How can my lower hollow, dropped eyelid be corrected? I already done eye bags surgery. (photo)
Doctor Answers 4
How overlooking eyelid support structures can cause pulled down eyelids, and restoring volume in adjacent area
Lower eyelid surgery addresses fat pockets or herniated fat. However, when those fat pockets are addressed, a lot of times surgeons overlook the adjacent area of the eyelid called the eyelid-cheek junction or not pay attention to the cheek area or the submalar area. As a cosmetic oculofacial cosmetic surgeon, I perform eyelid, facelift surgery as well as cheek implants so I really look at the eyes as a part of the whole face. During lower eyelid surgeries, I explain to my patients that there is often concurrent volumetric loss in the eyelid-cheek area as well as in the cheek area.
In your case, the position of your lower eyelid relative to your iris or pupil is slightly lower. The factors that are required for stability of the lower eyelid position needs to be addressed. This includes the lateral canthal tendon which is a tendon that attaches the outer corner of the eye to the bone and the orbicularis oculi muscle which supports the lower eyelid. Depending on the type of surgery you had, whether or not you had skin removal or whether it was done from the inside, there may still be some loss of support in the middle part of the inside of the eyelid called the middle lamella. When the lower eyelid sags in the middle, it may be an indication of that laxity of the support structures under the eyelid.
It is important to do a physical exam to really understand what the patient’s eyelid tone is. We do a snap test where we pull the eyelid down and let it snap up to see what the eyelid tone is. Laxity may be part of the situation with your lower eyelid. If you had skin removal, there may be some degree of a skin shortage.
In terms of problems like hollowing, there is often an involution or a loss of volume in between the rim of the eyelid and the cheek. In our practice, we discuss options for enhancing that area of the rim using a hyaluronic acid filler like Restylane and combining that with platelet-rich plasma. Platelet-rich plasma is derived from your own blood and it is used in our practice to stimulate blood supply, collagen and even increase fat volume in the layers of the skin. From my perspective, regenerative medicine is an important part of my surgical procedures and is independent of our surgical procedures such as in hair loss treatment. I really appreciate the importance of the healthy fat layer under the skin that we lose as we get a little older and because of genetics.
In addition, I’ll advise patients to also address a little volume in the submalar and cheek area so that there’s a continuity and a contour that is very smooth. Often we see patients who have had filler done along the rim or in the tear trough and it looks like their eyes are puffy, so we end up dissolving it or adding volume to create continuity. I always think of the eyelid and cheek as one unit and look at it from different angles.
In the absence of a physical exam, I think it’s best for you to move forward to meeting with either your original surgeon or other doctors who specialize in treating volume. At the same time, consider options related to the lower eyelid. The lower eyelid is deceptively complex and support structures have to be in perfect balance to get a really nice almond shape to the lower eyelid. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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