Ophthalmic plastic surgery is a treatment that primarily deals with eyelid disorders. The focus of ophthalmic surgery is geared toward the correction of cognitive or acquired disorders and cosmetic enhancements.

Blepharoplasty is one such cosmetic procedure that is commonly chosen to address issues like droopy eyelids, excess skin, circles around the eyes, and the appearance of tired eyes. People who opt for a Blepharoplasty often choose to combine the procedure with other cosmetic treatments like the brow lift, skin rejuvenation, or a mid-face lift for an improved look overall.

A Blepharoplasty can be performed on the upper and lower eyelids. Your surgeon will choose between two types of incisions, based on the amount of correction necessary and your individual needs.

Lower Eyelid Blepharoplasty

Loss of skin elasticity, herniation of orbital fat, crow’s feet, and periocular wrinkles are common signs of aging. Patients who wish to undergo a lower lid blepharoplasty often complain about sagging skin, bags, and wrinkles around the eyes. These issues can make one look older and more tired than they actually are or feel.

The traditional approach to a lower lid blepharoplasty is to remove the accumulated pseudo-herniated fat through an incision. The approach is now redefined to reposition this fat into deformed tears through subperiosteal spaces. In many cases, both techniques are combined with secondary strengthening and skin tightening processes.

Types of Incision

There are two types of incisions involved in a lower lid blepharoplasty. They are the transconjunctival and transcutaneous incisions. Using the transconjunctival incision during a lower lid Blepharoplasty, the incision is made 4-6mm away from the lower lid margin, across the lower lid retractors and conjunctiva.

Medial, central, and lateral fat pads are identified by applying gentle pressure on the prolapses of the eyeball. Fat is removed either by using bipolar cautery or radiofrequency technology. The eye muscle separating the medial from the central pocket of fat is left untouched. Aesthetic results are visible about a week after the incision heals.

The transcutaneous lower lid blepharoplasty, also known as the skin pinch technique, is perfectly suited to treat skin laxity when there is no fat prolapse. A subciliary incision is made right below the last line (2mm). The amount of tissue removed is estimated by pinching the excess skin between forceps.

Your surgeon will strategically place the incisions so that they remain hidden once the treated area heals. Such an incision is ideal to address excess sagging skin. The result of this procedure is a more youthful and vibrant look around the eyes.

One important consideration before deciding on the ideal approach is to check the quality of the skin. The transcutaneous approach is the most commonly preferred technique because of its effectiveness in the correction of muscle laxity and excess skin, but the primary disadvantage is greater chances of lower lid retraction.

The tranconjunctival technique, on the other hand, offers reduced chances of lower lid retraction, but is ineffective in the correction of sagging skin and muscle laxity. Presently, many cosmetic surgeons believe in a combination therapy based on the patient’s needs. Consult with your surgeon to identify the best technique for you.

Contact Our Office

To begin your journey to improved eyes, it is important for you to schedule a consultation with a surgeon you trust. Contact our office to schedule an appointment with Dr. Richard Balikian, a board-certified facial plastic surgeon, to learn more.