assessment. We do a blepharoplasty to remove excess skin and tighten the lower eye area. Your picture would be much more helpful without the glasses. However, it appears that you have enough excess skin to make a blepharoplasty very reasonable. The other option is totally unreasonable. We no longer remove fat from the lower eyelid area as it makes the area even more hollow than it already is since one of the problem with the aging eye is loss of volume. This is in addition to your already having little body fat. In those people without excess skin, transconjunctival repositioning (without removal) of the fat could be reasonable, but I personally prefer just volume replacement with a filler or fat. It appears that you need to see someone who is a true expert in rejuvenating this area.

Lower Blepharoplasty - is there a reason a doctor would not remove skin under eye and only do a transconjunctival fat removal?

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