Lower blepharoplasty (Lower lid lift)

Insurance may pay for eyelid surgery that is performed to improve your vision or comfort of your eyes. Insurance does not pay for lower blepharoplasty surgery since it is performed to improve appearance of your eyes and face.

Yes. It is very common for patients to undergo surgery that improves function simultaneously with cosmetic surgery. The portion of the surgery that is done to improve eyelid function and/or vision may be covered by your insurance company.

Typically, the incision is hidden behind the lower eyelid and no visible scar exists. Most patients with bags in the lower eyelids have little extra skin in the lower eyelids that can be addressed with a Blue peel. Occasionally, patients with significant excess skin can have a conservative amount of skin safely removed from the lower lids. The bags are typically caused by extra fat or fat that is positioned abnormally. If significant amount of skin is removed from the lower eyelids in patients with little extra skin the lower lid can droop causing the whites of the eyes to show between the lower lid and the colored part of the eye. This is called lower eyelid retraction. Lower eyelid retraction is a sign of aging and can create dry eye. Lower eyelid retraction from removing skin of the lower eyelids during blepharoplasty surgery is probably the most common complication of eyelid surgery. Lower eyelid retraction can be avoided by having a procedure with an experienced eyelid surgeon who is acutely aware of the amount of skin, if any, that can be safely removed from the lower eyelid.

Patients often have wrinkles or texture changes in the lower eyelid skin. Texture changes cannot be improved with removal of skin from the lids without causing eyelid retraction. They can often be safely improved by performing a Blue peel at the same time as, or following, lower blepharoplasty surgery.

Yes. This is a common situation. The lower lids become loose with age and in addition to removing the bags from the lower eyelid the lid can be horizontally tightened and elevated to reduce this drop of the lower eyelid. For significant amount of white showing between the lower eyelid and the colored part of the eye your surgeon may elect to put a very thin graft made to lift the lower eyelid on the back side of the eyelid. It is placed through the same hidden incision used for lower eyelid blepharoplasty.

The incision is made through the pink lining on the back side of the lower eyelid. Using this approach, the surgeon can remove excess fat in the lower eyelids or reposition the lower eyelid fat into the dark circle in the lower eyelid. This incision is hidden behind the lower eyelid and is not visible.

It is often more complicated than that. Well-done cosmetic eyelid surgery needs to correct all the problems that have occurred with facial aging to make the lids look more youthful. Some patients only have extra fat in the lower eyelids. This is typically not an aging change as it is first noted as early as high school. This tendency to develop eyelid bags at a young age tends to run in families. In this situation fat removal alone can often correct the entire problem. However, most patients develop bags in the lower eyelids because of facial aging. In this case, the changes that need to be addressed are more complicated than simply removing fat from the lower eyelids. Simply removing fat from the lower eyelids of an aging face can cause a hollow appearance and hollow lower eyelids make one look older, not younger.

Several changes may occur in the lower eyelid that cause bags and dark circles. A youthful lower eyelid is full, short, and has no dark circle under it. With aging of the face the fat from the cheek and the lower eyelid separates. This occurs because the cheek descends or droops with aging which makes the lower eyelid look longer and allows the eyelid fat to move forward. This scenario creates an empty space between the fat of the lower eyelids and the fat of the cheek just at the edge of the bone along the lower eyelid. The situation can be described as two mountains separated by a valley. The first mountain is the bulging lower eyelid fat. The second mountain is the drooping cheek fat. The valley lies in between. In overhead lighting the bulging fat of the lower eyelid creates a shadow in the valley, “dark circle”, at the intersection of the cheek and lower eyelid.

The operation needs to be customized to each patient. In many patients the result is best if the drooping lower eyelid fat is transposed as opposed to being removed. In some patients the result is even better if the drooping cheek or mid-face is also lifted. In some patients who have significant hollowing or dark circles fat transfer must be performed instead of fat repositioning since there may not be enough fat in the lower lid to fill the dark circle.

Fat transposition or repositioning involves moving fat from the lower eyelid into the valley between the cheek and the eyelid. In other words, the fat from the lower eyelid is moved down to fill in the dark circle.

Fat transfer or grafting involves taking fat from another part of the body (e.g., belly, inner thigh, etc.) via minimally invasive liposuction and transferring it to the dark circle in the lower lid. The fat can also be transferred to other facial areas in need of volume restoration such as temples and cheeks for a more youthful appearance.

Recovery varies depending on the exact procedure(s) performed and the individual patient. Generally, eyelid surgery results in bruising and swelling of the eyelids. We ask that patients plan on being at home on the day of surgery and two additional days. During these first three days cold compresses are applied to the eyelids to reduce bruising and swelling. After the third day most patients can drive a car and get about without much difficulty. We ask that patients avoid heavy lifting and strenuous exercise for two weeks after the procedure. Most patients will wear sunglasses for 2-3 weeks to hide bruising and swelling. We will provide you with detailed written instructions prior and after your procedure.

All medical procedures have some risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed. Many patients select Leyngold Institute for Plastic Surgery for their procedure because they believe that the risk of complications with cosmetic and/or reconstructive plastic surgery may be less when the procedure is performed by very experienced surgeons with specialized training and expertise in plastic surgery of the eyelids and face.