You appear to be a good candidate for a lower lid bleph. I always find it interesting that general plastic surgeons say that you should only see them for eyelid surgery. Oculoplastic surgeons have unique specialized training in eyelid surgery, so I would have a consult with them. I also would not recommend removing the fat. While this may eliminate the fat pad, it can also leave you more hollow. And you already have a fairly deep tear trough. So make sure your surgeon can perform a fat repositioning where that fat is moved down into the tear trough. This should be done from the inside of the lid with a transconjunctival approach. You should avoid an external, skin only approach to the surgery as this has more potential complications.
Yes, you will benefit from lower blepharoplasty.
However, it is absolutely not true that the approach does not matter. An external incision made through the skin to approach the lower eyelid fat damages the motor nerves of the lower eyelid margin. To compensate for this, surgeons often perform canthal tightening procedures that are simply less than natural. For this reason, more advanced techniques have moved away from this very problematic approach to lower eyelid surgery. A better approach is the tranconjunctival approach from behind the eyelid. Also, the lower eyelid fat should be preserved as a living graft and moved into the top of the cheek. This technique is called an arcus marginalis release. Some type of skin resurfacing would be helpful but it is not essential at the time of surgery to get a good result. Don't be pressured to have skin resurfacing at the same time as surgery unless you are motivated to also have that service. Be aware that general plastic surgeons ( specialists who would be board certified by the American Board of Plastic Surgery) are only one of several surgical specialties who offer eyelid surgery. Unfortunately, they lack the training, skill, experience, and equipment to actually do the very necessary assessment of the eye surface and eyelids prior to eyelid surgery. They are are also more likely to propose surgery through a skin approach. Consider also fellowship trained oculoplastic surgeons and facial plastic surgeons in your area. The American Society for Ophthalmic Plastics and Reconstructive Surgery maintains a regional directory on their website that can help you find a highly qualified eyelid surgeon in your area.
Your consultation is the time to have all of your questions answered - you are wise to contemplate your questions ahead of time! In addition to options, you will want to know risks, benefits, restrictions on activity, care of the lids after surgery, down time, and healing time with each of the various options. I agree with the direction of the Oculoplastic surgeons below - the transconjunctival blepharoplasty will avoid many of the potential complications seen with transcutaneous blepharoplasty. Your skin appears youthful and "plump" in the photos and it appears that you have no excess - therefore most would advise against skin removal. Once the fatty tissue has been removed or rearranged, the skin may be tightened with laser - but I would agree with Dr. Steinsapir's comments. If you have anticipated freshening of the skin or treatment of sun damage with laser resurfacing, it would be a service conveniently timed with blepharoplasty (one "down time"), but if you are uncertain, it may be best to consider that at a later date. Best wishes with your consultation!
There are many options for lower blepharoplasty and the experienced eyelid surgeons have the versatility to choose the technique that is going to deliver the best result for each patient. It is hard to be sure without examining you but based on the included photographs you seem to be an ideal candidate for a transconjunctival lower blepharoplasty with removal or repositioning of the fat and even some fat injection to the crease between your lower eyelids and your cheek bones. If you see lines in the lower eyelids during animation adding laser surfacing may provide even a better outcome.
I would ask if the surgeon is willing to use a trans-conjunctival approach from the inside of the eyelid to avoid an external scar. I would also ask if they plan on removing or just repositioning the fat that is pooching out. Reposition is preferred in order to avoid a hollowed out appearance
Lower blepharoplasty otpions
Lower blepharoplasty has 2 surgical options. A trans-conjunctival approach with the scar inside and fat removal only (if there is good skin tone) or lower subciliary incisions with a scar below the eyelashes in order to remove excess skin and fat. There is slightly higher risk of ectropion (curling of lid margin) or scleral show (change of shape of the eye) with the skin excision procedure.
You have obvious fat prolapse that can only be treated by surgery. I think in our practice you would likely be a candidate for Transconjunctival Lower Eyelid Blepharoplasty which is done through an incision inside the lower eyelid so no sutures or scars. This is a painless 30 minute outpatient procedure and can at times be combined with a post op checmical peel or laser to tighten any loose skin that develops secondarily.
There are some who might also recommend an external approach with some skin removal at the time of the procedure so that is certainly another valid option.
Others might use either of the two approaches mentioned above and transpose the fat into the tear trough region although I am not sure that is a good idea in your particular situation.
Hope this is helpful. Just make sure whoever you go to can do all of the procedures mentioned above and has plenty of experience with facial aesthetic surgery.
Generally, the upper and lower lids age together and show signs of bulging fat and lax skin. A true rejuvenation is accomplished with addressing both the upper and lower lids. Properly performed a blepharoplasty will yield a refreshed, alert and rejuvenated appearance. When only lower lid surgery is performed; and the uppers need work, the results are less than optimal. Seek a plastic surgeon who has surgical experience and an artistic eye.
Lower eyelid blepharoplasty procedure
The primary goal of lower eyelid surgery is to remove the puffiness located in the lower lids created from herniation of the 3 fat pads in the lower lids. In our practice, the fatty deposits are removed through a trans-conjunctival approach on the inside of the eyelids. When patient's have excess skin in the lower lids, a pinch technique of excess skin is performed and closed with tissue glue. Anticipate 2 weeks of bruising and swelling after the procedure. For many examples and more information, please see the link and the video below
chuggie1, I would recommend a "SOOF lift blepharoplasty". See an experienced surgeon that does only faces and has a lot of good photos to review. Search the Internet. Good luck!