Risks of Fat Pad Removal on Lower Eyelids?

Dear Eyelid Surgery Patient from San Jose,
Removal fat pad from lower eyelid is done with a procedure called Transconjunctival approach. With this technique, incisions are made on the inside of the lower lid and fat is extracted. There are less chances of abnormal tearing or dry eye syndrome associated with transconjunctival approach in compare to traditional lower blepharoplasty. Although in some case with transconjunctival approach there are swelling in the area that cause temporary abnormal tearing.
 

Dear Brown Spots,
2 questions in one.
1."When they remove the fat pads from the lower lids is there a risk to tear production?" - As was previously stated, any surgery on the eyelids COULD be associated with change to the tear film AND the way it drains across the eye. Lower lid surgery may be associated with a temporary dry eye which is controlled with eye drops.
2. "Risks of fat pad removal on lower eyelids?" Surgical complications are unlikely events that cannot be foreseen. Most are unlikely; some are VERY unlikely.
Removal of the fat pads of the lower lids can be done through a thru the skin (trans cutaneous) incision or through the smooth pink lining (transconjunctival) approach. The skin incision approach may be associated with the lower lid pulling down and white showing. Both approaches may be associated with damage to one of the muscles the move the eyeball resulting in double vision when looking down as well as the removal of too much fat, unveiling the rim of the eye socket giving an older Boris Karloff (look it up) appearance. Finally, there is a VERRRRRY small chance of blindness. (It has been reported - we all know about it - I never met a surgeon who has personally seen it).
Hope I did not scare you too much and that this was helpful.

The lacrimal gland is responsible for tear production and it is located beneath the tissues of the upper eyelid. There can be a very remote possibility of lacrimal gland injury with upper lid blepharoplasty, but not with lower lid blepharoplasty alone. However, tear film quality and quantity is often temporarily affected after blepharoplasty, and patients may notice dryness of the eyes after surgery. The dryness is almost always temporary, and is easily relieved with the use of over the counter artificial tears. For my patients with a preexisting problem with chronic dry eyes, I recommend that upper and lower lid blepharoplasty not be done at the same time. For most individuals, though, upper and/or lower lid blepharoplasty is a safe, effective way to enhance and refresh the appearance of the eyes.

Thank you for your question.  Dry eye can occur after lower Blepharoplasty.

The risk is greater when an external incision is made because the external incision can weaken lower eyelid support exposing more of the eye to air and dryness.

However transconjunctival lower Blepharoplasty is a more modern safer technique in which the incision is made inside the lower eyelid and leaves the eyelid support intact.

In my experience dry eye is very uncommon when this newer approach is used.

If you already have dry eye or decreased tear production your risk will be greater.

 

Lower lid surgery normally does not interfere with tear production. However, temporary dryness of the cornea can occur. Skilled surgeon's pay great attention to this potential problem and if it presents it can be treated with lubrication and other conservative options in the vast majority of cases. This problem is more likely to occur in those with a previous history of dryness or inability to wear contacts. In these individuals it is wise to test the tear production before surgery.

It is not unusual after a lower lid blepharoplasty (including removal of fat pads) to experience a brief period of dry eye (which can lead to excess tear production). This is temporary and the use of wetting agents are beneficial. There is no risk of damage to the lacrimal gland which produces the tears to begin with. If your symptoms persist beyond 7-10 days or you get red, irritated eyes see your surgeon.