Lower blepharoplasty CENTER FOR FACIAL PLASTIC SURGERY AT ENT SPECIALISTS
Lower blepharoplasty
Lower eyelid bags and dark circles are most effectively treated with a Lower
Blepharoplasty, also known as a Lower Eyelid Lift. The goal of lower blepharoplasty is to
restore the volume loss at the eyelid-cheek junction also known as the tear-troughor
the dark hollow circle under the eye.
In the past 20 years, lower blepharoplasty techniques have evolved from fat removal to
fat repositioning or fat addition. This involves transposing (moving) the fat from the
“bags” down into the dark hollow circle via a small incision on the inside of the eyelid, a
procedure called Fat Transposition. This is possible only when there is enough fat in the
lower eyelid bags that can be used as a filler. Fat transposition has many advantages: it
corrects the lower eyelid bags, it fills in the hollowness at the eyelid-cheek junction and
provides a long-lasting result with minimal downtime.
The transconjunctival (inside of the eyelid) blepharoplasty is the preferred approach
because it obviates cutting the orbicularis oculi muscle, the number one cause of post-
blepharoplasty lower eyelid retraction and ectropion (eyelid turned outwards). This is a
serious complication that, although usually treatable, can lead to severe functional and
cosmetic consequences, such as constant tearing from the eye, dry and red eyes, pain
and decreased vision. These complications can be avoided by having your blepharoplasty
performed by a surgeon that specializes in eyelid surgery.
Dr DAN’s Technique (#BelphbyDrDan)
Find Your Perfect Aesthetic
Similar to upper eyelid lift, lower blepharoplasty is a highly
customizable procedure because the consequences of periocular aging are different in
different people. Fort this reason, I routinely perform over 10 different types of lower
eyelid lift techniques. The procedure of choice depends on the individual needs of each
patient, the goal being to restore the youthful, rested look of the lower eyelids.
However, in the majority of patients I use a procedure that I developed, called: Stratafix
Fat-transposition Blepharoplasty. This procedure is
performed from the inside of the eyelid and involves redistributing the fat from the
lower eyelid bags into the dark hollow circles underneath. The fat is anchored deep
under the skin with self-dissolvable Stratafix sutures that have small barbes that attach
to the tissues. This obviates the need to place bolsters and remove sutures later on. It
also improves patient comfort postoperatively and speeds up recovery. Whenever in
excess, a conservative amount of skin is removed from underneath the lower lash line.
Fat transposition at the time of blepharoplasty can be used at any age as it restores the
normal anatomy and youthful look in both younger and elderly patients.
Adjuvant (Add-on) Procedures:
Micro-Fat Transfer.
Sometimes, there is not enough herniated fat in the lower eyelids (bags) to fill in the tear trough completely and autologous fat injections are necessary to fully correct the volume loss. This type of lower blepharoplasty called “Augmentation blepharoplasty” is becoming a very common cosmetic procedure in my practice. This procedure involves removing a small amount of fat via liposuction from the belly or the thighs, processing and reinjecting it with very small cannulas (blunt needles) deep under the skin. Using advanced techniques, the fat can be evenly distributed in order to avoid lumps and bumps visible under the skin.
Nano-Fat Transfer.
Sometimes the dark circles under the eyes are produced by excess
pigmentation (melanin pigment accumulation in the skin). In this instance, the best
treatment modality involves the injection of fat stem cells directly into the skin
(“Nanofat”), harvested from the belly or any other site where fat is found in excess. The
fat stem cells produce growth factors that decrease the number of melanocytes (the
pigmented cells in the skin) thus dramatically decreasing skin pigmentation. Nanofat
preparation involves a couple of extra steps of fat harvesting, purification and filtration
which selects the fat stem cells before being injected with very fine blunt needles
(cannulas).
An added benefit of lower eyelid and cheek fat injection results from the regenerative
effect of the fat stem cells that stimulate new collagen deposition in the skin, resulting in
improved skin texture. This leads to a healthier, shinier and younger looking skin over
the injected area.
Canthopexy.
When performed at the time of lower blepharoplasty, a canthopexy can have a significant cosmetic impact on the shape of the eyelid and the eye. Aging-related stretching of the lateral canthal tendon leads to a change from almond-shaped to round- shaped eyes. A canthopexy can restore the natural almond shape of the eye and, at the same time, tighten the lower eyelid muscle to make it look more youthful.
Midface (SOOF) Lift.
