Is a Lower Bleph Usually Done with a Mid-face Lift?

Hi 1554anon,

 

You stated the reason why mid-facelifts and lower eyelid surgery are often performed together, because of the potential for the lower eyelid skin bunching and causing more wrinkles under the eyes than prior to the mid-facelift.  

 

Just because they are often performed together for good reason, ultimately each person's face is different and their past surgical history is also different.  If a surgeon follows a cookie cutter approach to all faces, then there is a risk of performing unnecessary surgery and with each additional surgery additional risks apply.

 

If you smile, it is similar to a mid-facelift.  When people smile the cheek rises and the lower eyelid skin can bunch and wrinkle.  Not all mid-facelifts performed by different surgeons are equivalent.  You are not buying a shirt at one GAP store, which would be the same at another GAP store.  Instead each plastic surgeon is like a contractor.  Depending on which one you choose, you can get very different results.

 

Some patients who have had bad lower eyelid surgery with ectropion, or lower eyelid malposition already have had too much lower eyelid skin removed.  Some reconstructive eyelid plastic surgeons will perform a mid-facelift alone to help push the lower eyelid upwards to improve the post lower eyelid complications.  I have seen one patient who had a lower eyelid and mid-facelift combination have a problem when she opens her mouth, the lower eyelid pulls away from her eyeball.  When she doesn't have any facial expression, it looks fine, but obviously this is not natural, and for this patient the cosmetic improvement was not worth this post-operative problem.

 

If the mid-facelift is performed conservatively, and taking into consideration the fact you already had a lower eyelid surgery in the past, I can see why one of the surgeons did not recommend it.  

 

In general, I am not a big fan of the mid-facelift procedure and prefer volume restoration of the transition area of the lower eyelid and upper cheek using either fat grafting or fillers, depending on the patient's age and facial aging issues, and preference for surgical versus non-surgical improvement.

 

I am also not a fan of aggressive browlifts either.  I wrote an online article titled, "To Browlift or Not to Browlift that is the Question" explaining my thought process.

 

Be careful, do your research, and good luck on your plastic surgery journey!

 

Best,

 

Dr. Yang

The issue with mid-face lifts and lower blepharoplasty is that at surgery the cheek lifting can cause some bunching of lower eyelid skin. The surgeon then removes this skin. The problem is the patient is lying down not standing and some of the cheek lifting is also lost after surgery. The end result then is too much lower eyelid skin was removed at surgery. You have to be very conservative with this type of surgical combination to avoid future problems. Without photos or a face to face examination it is impossible to say what would best in your case.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

No, lower blepharoplasty is not ALWAYS indicated with midface surgery.  However, it is true that the subperiosteal midface lift creates a powerful lift of the cheek and can create excess skin that needs to be addressed through lower blepharoplasty.  Also, depending on the amount of excess lower lid fat that is present, blepharoplasty may or may not be indicated.  If you've had a lower bleph in the past, chances are, no lower bleph or a minimal lower bleph is necessary.