Common Questions

Eyelift Common Questions

Who is helped by a lower blepharoplasty?

A lower eyelift removes bulging fat and/or skin of the lower eyelid.  Loose skin is more typical in older patients and patients with a lot of sun damage.  The bulging of fat is genetic, and starts to occur in the early forties.  Though there are patients who in their thirties already have fat bulging.

What are the most important factors to consider when deciding whether or not to get a lower blepharoplasty?

Can the surgery make the changes you want?  Are the risks and costs acceptable to you?  Removing the puffy fat is highly successful.  Removing a bit of extra skin is successful.  But many patients expect that extremely sun damaged and crepey skin will be helped, and it is not.  Skin problems are solved – or perhaps just improved – by skin care and lasers.

What is the best age to have a lower blepharoplasty?

Deciding when to have a lower blepharoplasty is not an issue of age.  It is purely a matter of when there is enough of an issue to be worth doing.  Younger patients do not have excesses of skin.  The young lower blepharoplasty patients will notice bulging of fat in their lower eyelids.  That would be the time to at least get a consultation.

Where are the incisions made for the lower blepharoplasty?

To remove fat the incision is made on the inside of the lower eyelid.  The fancy name for this is transconjunctival blepharoplasty.  If skin needs to be removed, then a small incision is made just beneath the lashes along the lower eyelid.  In the past fat was removed from the external incision, but the problem with that is the surgery crosses all the layers of the eye, which can result in scarring throughout all of those layers, which can cause the lower eyelid to roll out.  For this reason many surgeons today, Dr. Teitelbaum included, make a separate incision inside the lower eyelid when they need to remove fat.  And since it is invisible, it is not something that a patient ever notices.

What about lower lid laxity?

It is amazing how fragile the lower eyelid is; just a little tension on it from moving skin beneath it can pull it down, resulting in a loss of the crisp outer corner of the eye, eliminating the almond shape to the eye and showing too much white of the eye.  If you look around, you will notice a lot of people who have this configuration of their eyelids.  To avoid this, Dr. Teitelbaum is very conservative about whether he will remove skin, and when he does, to not be aggressive about how much he removes.  And he will check for so-called lower lid laxity.  He will pull out gently on the lower eyelid to see how quickly it snaps back.  If there is a lot of laxity, he will do a procedure that tightens the lower eyelid so that it can withstand the pull of the removed skin.

What about fat repositioning?

In days past, too much fat was removed from the lower eyelid resulting in a hollowed out appearance.  Plastic surgeons now realize that preservation of fat in the lower eyelids is important.  If there is a pronounced bulge, then fat typically will be removed. But if there is not a lot of fat, but there is a so-called tear trough deformity, meaning a depression along the nose underneath the lower eyelid, then fat from the lower eyelid can be repositioned into this space to fill it up and smooth the contour of the lower lid.

How do you decide how much lower eyelid fat to remove with a lower blepharoplasty?

There was a time when surgeons sought to remove too much fat, thinking that if removal of some of a bulge is good removing more fat would be better.  But if you think about the appearance of a young person’s eyes, they are usually full.  Hollowed can make someone look thinner, but they will look older.  Only enough fat is removed so that the contour is smooth and any outward bulging is removed.  Dr. Teitelbaum is experienced at this and will have a good idea just from looking at someone before surgery to know how much lower eyelid fat will need to be removed with their lower blepharoplasty.  He will also assess the contour during surgery to be sure that it is smooth and even between the two sides.

Will there be scars?

For a transconjunctival blepharoplasty (for removal of just fat), fat is removed from inside the lower eyelid, so there is no visible scar at all.  If skin needs to be removed, there will be a scar along the lower eyelid just beneath the lashes.  This heals very well and is really not visible.

Can I have other procedures done at the same time as my lower blepharoplasty?

A lower eyelid lift can be done as the sole procedure, but it is safe to do with just about any other plastic surgery procedure.  Patients who need a lower blepharoplasty frequently have other issues of concern, such as their upper eyes or face.  A younger patient may also have excess fat in their neck or want a rhinoplasty.

Will a lower blepharoplasty get rid of the deep lines (crow’s feet) on the sides of my eyes?

A lower blepharoplasty only makes changes in the lower eyelid itself; it does not make changes out to the sides of the eyes in the crow’s feet area.

Will a lower blepharoplasty get rid of the wrinkles and loose, crepey skin under my eyes?

