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.

1554Anon

 

Sean has contributed many articles on this subject.  However, in his article, transconjunctival sub-orbicularis oculi fat (SOOF) pad lift blepharoplasty which appeared in the Archives of Facial Plastic Surgery in 2000, he stated: "The transconjunvtival suborbicularis oculi fat (SOOF) pad lift blepharoplasty is a new approach that I have used for more than 18 months in 64 patients." However, many surgeons have been working on these techniques really over the past 25 years.  No one individual owns these methods.I do recommend getting additional opinions. Consider traveling to NYC for some consultations as well.  A photograph would also be helpful.  It is my opinion that mid face lifts have probably hurt more people than helped them.  The lower eyelid is a humbling area to work on with many well meaning surgeons going awry.  The important thing here is to find a surgeon who makes sense to you.  Don't get hustled into more surgery than you need.  Avoid surgeons who are cookie cutterish.  Ask yourself if your consultation involved an examination.  Did the surgeon actually touch and manipulate your face or was everything discussed over a desk.  If you are not certain, that may be a sign that neither surgeon was your guy or gal.   

There is not one procedure that is applicable to all patients.  The procedure needs to be customized to the individual patient.  Without seeing pictures of you or examining you in person, it is impossible to give you specific or individualized advice.  There are many different techniques for lifting the face, the mid face and addressing the lower eyelids.

 

Good luck.

As with many situations in facial plastic surgery there is not one answer that applies to all situations. The issue here is that when the tissues of the mid face are lifted upwards they tend to push the lower eyelid skin towards the lid margin, causing some wrinkling of the lower lid skin. Whether or not you need a lower lid blepharoplasty with your mid face lift depends on how much wrinkling of the lower eyelid skin you get. If you have had your lower lids done before, you may not get enough wrinkling of the lower lid skin for this to be an issue. Sometimes though, even if you don't seem to have much lower lid skin present prior to the surgery, you get enough mid face elevation with the lift that you end up with enough lower lid wrinkling that you will need to have the extra lower lid skin removed in order to get a result you like. My personal preference is usually to make the judgement at the time of surgery. After the mid face lift is done, I will reassess the lower lid skin to see if it needs to be addressed. The key, remember, is to get the results you desire. We don't want to do surgery that doesn't need to be done, but also want to make sure that after having the amount of surgery you are talking about, that you are not unhappy with the results because of remaining wrinkles under the eyes. I hope this helps. Good luck. 

if you have been operated on years ago of lower bleph, and you are  going to get  a mid, lower and upper lifting  you  surely will need  an uncomplete  lower  bleph correcting  only skin and muscles  without touching the palpebral fat sacs.

si tu ya has sido operada previamente de los parpados infs y te vas a someter a una riti medial, inferior y superior seguramente vas a requerir tocar los parpados infs, pero en forma incompleta es  decir  solo tocarias la piel y el musculo pero no las bolsas  palpebrales

I am not a big fan of mid face lifts alone.  I usually elevate the cheek from a full facelift.  The midface lift has a significant complication rate in many studies.  One problem is when too much skin is removed from the lower lid.

There has been a trend moving away from midface lifting towards more conservative (and therefore, more safe) lower eyelid surgery.  While some limited fat and skin removal may be required (not always), many physicians are relying on resurfacing (e.g. fractionated resurfacing lasers) and fillers (e.g. hyaluronic acid fillers such as Juvederm and  Restylane, or fat injections) either with or without surgery.  In my experience, and seemingly the experience of many other facial surgeons that I greatly respect, the risks of particularly aggressive midface lifst do not predictably match up to the rewards.   

There is no usual in facial rejuvenation surgery. Every case is unique and based on the patient's needs and concerns. Photos would certainly be helpful. I also agree with others that there is a difference between a little "nip/tuck" in the lower lids and a full blepharoplasty so you may want to get a clarification on this point. Good luck!