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Lower eyelid blepharoplasty is commonly performed along with an upper eyelid blepharoplasty (eyelid lift). Lower eyelid blepharoplasty helps to remove baggy lower eyelids and take away the shadows that make your eyes look tired.  Here are the most common questions, with answers, that we get from patients about the procedure.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How is lower eyelid blepharoplasty performed?

Lower eyelid blepharoplasty is performed by making an incision through the inside of the lower eyelid (transconjunctival approach). Through this incision, the fat pads in the lower lids that form the bags are either removed or repositioned. This smoothes out the lower eyelids. Normally, skin is removed from the lower eyelid just below the eyelashes as well. This is closed with dissolvable stitches.

Question: What will I look like right after surgery?

Lower eyelid blepharoplasty normally causes some bruising and swelling of the lower eyelids, which can travel into the cheeks. The bruising lasts about 2 weeks. The swelling can take 2-6 weeks to completely resolve, depending on your age and the health of your skin.  I tell people they’ll look like they’ve been in a fight, but won’t have significant pain.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: What do I have to do after surgery so I heal properly?

The most important treatment for lower eyelid blepharoplasty is to use ice on the eyelids 20 minutes, on and off, for the first 48 hours after the procedure. This will reduce swelling and speed recovery. You’ll also use antibiotic ointment on the incisions 3-4 times daily for the first week.  Avoiding strenuous activity and not touching the incisions excessively is also important to allow healing.

Question: How long does healing take?

Lower eyelid blepharoplasty takes about 6 months to completely heal, but within 3-4 weeks, you’ll have a good idea of what your appearance will be like. You can conceal any of the mild redness with light makeup.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How long does it last?

While your skin will keep changing after surgery, you can expect the lower lids to look great for many years. It is uncommon that we have to repeat lower eyelid blepharoplasty.

Question: How much does it cost?

Costs vary around the country and depending on if you have lower eyelid blepharoplasty along with other procedures.  As of March of 2016, when this article was written, we charge $2500 for the lower eyelids alone, when done in our office.  When done together with the upper eyelids, the cost is $4000. We also recommend having an anesthesia provider present, which costs around $300 extra.  When done in conjunction with other elective surgery in a surgery center, we charge $1500 for the lower eyelids, which doesn’t cover the extra facility and anesthesia charges.

facial plastic surgery - eyelid lift

Upper eyelid blepharoplasty

Facial plastic surgery: Does it make you look younger or more attractive?

A recent study in the Journal of the American Medical Association: Facial Plastic Surgery looked at how much younger people appeared after certain facial plastic surgery procedures.  It involved one rater looking at before pictures and guessing the patient’s age and rating their attractiveness. A different rater did the same with the after photos and the results were compared. On average, the patients looked 3.1 years younger and were slightly more attractive. The problem with the study was that the same person didn’t see the before and after photos together, which is typically where the most difference is noted and what would happen in real life with a patient’s acquaintances.  But it does highlight a question: Does plastic surgery make you look younger or more attractive, and is this actually the goal?

Expectations around facial plastic surgery

When discussing patients’ expectations before eyelid & brow surgery, I try and stress that I’m not trying to shave off years, just trying to improve their peripheral vision with the added benefit that they won’t look as tired or angry.  We all know that there is “good old” and “bad old” when it comes to how people age.  Some patients, although into their 70’s or 80’s, still stand up straight, show good muscle tone and weight, and carry themselves like much younger people. While many patients in their 40’s to 60’s are just the opposite: overweight, sedentary, with poor skin and poor diet.  Plastic surgery isn’t likely to make this second group significantly more attractive or youthful, given all the other factors making them look prematurely older.  A red flag that someone is going to be unhappy after surgery, no matter how good the outcome, is their expectation that changing this one small aspect of their appearance will solve their problem of not feeling young or attractive.  It just doesn’t work like that.

