Lower Eyelid Surgery (Blepharoplasty)

(Click to enlarge images)

Dr. Abedi routinely performs upper and lower lid blepharoplasty at the same time. Patients who often have upper lid aging signs may also have lower lid aging signs which include prominent lower lid fat pockets (lower lid eye bags), volume loss and hollowing, and even excess lower lid skin. A lower lid blepharoplasty can help improve the look of the lower lid. Dr. Abedi employs the latest advanced techniques to help allow you to look as natural looking as possible while having a result that leaves you looking refreshed and youthful again. When you meet with Dr. Abedi, ask if you would benefit from a lower lid blepharoplasty at the same time as an upper lid surgery.

Dr. Abedi is an eyelid plastic surgeon and exclusively performs cosmetic eyelid surgery. Every patient that he examines for cosmetic eyelid surgery presents with variations in eyelid aging, and each surgery has to be customized and tailored to that specific patient.

When evaluating each patient, Dr. Abedi examines for the following Amount of excess lower lid fat (also termed ‘prominent orbital fat’). Excess fat will likely have to be removed in order to rejuvenate the lower lid’s appearance. The type of surgery that Dr. Abedi performs to remove the excess lower lid fat is called a lower lid blepharoplasty.

Volume loss along the lower lid and cheek area. Volume loss appears as hollowing, which is usually seen along the infraorbital rim, which is the bone below the lower eyelids. This hollowing is located below where the prominent lower lid fat occurs.

This is a patient with BOTH prominent lower lid orbital fat and infraorbital rim hollowing. Black dotted line denotes the infraorbital rim. Prominent fat pockets are seen above that. Double asterisks denote the “tear trough deformity,” and single asterisk denotes the “lid-cheek junction.”Both the tear trough and the lid-cheek junction are part of the infraorbital rim.

Patients that have both excess lower lid fat AND hollowing along the infraorbital rim can benefit from a lower lid blepharoplasty with fat repositioning.

Amount of excess skin. In addition, to remove excess lower lid fat pockets, lower lid blepharoplasty should also address the excess lower lid skin. Some patients may have mild excess skin which often ablative resurfacing through a chemical peel or laser resurfacing can help tighten the skin and improve the appearance. Patients that have a significant amount of skin will likely require excision of the skin through either a skin pinch or a skin-muscle flap blepharoplasty approach. Dr. Abedi will examine you and determine what you are the best candidate for.

Transconjunctival versus transcutaneous lower lid blepharoplasty

Dr. Abedi performs her lower lid blepharoplasty through either a transconjunctival approach OR a transcutaneous approach. Dr. Abedi will perform a complete Oculoplastic examination and determine what approach will better serve you and your surgery goals.

Transconjunctival blepharoplasty:

This is an advanced scarless technique that Dr. Abedi uses in many of her patients. The incision is carefully made inside the lower lid so that the skin is not directly cut and hence no visible scars. The transconjunctival approach allows for direct access to the prominent fat pockets. Excess fat pockets can be removed or repositioned through this approach. Fat pockets are removed through heat-induced sculpting while repositioning actually involves moving the excess fat to help fill in the under eye hollows that people have with aging. Dr. Zoumalan will determine if you are a candidate for fat repositioning. The fine wrinkles or excess skin cannot be improved with a transconjunctival procedure alone; usually, Dr. Abedi will recommend either a chemical peel or a laser to help improve the fine wrinkles or excess skin underneath the eyes. Both are effective and can provide a tightening effect to the skin and also help reduce the fine wrinkles. Either laser or a chemical peel can be applied to the lower lids at the same of your transconjunctival lower lid blepharoplasty. Botox can also be used to relax the crow’s feet in the corners of the lids which laser or chemical peel cannot treat.

Transcutaneous blepharoplasty:

This is a well-described lower lid cosmetic surgery procedure, which involves directly removing excess lower lid skin at the same time as removing excess fat. A transcutaneous blepharoplasty is performed in cases where there is excess skin and weakened muscle in the lower lids that a chemical peel or a laser alone may not adequately treat. Excess fat pockets can still be removed or repositioned with this procedure

This procedure not only rejuvenates the lower lids by removing the puffiness and dark circles but can also help tighten the lower lid muscle and skin where a laser or chemical may not do as well. Dr. Abedi specializes in skin muscle flap blepharoplasty, which is an advanced, minimally invasive transcutaneous technique that tightens the excess skin and underlying weak muscle. Dr. Abedi will examine you and determine if you are a candidate for this procedure. Dr. Abedi has published her latest findings in advanced lower lid blepharoplasty and continues to speak at conferences about her expertise in this topic.

Fat repositioning

Fat repositioning is a technique that Dr. Abedi performs in patients that have BOTH excess lower lid fat pockets and hollowing along the infraorbital rim. The excess fat pockets are identified at the time of surgery and carefully prepared as fat pedicles. They are then trimmed to the desired size and repositioned into the areas along the infraorbital rim where hollowing is noted. Fat repositioning allows for a more natural looking appearance while preserving the patient’s volume during surgery. Fat repositioning can help prevent hollowing after lower lid blepharoplasty. However, some patients may still have hollowing despite lower lid fat repositioning, and in that case, Dr. Abedi will recommend if you may need further procedures such as injectable fillers to better improve the hollowing after surgery. The injectable fillers that Dr. Abedi uses around the eyelid area are composed of hyaluronic acid and can be performed in the office using topical numbing cream.

This figure shows two fat pedicles that are repositioned along the infraorbital rim to fill in the hollowing. The white line is the infraorbital rim. The arrows along the fat pads show the direction of where the fat pockets are directed.

This is a side view illustration of how the fat pocket is repositioned to fill in the hollowing. This is all done without an open direct incision and through an incision that is not visible.

Combined cosmetic procedures

Eyelid surgeries and Brow lifting procedures A lower lid blepharoplasty can be performed with other cosmetic surgeries at the same time. The most common combined procedure with a lower lid blepharoplasty is an upper lid blepharoplasty, where excess skin and fat pockets in the upper lid are removed. Dr. Abedi commonly performs both procedures at the same setting. Endoscopic brow lift or a temporal-based brow lift can also be performed at the same time to help rejuvenate the brows in patients that have droopy and low set eyebrows.

Other combined surgeries with other specialty plastic surgeons

Dr. Abedi routinely works with her colleagues in combined cosmetic surgeries to help achieve her patients’ comprehensive cosmetic goals. If you desire to undergo other cosmetic surgeries to be performed at the same time as your lower lid blepharoplasty such as Rhinoplasty, Facelift, Necklift, Breast or Bodywork, Dr. Abedi, and her staff will help you in achieving your goals. Dr. Abedi exclusively performs eyelid surgery, but he works with a multi-specialty plastic surgery team comprised of board-certified plastic surgeons and facial plastic surgeons, which all together can help address your cosmetic needs.

Preoperative diagnosis: Bilateral upper lid ptosis and brow ptosis, lower lid excess fat pockets.

Procedure performed: Bilateral upper lid ptosis repair, upper and lower lid blepharoplasty with fat repositioning to lower lids, and left external brow pexy.

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