The Truth About Lower Lid Blepharoplasty (Ep. 78)

Dr. Jason Hall:

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All right, you ever looked in the mirror and felt like you look just sad or tired, even though you've had a full night's sleep, or kind of have like droopy, sad, like puppy dog eyes? Both of those things are reasons that people come and see me for lower lid blepharoplasty or lower eyelid lips. Today, we're going to talk all about them. You welcome to the Trillium show, where each week we discuss different tips to help you improve your mind, your body and your life. I'm your host, board certified plastic surgeon and medical director of Trillium plastic surgery and Trillium esthetics. Dr Jason Hall, so lower lid blepharoplasty is one of these operations that a lot of people come in asking about, they want lower lid bags removed. They don't like the crepiness or the crinkliness of their lower eyelid skin. And so lower lid blepharoplasty is often thing that we talk about to help improve that. In this show, what we're going to do is kind of go through lower lip buffer plastic from soup to nuts, and you can tell it's kind of hard to say left for row plastic eyelid lift. So what are the goals? Because it's important before we start talking about treatments, to understand what the goals are. Goals of a lower lip buffer plastic are three fold. One is to get rid of the sad, tired puppy dog eye look. Number two is to remove or smooth excess wrinkly skin. Number three is to remove and contour the hollow that develops in our lower eyes with time. But just important, as important as it is to know what things can do. It's important to know what things can't do. So what doesn't a lower lid blepharoplasty do? Well, first of all, while it eliminates some of the crinkliness under your eyelids, it doesn't eliminate all of it, and certainly doesn't eliminate wrinkles and crows feet out to the sides. Those are things that things like Botox and Juve and disport will still be needed to really get rid of those crows feet. The other thing that it won't do is it won't take away completely the dark circles. Now, we could do a whole nother show about dark circles under the eyes and what causes those but a lot of times, people get pigment that gets deposited here in the lower eyelid that occurs over time. A lower lid blepharoplasty will not address that by itself. Now, there are other things that we can do with our lower lid buffer plastic, but a blepharoplasty itself won't get rid of the dark circles 100% and the pigment that's under the eyes. Now it's really important, when we talk about lower eyelid surgery, to understand why we're seeing what we're seeing. If you've listened to my facial aging podcast, which we'll link right up here, the facial aging happens as a result of three main components, skin changes, volume loss, and then gravity. The volume loss is something that around the eyes shows up typically, you know, different strokes for different folks, typically start seeing that late 30s, early 40s, and is what contributes to that tear trough or that eyelid hollow. Some people that happens much earlier. Some people have them their whole lives because of the way that their eye sockets their facial skeleton are put together. But it's important, and one of the things that has really changed in lower blepharoplasty surgery since I've been in training and learned how to do this 15 years ago was we now know that volume replacement is just as important as volume removal. The bag that you see under your lower eyelid, really is the result of the covering of some fat that's in your eye weakening, and that causes that lower eyelid fat to be to protrude out and be a little bit more prominent. At the same time, we lose volume in our cheeks, overlying it. And so good analogy for this is it's like the tide going out at the beach. You know this that volume loss is like the tide going out and exposes the stuff that's underneath. And so bringing the tide back, replacing some of that volume is really important to help smooth the contour between your cheek and your lower eyelid. And so every single lower blepharoplasty that I do, we talk about bringing some fat back into the upper cheek to help soften that transition between the lid and the cheek. The other thing that has really changed a lot since I learned how to do this is that the concept. Kind of opening everything up and and really weakening the lower eyelid has largely been replaced with non invasive, or less invasive approaches where we go in through the inside of the lower eyelid and we avoid the support that is in the lower eyelid, and we'll talk about that here in just a second. That improves. But by avoiding that, we still have to address the skin of the lower eyelid, and we I do that now in two ways. I either use what's called a skin pinch, where we just do exactly what it sounds like, remove a little pinch of skin at the end of the procedure, or what I do most of the time now is use a laser to help resurface that under eyelid skin. And that is, that is by far the most common thing that I do, and we'll get into that here in just a second. So what does a lower blepharoplasty procedure look like? Most of mine are trans conjunct, or going in through the inside, and that's a hard word to say, trans conjunctival. So go in through the inside, and then contour some of that delicate fat that sits underneath your your lower eyelid. Once that is done, then on the outside, will either take a little skin pinch through a little incision right underneath your eyelashes that hides beautifully, or we use a laser to help resurface that lower lid skin. At the same time, we'll use some fat and inject some fat, take a little bit of fat from your abdomen, take a little fat from your thighs and inject that in to fill in some of that hollow the final thing, and I'm very conservative in doing this, is using what's called cancel support. So supporting that your lower eyelid, in the