A SOOF (Sub-Orbicularis Oculi Fat) Lift is a cheek lift performed through the upper eyelid skin crease incision at the time of lower blepharoplasty. This minimally-invasive procedure lifts the orbicularis muscle and the fat situated underneath in order to improve the convexity and the projection of the cheek and further smoothen the eyelid-cheek junction. The SOOF is anchored to the bone lining (the periosteum) with absorbable sutures that go away after a couple of months, at the time when the tissues have already been fixated in the desired position.
BEFORE THE SURGERY
From the time of your first consultation (whether on-line or in person) till the day of surgery you will have the opportunity to discuss with Dr Georgescu and his staff all your questions and concerns related to the surgical procedure, the preparation and the recovery. Make sure you fulfill all your financial obligations at least 2 weeks prior to surgery. Stop all anticoagulants (Eliquis, Pradaxa, Xarelto, Plavix, Coumadin, Warfarin), anti-inflammatory medication (Aspirin, Ibuprofen, Naproxen, Diclofenac, Indomethacin) and all vitamins and supplements (except for Calcium and Vit. D) two weeks prior to surgery, but only with the approval of your primary care doctor or cardiologist. Make sure you fill your prescriptions before surgery. You need to make arrangements for someone to bring you to the surgery center and take you back home, as you will not be able to drive the day of surgery. You also need someone to stay with you for at least the first night after surgery.
THE DAY OF SURGERY
If your surgery is scheduled in the office, you can have a light meal before coming in.
Take your regular medication as usual. Avoid drinking coffee or alcohol on the day of
surgery.
If the surgery is scheduled in the ambulatory surgery center, do not eat or drink anything
past 10:00 PM the night before! If you need to take your blood pressure or anxiety
medication, do so with a sip of water when you wake up. Make sure you arrive at the
office or the surgery center at the time indicated (our staff will call you the day prior
with the exact time you need to be there). Our surgery center staff will greet you and
make sure all the consent forms have been signed. Your companion can either wait in
our comfortable waiting area, where there is coffee, water and snacks, or can return
back home and we will call as soon as the surgery is over. You will be then taken to your
room where our nurses will place an IV and EKG electrodes. A urine pregnancy test is
performed on all pre-menopausal women. Then, you will meet in person our
anesthesiologist who will explain the anesthesia procedure. Most surgeries are done
under sedation. Dr Georgescu will come and read to you the consent form and answer
any last-minute questions you may have. He will then do the skin markings and may take
some additional photographs. The bed will then be wheeled into the operating room
where the time out will be performed before you go to sleep. The anesthesiologist will
then give you IV medication that will allow you to fall asleep. At the end of surgery, you
will be taken to the recovery room where you will wake up with no pain. We typically
use ice-packs in recovery for 20 minutes to decrease swelling. You and your companion
will be shown in detail how to apply the ointments and ice. After approximately 30
minutes you will be discharged to go home with your companion. We will bring you to
the car in a wheelchair. You will be given Dr Georgescu’s personal cell number to call at
any time if you have any questions or concerns.
RECOVERY & RESULTS
Most patients take between 7 and 10 days off after blepharoplasty surgery. Stitches
dissolve or are removed at 10 days. Bruising and swelling typically go away in about 2-3
weeks. Antibiotic and pain medication may be prescribed for a few days. You will need
to apply ice packs 20 min / hour while awake for 2 days. Starting on the 3 rd day you
switch to warm compresses twice a day 10 min each till the bruising is completely gone.
You will need to apply antibiotic ophthalmic ointment on the incisions and inside the
eyes 4 times a day for 3 weeks. You will also apply Refresh Relieva PF artificial tears
every hour for 2 weeks followed by every 2 hours for 2 weeks and 6 times a day for 2
more weeks.
Starting on the 5 th day we will begin the INDIBA RF lymph massage that is performed in
our office and takes less than 30 minutes. The 3 complimentary sessions are scheduled 3
days apart and will speed-up your recovery by decreasing bruising and swelling.
Strenuous activity, such as golfing, swimming, tennis and weightlifting should be avoided
for 3 weeks. Walking is allowed the day after surgery. Light running and biking can be
resumed after 1 week. The hair can be dyed after one month. Makeup can be applied as
early as 2 weeks after surgery.
You will need to come back to the office the following day to ensure that your eyes are
not dry and that you are healing well. You will also be seen on days 7 and 14 followed
by 1 month, 3 months and 6 months. However, Dr Georgescu is available to see you at
any time if you have questions or concerns.
Although most patients look really good at 6 weeks, they are only 25% healed at this
time and may still experience dry eyes, tearing and blurry vision, especially when
working on the computer or phone for extended periods of time. Full healing normally
takes 6 months, at which time the numbness around the incisions is typically resolved.
Seek Dr DAN’s Advice
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2122 NW 62nd ST, Ste 229 Fort Lauderdale, FL 33309
