Lower Transconjunctival Blepharplasty: Day-by-day Recovery Details/testimonials? (photo)

and What Are the Chances of "Hollow" Effect? I am quite interested in lower trans bleph. My questions: 1) What are the chances of ending up with a "hollowed" look 5-10 years down the line? Why does that even happen? If it can go from "normal" to "hollow", the fat must be shrinking as we age, so why can't it go from "bag" to "normal"? What can the doc to do prevent this? 2) Are there photos/detailed testimonials of day-by-day recovery process? Is it 2-3 days or 2-3 weeks? Is it just swollen a bit, or all purple?

Doctor Answers 4

Removing Eyelid Fat and the "Hollow" Effect

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The eyeball is surrounded by fat within it's boney socket. This boney socket is cone-shaped.  So there is a downward slope from the back of the socket to the front.  Therefore gravity is always pulling this "peri-orbital" fat downward and forward.  After years of this constant pulling, the fat of the lower eyelid bulges forward, rather than becoming more "hollow".  The "hallow" is produced by the relative depression that occurs just below the bulging fat, which tends to deepen even more as gravity pulls the tissues in this area below the fat bulge downward. (The upper middle and lateral eyelid fat can also recede and start looking more hollow - again, due to gravity's effect on the fat behind the upper eyelid).

In any case, an area of bulging fat in the lower eyelid always makes a person look tired or weary.  To address this bulge, the surgeon can either remove the bulge (fat) itself, or build up the relative depressions around it (especially under it) with either your own fat or with a synthetic "filler" material -- or even do a combination of removing and building up.  Which method is used, and how it is used, is determined by how natural and aesthetic the result will be with either method.

In your case, the most natural look would be achieved by removing some of the fat surgically along the entire length of the under-eye area and filling in the "tear trough" area (below the medial part of the bulge nearer the nose) with some of the removed fat. This is called "lower eyelid fat transposition" surgery, where fat from an area of excess is released and then advanced into an area where there is too little fat.

Most people take 2 weeks off of work after having this procedure done. Bruising and swelling can be minimized by the meticulous technique of the surgeon combined with proper post-surgery care by the patient.

Trans-conjunctival blepharoplasty

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Orbital fat should always be removed through trans-conjunctival approach for best results. The amount of fat removed will determine whether not too much or not enough was taken Resorption of fat does not occur 5 and 10 years after the procedure.

Transconjunctival Blepharoplasty vs. Fat Transposition Lower Blepharoplasty

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Thank yo for the question and your photo.  You bring up some very valid concerns and important issues.  The transconj lower bleph removes fat via an incision inside the lower eyelid.  The benefit of this approach is the relatively quick recovery.  However, the problem is that many patients will end up looking hollow.  Removing the fat from this area can give a smoother contour to the lower eyelid/upper cheek region.  However, with time and further changes in the fat of the cheek, the eyes often look sunken or hollow.  In my practice, I perform a fat transposition lower blepharoplasty.  In this procedure, the fat from the under eye area is used to fill in the hollow area under the eyes (tear trough region) and is connected to the cheek fat.  This gives a smoother appearance and a fuller, more youthful cheek and lower eyelid.  Lastly, this approach allows extra skin and muscle to be removed at the same time, if needed. Best of luck moving forward!

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Lower transconjunctival blepharoplasty questions

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When a transconjunctival lower blepharoplasty is performed, excess fat is removed through the inner part of the eyelid to improve the bags under the eyes.  If too much fat is removed, it can result in some hollowness beneath the eyes.  If this occurs, it would be noticeable fairly soon after the surgery and not occur 5-10 years later.  The recovery period is about a week, but can vary by individual.  Some people may get bruising while others do not.  The amount of swelling can also vary.  I would say for most people, the eyes look presentable after a week.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.