What I hope my patients can understand is that we are all aging chronologically at the same rate, which no one escapes. No one can expect to look younger than the calendar suggests if they aren’t taking the best care of their bodies. We can slow the feeling of inevitable degeneration by first living a healthful life and only addressing those aspects we can’t otherwise change, such as baggy eyelids or a sagging brow, with facial plastic surgery or other procedure.  Patient’s with these realistic expectations are nearly always satisfied with their outcomes and will radiate both youth and attractiveness to the people they know and love.

 

Dark Circles Under Eyes: 5 deep tear trough treatments

We’ve talked before about dark circles under eyes. One of the most common causes is a deep tear trough.  The tear trough is that depression extending from the inner corner of your eye diagonally toward your cheek.  This depression occurs where the facial fat has thinned out and dropped down into the cheeks. The bone of the eye socket is now right below the skin and the two are fairly well attached to each other.  As the skin above and below age and change, this area becomes even more apparent. It can become dark and develop a noticeable shadow, which makes one appear tired and more aged.  There are many options to treat this, and the methods are changing as we better understand facial aging.

dark circles under eyes - Facial filler Juverderm

Juvederm treatment under eyes and around mouth.

1. Make-up:

Many women (and even some men) utilize concealer in this area to lighten the skin and diminish the shadow.  When the problem is subtle, make-up is a great, non-invasive and inexpensive treatment.  As the problem worsens, however, make-up cannot fully hide the changes and may begin to accentuate it.

2. Skin lightening creams:

In certain people and ethnic groups, the skin in this area darkens. This can be due to actual pigment changes in the skin or from very shallow blood vessels just below the thin skin. When it is pigment related, skin lightening creams, such as hydroquinone, can be effective.  When starting this type of treatment, it is helpful to consult a skin specialist or aesthetician highly experienced in its use. Start with a weaker concentration (no higher than 4%) and use it for a short time until you are sure you aren’t especially sensitive.  Slowly increase the use and concentration until the desired effect is achieved. Rarely will these types of creams completely fix the problem, but they can make a noticeable improvement.

dark circles under eyes - Hydroquinone skin cream

Hydroquinone skin cream

3. Phototherapy:

Intense pulsed light, and even some laser treatments, are used to lighten skin pigmentation and tighten skin in the under eye area. Often this is proceeded by use of a topical lightening cream and possibly a short course of Retin-A to maximize effect.  Again, this should be done by someone with a lot of experience in administering the whole treatment.  Different skin types react differently, so be sure your practitioner explains how they are tailoring your treatment to you personally.

4. Facial Filler:

Hyaluronic acid fillers such as Juvederm, Belotero, and Restylane are well suited to treating the tear trough area when the problem is loss of facial fat volume.  Filling this area back up with a substance that is similar to the building blocks of normal collagen can give a new youthful appearance to the mid-face. It is relatively inexpensive, costing around $500 for a treatment. In many cases it lasts 12-18 months.  Filler is injected with a small needle into the space directly above the bone and then massage around until it appears smooth.  In a few weeks, it softens up be hardly be felt.  It is a safe procedure with some occasional bruising taking place. When injected deep, the chances of it getting into a blood vessel and causing problems in uncommon, although this is the greatest risk. See Dr. Harris explain more about facial filler in a short video here.

dark circles under eyes - Belotero facial filler

Belotero facial filler

5. Lower eyelid fat repositioning and blepharoplasty:

When fat in the lower eye socket begins to come forward, it creates a bag in the lower eyelid. A crease forms at the bottom of the bag over the bone of the eye socket. Lower eyelid surgery (blepharoplasty) is performed to move fat from this bag into the upper cheek and tear trough, which fills in the depression and returns the fat to a normal location, where it was before it descended into the cheek.  In some people, a portion of the fat is also removed. In others we also remove a small amount of skin below the eyelashes. All of these techniques serve to smooth out the transition from the eyelid to the cheek, which is a hallmark of a youthful, rested appearance. See our gallery for eyelid before and after photos.

If under eye shadow or bags are a problem for you, give us a call for a free consultation at (801)264-4420, or email Dr. Harris directly at [email protected].