corner of your eye, which is really is less a cosmetic thing, if you really think about it, we're not really changing the shape of your lower eyelid. What we're doing is helping to kind of tighten that lower lid, which tends to get loose over time, and prevent it from dragging down. You've seen people who have had lower lids that kind of walk around like this, not a good look, and very, very difficult to treat. So kind of like most things we talk about in in facial surgery, ounce of prevention is worth a pound of cure. And so what's called a canthopexy, or a little suture that helps to tighten that from the inside, is used a lot in lower lid surgery. In terms of recovery, really swelling for lower lid surgery is the main issue. Typically, like most facial surgeries, I recommend people kind of hide out for about two weeks to make sure that that swelling is gone. If there's a little bit of bruising, a lot of that stuff, we can treat with a laser here in the office right after surgery. And for the fat grafting, the fat transfer, especially in patients who have very thin skin, that swelling under the eye can be noticeable for about six weeks. And that's why I have people I just tell patients, pause your workouts for about six weeks, because the more you exercise, the more you get your heart rate up, your head sees a lot of that blood flow. You're going to worsen your swelling and make it stay around even longer. The other question we get, especially with lower lid surgeries, for people who wear contacts. You want to avoid contacts for about 10 days after the surgery is over. We don't want to lose a contact in an incision. That's a big problem. Never had it happen, but we don't want you to be the first person. So what are the what are the procedures? Can we do with a lower libroplasty? Well, pretty much any facial surgery can be done at the same time we do a lower lid buffer plastic. It's very oftentimes combined with brow lift and upper blepharoplasty surgery. Because we've got the laser out and are using it, we will often do full face laser resurfacing to varying depths, depending on kind of what skin problems we're looking to treat. And a lot of times, a deep plane face and neck lift is done in conjunction with our lower lip blepharoplasty surgery. Few things to watch out for if you've ever had filler in your under eyes and tear trough filler is really common these days. If you've ever had filler in your under eyes, we have to know about that on the front end so that we can dissolve it first under eye filler and surgery doesn't typically go well because of swelling you can have that filler tends to obstruct the fluid drainage, the lymphatic channels under your eyes, and can cause prolonged swelling. So if you've got filler under your eyes, it's important that we know about that so we can dissolve it before surgery. It's also important so we know kind of what we're dealing with in terms of volume replacement before surgery. If you have dry eyes, lower libroplasty surgery will make this worse, at least temporarily, and. If you've got really dry eyes, that it could even be something that will make lower lid Bleu prostate surgery, not something we want to deal with. So it's important to kind of we talk through this before surgery. The other thing that can happen after surgery is something called chemosis, which is swelling of the white part of your of your eyeball itself. It's benign, but it can be a pain in the butt and needs to be treated. So we have some steroid eye drops. Sometimes we'll have to patch for a couple of days to get that swelling to go down. And if it's really severe, we actually need to drain that fluid out in the office, which sounds horrible, but really, isn't we just put a little numbing drop in, make a little snip in the in the covering heals uneventfully, but we that's kind of a last ditch effort. The other thing that can happen, you can have some sub conjunctible hemorrhage. So in the in the white part of your eye can get a little bit of bleeding doesn't happen often. It's impressive looking, but isn't because that part of your eye turned to red. But isn't dangerous. So speaking of dangerous, can't talk about surgery without talking about complications. What's the worst possible thing that can happen? You could go blind. Now this is exceedingly rare. The quoted rate is one in 10,000 it's probably even more rare than that, to the point that most of us who do this have never seen that. Knock wood eyelid malposition is the other big problem. You know, your lower lid getting dragged down by the swelling after surgery. That's a reason for doing the transconjunctible approach, so we're staying away from the support. It's also a reason that we use canthopexy sutures routinely to help support that and prevent that mal position. Corneal abrasions are another issue. Those are really rare kind of eyes scratchy. You have eye shields in during surgery to protect your eyes, but you can get a little scratch, which is painful, but heals without issue. And then, obviously, with any surgery, there's a chance that things couldn't look exactly like we wanted to, and we would have to go back and revise that. So this has been lower lid blepharoplasty in a nutshell. I hope this gives you good information, kind of about how the procedure works, what types of things that this can treat, and, more importantly, what types of things it can't treat. I would recommend everybody go back and in look at the facial aging show that I did. It is a good resource if you're contemplating any facial rejuvenation surgery, to kind of know why you're seeing what you're seeing first. But thanks for listening. If you enjoy the show, please leave me a review on Apple podcast. Please comment down below if you have an idea you'd like to see made into a show. Have a question you want answered, send me an email media Dr Jason hall.com, drop me a DM on Instagram or x at Dr. Jason Hall, thanks again, and we'll see you guys soon. You.