With age, fat begins to protrude and skin and muscle start to sag at the lower eyelid region. This can spontaneously occur with age when the soft tissue structure called septum of the eyelid begins to weaken and atrophy. Septum functions as a thin wall that confines fat tissue, and as the septum begins to loosen, the fat around the eye starts to move below the eye giving the look of puffiness or eye bags. Also, the lower eyelid skin is stretched and weakened that it accumulates lines.
Additionally for Asians, the orbicularis oculi muscle under the lash line descends, deflating the youthful lower eyelid fullness. Lower eyelid surgery, if performed properly, can improve the appearance of these conditions: eye bags, loose skin, and dark circles (depending on the cause). Because eye sagging may appear to be caused by fat deposition, merely removing fat will not solve the problem. Surgeons will have to examine whether the facial bone structures underneath the lower eyelid is normal, and find out whether a patient requires a fat removal or fat reposition. The correct method depends on the condition of each patient.
Modern advancements have been made to correct some of the problems associated with traditional lower eyelid surgery. Lower complex blepharoplasty is a procedure that incorporates the following advancements.
- Fat Transposition
Newer techniques no longer remove the excess fat but reposition it, transposing it to the area that is depressed or concave. As stated above, the main problem of the sagging lower eyelid was due to the weakened septum that could no longer tightly hold fat tissue. Thus, fat repositioning would not only remove excess fat but also enhances the area that is deprived of the fullness. This way, patients will not have to worry about a malnourished appearance.
- Muscle Release
The muscle that is attached to the bone of the lower eye rim is released to create space for placement of fat, therefore building more volume to the face.
- Cheek Lift
Re-elevation of the soft tissue in the cheek is also performed in combination with the lower blepharoplasty. This will result in a smooth, flush surface from the lower eyelid, allowing the patient to appear younger.
- Muscle Suspension
Muscle suspension is also performed by re-elevating the orbicularis oculi muscle back to its original position. For many Asian patients, this creates the highly desired youthful lower eyelid fullness (see Youthful Lower Eyelid Fullness). And unlike the traditional technique of canthopexy or canthoplasty, the advancements do not alter the eye’s anatomy, providing for the eye’s natural shape.
- Dark Circles
Depending on the cause of the dark circles underneath eyes, modern blepharoplasty may significantly improve the discoloration. Dark circles under the eyes can be caused by two factors. One cause can be due to blood flow blockage or vessel congestion (technically called venus congestion). Another cause of dark under eye circles is the over production of melanin, a substance in our skin that causes pigmentation. If the dark circles are caused by venus congestion, releasing the vessels and increasing blood flow can drastically improve the discoloration. However, if caused by overproduction of melanin, surgery will not be effective. If both factors play a part in the dark circles, the ratio of the attributing cause will determine how effective the surgery will be in improving the dark circles.
The surgery takes place under local anesthesia, with or without oral sedatives. The duration of the surgery is 1.5 to 2 hours. The skin stitches will be removed 5-7 days after the surgery at our office. The critical swelling will subside in 1 week, and the remaining swelling will subside gradually within 8-12 weeks.