Post Eyelid Surgery: No Under Eye Skin Was Removed During Surgery

What should I ask my Dr. to do now to correct this?

Doctor Answers 11

Lower Eyelid Skin Redundancy After Blepharoplasty

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From what you seem to be describing, it appears you had a tranconjunctival Blepharoplasty (incisions made on the inside of the lower eyelid).  Routinely this is the procedure of choice in young individuals who present with excess fatty deposits under the eyes without much redundant skin.  It is an excellent approach which forgoes the need for visible external incisions, and preserves the strength and integrity of the lower eyelid.  If redundant skin is present after a tranconjunctival Blepharoplasty it can be removed with a minor skin pinch procedure.  I suggest you consult with your surgeon regarding the latter once you are fully healed.... Good Luck  Dr. Corrado

Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Excess eyelid skin after Transconjunctival Blepharoplasty can be treated with Laser Resurfacing or Pinch Blepharoplasty

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If no skin was removed during your lower eyelid Blepharoplasty then you most likely had a Transconjunctival Blepharoplasty.

Excess lower eyelid skin can be treated with either Laser Resurfacing using Fractional Ablative 2940 Erbium laser or a small "Pinch Excision" of eyelid skin will correct the skin excess.

After eyelid surgery, now what.

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You can always go back and review your before photos, with your surgeon and discuss the results.  That's what postop visits are for...your surgeon may have a very good reason that no lower lid skin was removed.  Just because it's there doesn't mean it's safe to take it away.  In some cases, the lower eylid is weak and removing excess skin can lead to lower eyelid malposition.  Ask, you'll fell better when you have an answer.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Skin removal not necesarry in a lower eyelid blepharoplasty

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In my practice, I perform Tranconjunctival Blepharoplasty where I make the incisions on the inside of the lower eyelid- I would assume that this is the procedure that you underwent as well.  This is my procedure of choice because my patients do not present with visible external incisions and I find that this technique preserves the strength and integrity of the lower eyelid.  Nearly 100% of the time, my patients will undergo a skin resurfacing procedure at the time of their blepharoplasty to "shrink wrap" and tighten the skin under the eye for a more youthful appearance.  I would suggest that you consult with you surgeon and see if you are a candidate for CO2 Laser skin resurfacing or another type of resurfacing under the eyes to assist with tightening the skin. Best of luck.  Dr. Clevens

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Skin Removal in Lower Lid Blepahroplasty

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Skin removal in lower lid Blepharoplasty is sometimes, but not always performed based on the preoperative indications.  In fact, excessive skin removal in this area can be detrimental if performed without the proper indications and precautions.  Younger patients with isolated orbital fat pseudo-herniation (fat bags) can have the procedure performed in a transconjunctival fashion, avoiding skin removal and an external incision.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Lower Eyelid Surgery - Skin , Muscle, or Fat

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Lower eyelid bags and wrinkles are due to a combination of factors, including skin, muscle, and fat. Blepharoplasty on the lower eyelid lifts and tightens this tissue. Some patients require only fat removal, some muscle tightening, or some require a combination of eyelid tissue modification. Skin does not need to be removed in every blepharoplasty. Lastly, some approaches such as transconjunctival or "internal" approach is used to remove fat without removing skin.

Speak with your plastic surgeon to help determine appropriate options at this time. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Not all patients undergoing lower blepharoplasty (eyelid surgery) require removal of skin

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Not all patients undergoing lower blepharoplasty (eyelid surgery) require removal of skin. If your main concern was bulging of the lower eyelid, you might not require skin removal, only bulging fat pockets, to achieve a good result. As many of my colleagues have recommended, wait until your eyelids are fully healed to re-assess. It is possible that you will not require any further treatment. If excess skin is an issue a simple excision of lower eyelid skin can typically be performed in the office.

Stephen Weber MD, FACS

No skin removed

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the lower eyelid has multiple components. the skin is simply the outer layer and should be "trimmed, pinched, peeled or lasered" if necessary but left untouched if it is normal. you and your doctor should have a discussion about your case specifics. if necessary the skin can always be managed after 3-6 months minimum. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Do you need eyelid skin removed?

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A personal consultation is need to actually answer this.  For many, particularly young people, addressing the fat from behind the lower eyelid is the best option.  I certainly wait until you are fully healed before concluding that something more is needed.  If so, a skin pinch or chemical peel would be possible options.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

It is often not necessary to remove lower eyelid skin during blepharoplasty.

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1)  Sometimes the bags can be corrected by repositioning the fat through the conjunctiva (the inside of the eyelid).  This approach eliminates the need for a scar and can prevent complications.

2)  Loose or wrinkled skin in the lower eyelids can be smoothed with laser resurfacing.  Again, this avoids the need for skin resection.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.