Lower bleph + SOOF lift + external excision - would you recommend this approach? (Photos)

Question

I had a Zoom consultation with an oculoplastic surgeon today regarding my festoons and saggy, wrinkled lower eyelids. His recommendation was a lower blepharoplasty with SOOF lift and external skin excision, but no fat grafting. I’m interested in hearing opinions from other oculoplastic surgeons. Does this sound like a reasonable approach for someone whose main concerns are festoons, mloose crepey skin and under-eye sagging? My biggest concern is the external skin excision. As a man, I don’t wear makeup, so I’m worried that any visible scarring could be difficult to conceal. I Would you consider fat grafting in this situation, or is it reasonable to avoid it if there isn’t significant volume loss? Thank you for any advice.

Julian De Silva, MD · Answer

Festoons are one of the harder problems in this area, so it is sensible you are seeking more than one opinion. The approach you were offered, a lower blepharoplasty with a SOOF lift and external (transcutaneous) skin excision, is a recognised and reasonable plan for true festoons with loose, crepey skin. Festoons sit at the cheek-lid junction and respond poorly to filler or to a purely internal approach, which is why a technique that addresses the skin and the deeper SOOF layer is often needed. On the skin excision, I would reassure you: in men the lower-lid incision sits in a natural crease and tends to settle very well, and good lower-lid tone and support at the time of surgery are what protect against the lid pulling down afterwards. The judgement points are how much skin to remove and how carefully the lid is supported, not whether to use an external approach. I would examine your lid tone and the festoons in person before confirming, but the direction you have been given is sound. As a surgeon who specialises in eyelid surgery I often advocate releasing of a tendon that sits in this area that can also aid in reducing festoon swelling and skin tightening procedures (CO2 laser and radiofrequency). Best of luck

Lower bleph + SOOF lift + external excision - would you recommend this approach? (Photos)

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