I'm considering various procedures to eliminate thin, sagging skin that I'm starting to under my eyes. I had heard that lower blepharoplasty left no visible scars - that the scar is inside the lower eyelid. However, everyone having gone through it here says they now have visible scars. Can someone shed some light on this? Thanks in advance! - michelle
Visible Scars from Lower Blepharoplasty?
Doctor Answers 15
Loose skin under the eyes
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.
Lower eyelid blepoharoplasty: the incision options
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.
Scars and lower lid blepharoplasty
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.
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Visible scars from lower blepharoplasty?
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!
Lower lid scars
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.
Lower blepharoplasty may result in barely visible scars
Lower eyelid blepharoplasty can be performed in a number of ways. Some approaches allow for an incision through the inside of the lower eyelid. In this situation, no visible scarring will be seen.
Other approaches, however, require an incision through the skin just beneath the lower lashes. In this situation, a visible scar will be present. This scar however tends to be barely perceptible and easily camouflaged with normal eyeliner. The type of procedure most appropriate, depends upon the type of eyelid deformity one has.
If the problem is one of excess fat in the lower eyelid without excess skin, then a trans-conjuctival approach through the inside of the lower eyelid will be appropriate.
If, however, one has a significant amount of excess skin in addition to excess fat, then a more traditional transcutaneous approach through the skin beneath eyelid lashes will be more appropriate. This will allow for removal of both fat as well as excess skin. Although this approach does result in a visible scar, it is rare that the scar is of any clinical significance.
For most patients, it is difficult to see the scar in as little as two or three months their surgery. Your doctor should be able to advise you as to the most appropriate approach for your situation.
Scars after blepharoplasty
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.
Subciliary for skin removal
If you have sagging skin you will need a small incision under the eye lashes. This incision usually heals very well and leaves behind a very thin scar that is hard to see.
The transconjuctival incison allows removal or redraping of excess fat pockets. It does not allow removal of excess skin.
Lower Eyelid Blepharoplasty Incision Options
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.
If you have extra skin you will have a scar
It's true that lower lid blepharoplasties can be done in many different ways. The transconjunctival or incision inside the lower lid is used when only fat removal or fat redraping is needed.
However, if any skin needs to be removed or if the lid needs tightening than a skin incision is made. This incision is just under the eyelashes and extends into the lateral crease a few millimeters. The scar is very imperceptible when healed.
See several Board Certified Plastic Surgeons to find the one you're most comfortable with.