If skin is removed, some of the redundant skin will be removed.  But if so much skin is removed that all the lower eyelid wrinkles are smoothed out, then it will pull down on the lower eyelids.  Crepiness is obviously not a proper medical term, but in most people’s rhetoric it refers to extremely thin and fine lines that are the product of dry and sun damaged skin, not the sort of excess.  Such fundamental problems with the underlying properties of skin cannot be totally corrected.  But whatever improvement that is attainable will be a result of skin care or some type of laser or other external energy treatment.

Are the results of a lower blepharoplasty permanent?

The fat that is removed from a lower eyelid will never come back.  As someone ages, there can be a bit more fat herniation, but that is fairly uncommon.  Usually this is a once in a lifetime procedure.  The same is true with skin removal.

If I am unhappy with my results, or if I simply want another lower blepharoplasty down the line, is it safe to do another one?

The most common reason for operating again after a lower blepharoplasty is for removal of some excess fat out to the sides of the lower eyelid.  It can sometimes be tricky to get it out and therefore it is sometimes missed by surgeons.  Dr. Teitelbaum is aware of this and focuses on being sure that he gets this fat out.

Will I have dark circles under my eyes after a lower blepharoplasty?

If your circles are the result of a bulge creating a shadow underneath them, then there will be an improvement.  But true changes to the pigment of the skin are not changed with a lower blepharoplasty.

Will I have loose, crepey skin under my eyes after a lower blepharoplasty?

Crepey skin is fixed only with skin care and a laser, radio frequency, or some other type of energy device.  Small amounts of loose skin can be removed with an incision along the lower border of the lower eyelid along the lash line.

Can lasers that claim to tighten skin give me the same result a lower blepharoplasty?

At best a laser can tighten the lower eyelid skin, but it cannot actually remove skin and especially it does not one thing to remove excess fat.  If there is no true skin excess or bulging a fat, and if the problem is predominantly the skin, then a laser is the appropriate choice.  But a lower blepharoplasty does not replace a laser when a laser is indicated and a laser does not replace a lower blepharoplasty when it is indicated.

What form of aesthesia will be used for a lower eye lift?

It is possible to do a lower eyelid lift under local anesthesia, but given how close you are working to the eye, particularly with a transconjunctival (inside the eye) approach, patients are much happier with a general anesthesia.

How soon can I go to work after a lower blepharoplasty?

When you feel ready to do your job is highly individualized.  So long as your work doesn’t involve straining ad heavy lifting, you can expect to be back to work after three or four days.  Bruising can last up to five or six days, so if you do not want anyone to see you with a bruise plan on being out of work about a week.

When can I drive after a lower blepharoplasty?

You can drive when you are off of all narcotic pain medication ad feel totally unrestricted by your discomfort and vision such that you could make any movement you might need to safely drive your car.  That is ultimately a decision you need to make for yourself.

When can I resume exercise?

I suggest you wait 3 weeks.  I want to be sure that everything is healed.  There is always a chance of causing bleeding if you start much before that time.

When can I shower/take a bath after a lower blepharoplasty?

You can shower or take a bath the same night as a lower blepharoplasty, even if you have stitches along the lower eyelid from a fat removal.

Will I have bruising ad if so, how long will it last?

Patients that ice well the first 48 hours usually have little bruising.  If there is bruising, it is usually gone by about a week.

How long does the swelling last?

Swelling increases after surgery, usually peaking about 5-6 days after surgery.  After that, the swelling will subside, rapidly at first, and then gradually.  After one month, you’ll think the swelling is gone, but it will still go down more at three months, ad even more at six months and even a year, though at that point changes are subtle.

What do I have to do to care for the incision?

The recovery and the pain after a lower blepharoplasty are relatively minor.  Patients are given pain medicine but it is uncommon to take more than one or two of them.  Just putting ice on the eyes is all that is usually necessary.

Will I need to go to an aftercare facility after a lower blepharoplasty?

No.  The pain is minor and it is easy for you to be taken care of at home by a friend.  You really just need someone to bring you ice and your meals for the first day or two.

When do the stitches need to be removed?

There are no stitches on the inside of the lower eye after a lower blepharoplasty and if you have stitches on the outside from removal of skin, those will dissolve.

What should I do to prevent scarring after blepharoplasty?

Eyelid skin heals better than any skin in the body so there is no reason to do anything on the incisions to prevent scarring.

What do I need to watch out for?

The biggest concern after a lower blepharoplasty is bleeding.  If this occurs, there is severe pain on the one eye, the eye swells, and there can be loss of vision.  This is an absolute emergency and you should call 911 immediately.