Lidlift Kenneth D. Steinsapir, M.D.
Cosmetic, Facial & Eye Plastic Surgery

In our last post, we discussed upper blepharoplasty or upper eyelid cosmetic surgery and its benefits in solving particular cosmetic concerns. Lower blepharoplasty or lower eyelid cosmetic surgery (also known as lower lidlift) has its own set of indications and can vastly improve many lower eyelid or under-eye problems. By removing excess fat, skin, or both on and around the lower eyelid, lower eyelid surgery can eliminate bags under the eyes by correcting problems caused by excess and unsightly skin, muscle, and tissue.

Lower Eyelid Surgery Before and After

Transconjunctival blepharoplasty, or tranconjunctival lower eyelid surgery, is the preferred lower eyelid procedure, although what is best for you depends on your particular situation. Transconjunctival blepharoplasty improves the contour of the lower eyelid by correcting herniated orbital fat trapped beneath the eyelid, causing a ‘puffy’ look. This approach uses an incision made behind the eyelid to avoid scaring the eyelid skin or altering the eyelid margin. With an incision from behind the eyelid, unwanted results can be more easily avoided with the utmost precision. Removing this excess fatty tissue will give you a softer, more alert and interested appearance.

Often the puffy lower eyes are confounded by two problems: as previously addressed, excessive herniated orbital fat under the lower eyelid gives this area an inflated look, while the sagging of the cheeks caused from age, stress, or genetics creates a hollow that exaggerates the appearance of swelling or circles under the eyes. Having both these concerns simultaneously means that each problem exacerbates the other; hollow under-eyes make the lower eyelids look even more overly full, while full eyelids makes the under-eye hollows stand out. This compounded problem can be resolved with a procedure called arcus marginalis release, which takes the transconjunctival blepharoplasty one step further. The lower eyelid fat is used to make a living fat graft with its own blood supply. This pedicle of tissue is rotated into the top of the cheek where there is hollowness. This is done through a small incision at a condensation of tissue known as the arcus marginalis. The acrus marginalis release corrects problems of both excessive eyelid fat and the hollow or circle that develops in many of us at the top of the cheek in a single procedure with no skin incision. Like other forms of fat transfers, this procedure is very safe because the body cannot reject its own natural cells. However, unlike other fat transfer procedures that need to develop their own blood supply, the fat from the lower eyelid already has its own blood supply making this transfer of volume highly dependable.

During a lower eyelid procedure, your surgeon’s goal is to correct these problems and aim for a natural, symmetrical look. Your surgeon will take care to remove and/or transfer just the right amount of fat, taking special care to not remove too much, because it is easier to remove more fat later than add it back.

The lateral canthal angle, which is the outer eye corner, may be used as a point of access to perform different procedures. If you are dissatisfied with your lateral canthal angle, this may be a good time for the surgeon to improve it. Dissatisfaction of this anatomic feature is usually caused by prior eyelid surgery. With canthoplasty the surgeon can tighten the lower eyelid and also reconstruct the lateral canthal angle adjusting unsatisfactory issues like a position that is too high or too low. By controlling the shape and position of this corner with precision, an experienced oculoplastic surgeon can attain the desired results.

Improved Methods

Years ago, it was popular to perform related procedures through an incision made just below the lower eyelid lashes. Unfortunately this method sometimes damaged the lower eyelid muscles and created scar tissue. The good news is that the introduction of transconjunctival lower blepharoplasty many changes associated with old style lower blepharoplasty can now be avoided. What does this mean for you? If you are worried about problems you’ve heard are associated with lower eyelid surgery, these are likely the results of older methods that are completely avoidable through more appropriate methods available today. Professionals like Dr. Steinsapir have extensive experience performing transconjunctival lower blepharoplasty, enabling them to obtain the desired eyelid improvement with a significantly reduced risk of complications.

Combined Procedures

Many eyelid procedures can be combine with other facial surgery such as a facelift or forehead lift. Most oculoplastic surgeries can be performed under local anesthesia or local anesthesia augmented with intravenous sedation. Dr. Steinsapir performs many of his surgeries at the UCLA Medical Center Outpatient Surgery Center. Many eyelid procedures can be performed under local anesthesia in the office setting. The doctor will discuss with you the appropriate setting for your surgery. Receiving a chemical peel at the time of lower eyelid surgery is often a fantastic option that will improve your results. Often lower eyelid wrinkles are the result of a combination of fullness and skin laxity. A chemical peel firms the skin and together with fat removal from surgery, the results is improved lower eyelid rejuvenation. A skin pinch is sometimes used as an alternative to the chemical peel in the right circumstance.

Personalizing Your Results

Because no one has eyes quite like your own, a one-size-fits-all approach simply will not do. This is why consulting a doctor who has worked on a diverse range of eyelids will be most informative and yield the best results. Dr. Steinsapir is such a doctor who has improved many combinations of eye concerns. He specializes in minimally invasive techniques and is exceptionally adept at performing corrective procedures. He has developed an number of surgical techniques and treatment methods. His specialization in treating the eyelids is supported by multiple fellowships, residencies, professorial positions, published papers, and of course extensive experience. Dr. Steinsapir never turns over his work to nurses or “physician extenders,” ensuring that you receive the best treatment possible. Contact us today for a consultation to discuss your specific concerns and learn how Dr. Steinsapir can help.