Visible Scars from Lower Blepharoplasty?

Loose skin under the eyes is a difficult problem.
A transconjunctival blepharoplasty (removal of the fat from the inside of the eye) can actually make the loose skin worse. A TCA or laser peel often helps somewhat but is typically not powerful enough to tighten the skin significantly.
Incisions below the eye (subciliary incision) leave scars that can be visible and in fact are visible in almost all patients, if you look closely enough. Also, removal of skin from below the eye can alter eye shape by pulling down on the eyelid, chaning or rounding the eyelid shape.
Many patients in our practice benefit from a limited cheeklift with an ultrashort incision (USIC), an incision that does not go completely across the lower eyelid but is confined to the lateral portion of the cheek. This accomplishes elevation of the cheekpad (usually also a problem with the aging eye), reduction in the apparent eye-cheek junction (the stepoff between the lower eyelid and the upper part of the cheek), as well as safer tightening of lower eyelid skin than removal of skin alone, or removal of skin with a canthopexy, which can result in a cat-eye appearance when the corner of the eye severely turns upward but the center of the eyelid is rounded downward.
At some point we recognize as surgeons that we cannot fully correct all deformities completely, at least not without causing considerable surgical artifact. So good judgment, conservative thinking and an interest in the midface are recommended when selecting your lower eyelid/cheeklift surgeon.

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Lower eyelid surgery can be performed through both subciliary and transconjunctival incisions. The transconjuctival approach utilizes an incision on the inside of the eyelid and doesn't remove excess eyelid skin. When this method is utilized, there's no visible scarring.In contrast, the subciliary approach utilizes an incision beneath the lash line. When this type of incision is utilized, it's not unusual for patients to have noticeable scarring in the immediate post-operative period. It's important to realize that all incisions heal with some scarring, but the eyelid skin has unique qualities that tend to minimize scarring.In the immediate post-operative period, eyelid incisions tend to be red and raised. These scars tend to respond nicely to massage and avoidance of sun exposure. These incisions tend to heal nicely with the passage of time and in most cases are eventually imperceptible.If you're considering lower eyelid blepharoplasty, it's important to discuss incision placement with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Hello! Thank you for the question! For the lower lid blepharoplasty, the incisions may be made on the skin or on the conjunctive in the inside. It depends on what you need done. If extra skin is required to be removed, there is no other way to do this but excise the skin, leaving an incision just beneath your lashes. The transcontinental approach is limited to remove or repositioning fat in the lower eyelid/orbit. Regardless, blepharoplasty incisions are virtually imperceptible, butonce fully healed. It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Hope that this helps! Best wishes!

The lower lid rejuvenation process can be addressed by a trans-cutaneous approach, which is the route that places the incision just beneath the lashes. The other route is the transconjunctival approach which simply removes the fat from the inside of the lower lid with out any visible skin incisions. The transcunjunctival is not for every one and most times requires some level of skin tightening. This can be in the form of laser skin tightening or just a pinch excision. In general the incision under the eyelashes should be a fine one with a nearly invisible characteristics.

I had a lower (and upper) eye lid blepharoplasty 26 years ago and it was one of the best things I ever did, other than marry my wife. While there is a scar on my lower lids, as I had the outside incision, you are welcome to see for yourself that it is not visible.

The incision behind the eyelid has become popular and can be done in the majority of cases where puffiness is the primary problem. External skin tightening can be achieved with topical treatments instead of skin excision. Obviously you need to be seen in consultation and your surgeon will advise you as to the best way your particular situation can be addressed.

In order to address both contour and skin excess of the lower lids, an incision is placed right below the lash line. Because the skin is very thin here, this line heals up very well without leaving aesthetic issues.
Inside the eye incisions for a transconjunctival eyelid lift sometimes leads to additional skin laxity. In order to prevent this, some surgeon like laser resurfacing in combination with this technique. If you have significant skin laxity to begin with, this may not be enough, though.

Thanks for your question -
You're describing two different approaches for blepharoplasty - One is subciliary (meaning below the eyelash) and the other is transconjunctival (through the conjunctiva at the inside of the lid).
The transconjuntival approach only addresses the contents of the tear trough area. It cannot correct excess skin. This technique can be used with other techniqes (such as laser) to tighten the skin and avoid scars.
I hope this helps.

You are discussing two different approaches to the lower eyelid:

The transconjuntival approach: the incision is made on the inside lining of the eyelid across the conjunctiva hence the name transconjunctival approach. This is used to remove or rearrange the fat but does not treat the skin. Therefore, it tends to be performed in young individuals or those with minimal skin excess or muscle redundancy.
The subciliary approach: the incision is usually placed immediately below the lower eyelid lash line. It tends to heal well with subtle scarring. It is very useful and many surgeries can be accomplished through this approach to treat problems of the skin, fat, muscle or bone. In addition to the lower lid, midface lifts and cheek implants are possible.

Depending on your anatomy and desired treatment goals, your surgeon will discuss if you are a candidate for either procedure.
I hope this helps.

Hi! Thanks for the question! Glad you tried to do more research regarding this matter. To start off, extra under eye skin is quite troublesome. Blepharoplasty can certainly be very helpful, although not all types of blepharoplasty procedures can be useful for the matter. For instance, transconjunctival blepharoplasty or procedure for the fat removal from the inside may make loose skin even work.On the other hand, chemical and laser peels may provide a bit of help, but not really as powerful as blepharoplasty in remarkably tightening one’s skin. Another possible option is subciliary incision or making surgical incisions under the eye. These will leave visible scars when observed closely. This option may even modify the shape of the eye. While these may cause some scarring which may eventually heal overtime, you may want to discuss this with a board certified plastic surgeon. He or she can help evaluate the looseness of your skin, skin quality, as well as possible options that are suitable for your skin type. Hope this helps!