Lower Eyelid (Blepharoplasty) Technique
Written by Dr. Julian De Silva
Dr. De Silva’s preferred technique for lower eyelid surgery trans-conjunctival blepharoplasty and this technique involves a hidden incision on the inside lining of the eyelid and avoids a scar in the skin. The more traditional method that is used by surgeons who use older surgical techniques is termed trans-cutaneous blepharoplasty, and involves making an incision immediately below the eyelid, this can be seen after the surgery as a scar. Dr. De Silva uses hidden incision techniques with facial procedures as once an incision is made in the skin on the face it can be difficult to hide. Dr. De Silva almost always uses the hidden incision technique with lower blepharoplasty, although technically more demanding to achieve it avoids any visible scar on the eyelid. There are multiple associated surgical refinements that are utilised by Dr. De Silva that involve alteration of the eyelid curvature, volume replacement and skin rejuvenation that are tailored to the individual these include volume replacement with fat transfer, skin resurfacing for sun-damaged skin and supporting of the lower eyelid with canthopexy and canthoplasty techniques.
Lower Eyelid Blepharoplasty
Dr. De Silva prefers to use hidden incision (termed trans-conjunctival blepharoplasty) in most lower eyelid cases as the surgery although technically more challenging avoids a scar in the skin. In the figure above an incision is being made on the inside lining of the eyelid with a specialised instrument (CO2 laser or monopolar electrocautery machine) this technology prevents bleeding instantaneously, thereby reducing swelling and speeding up recovery. The soft tissues are then supported both superiorly and inferiorly to enable the fibrous septum to be seen in the lower eyelid.
A structurally fibrous layer known as the orbital septum is opened, this reveals the orbital fat pockets, the orbital fat result in the appearance of bags beneath the eyes.There is controversy between surgeons whether the fat should be removed or repositioned (“tissue-sparing”), removal of excessive fat may result in a hollowed appearance that is unsatisfactory and difficult to treat. Dr. De Silva utilises both techniques depending on the individual patient, no two people have identical eyes and facial ageing is dependent on many individual factors. Dr. De Silva’s preferred technique is conservative approach to transpose fat immediately below the eyelid at the cheek, termed fat transposition. In patients where there is a large volume of fat prolapsing forward both transposition of some fat and excision of the remaining fat may be the preferred option.
Dr. De Silva uses specialised state of the art technology including a US-manufactured CO2 laser or monopolar electrocautery to establish meticulous control of bleeding, key to preventing both bruising and preserving good vision after surgery.
Dr. De Silva often supports the lower eyelid with a supporting stitch during the healing period to improve the final result. In the figure above, a canthopexy support stitch has been used to support the lower eyelid to the boney orbital rim this stitch is completely hidden and dissolvable, the stitch dissolves a few weeks after surgery. In addition Dr. De Silva uses special US-tape to reduce swelling after the surgery, this avoid the need for any pads after surgery.
All of Dr. De Silva’s patients are able to see after the surgery and able to home less than 30minutes after the procedure is completed, and no patients require hospital admission overnight with the Dr. De Silva’s techniques.
Other procedures with Blepharoplasty:
Eyelid changes occur as a consequence of genetic and environmental factors and affect multiple layers of the face, including the skin, the soft tissues and the underlying bone. A lower blepharoplasty restores soft tissue changes in the lower eyelid. To give a patient a natural rejuvenation, Dr. De Silva often combines lower blepharoplasty with other procedures to give a fully rejuvenated natural looking result.
- Skin Resurfacing. The skin around the lower eyelids often has wrinkles, lines and changes in colour as a consequence of accumulated sun damage. Fine wrinkles may be smoothened, skin quality improved, and the skin tightened slightly with skin resurfacing techniques. Dr. De Silva tailors the type of skin resurfacing to the individual and includes the use of trichloroacetic acid (TCA chemical peel) and controlled laser resurfacing.
- Volume replacement. One of the commonest changes associated with facial ageing is loss of facial volume, this can result in a sunken depression between the eyelid and the cheek, giving the appearance of a dark circle under the eye. Dr. De Silva uses fat grafting as an effective technique to rejuvenate the appearance of the lower eyelid at the same time as blepharoplasty.
- Droopy Eyelid (Ptosis). Dr. De Silva is a specialist in contouring the eyelids, in approximately 10% of patients aging of the upper eyelids can additionally result in drooping of the upper eyelid. Dr. De Silva utilizes a novel technique for raising the upper eyelid to open up the eyes, freshening up the eyes appearance making them appear brighter and youthful.
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