In the right care, a blepharoplasty can transform your appearance by removing excess fat and skin around the eyelids and provide needed structure. The result should be a brighter and more youthful appearance. Depending upon your unique issues, surgery may be needed for the upper, lower, or all eyelids. Attention to detail and careful planning with a highly experienced surgeon are a must. You have every reason to expect excellent results from your eyelid surgery. When this does not happen, it is normal to be profoundly disappointed by your surgery.
Fortunately, help is available. You do not need to live with unsatisfactory results. In this article, we address improving a disappointing lower blepharoplasty.
Seeking a Second Opinion
Lower blepharoplasty surgery includes correction of herniated orbital fat and in many cases, removal of excess lower eyelid skin. Lower blepharoplasty is generally a safe surgery that yields great results when you work with an experienced surgeon who specializes in this procedure. When performed well, excessive lower eyelid fullness can be removed to transform a puffy or tired look into a bright and youthful appearance. This is the reason why eyelid surgery is one of the most popular cosmetic surgeries.
Complications from lower blepharoplasty are most commonly seen when the surgeon uses a skin incision just below the lower eyelid lashes to approach the lower eyelid fat. This is also known as a transcutaneous lower blepharoplasty. You have to know the various types of surgeons who offer eyelid surgery. Board certified general plastic surgeons most commonly perform this type of eyelid surgery. Fellowship trained oculoplastic surgeons favor the scar free approach from behind the eyelid. It is associated with far fewer complications but requires the surgeon to work closer to the eye. Oculoplastic surgeons are board certified Ophthalmologists and are very comfortable working near the eye. General plastic surgeons lack the needed training in ophthalmology and avoid surgery close to the eye. They prefer working from outside the eyelid even though this type of surgery is associated with many more complications.
The external incision damages the motor nerves that supply the muscle responsible for holding the eyelid against the eye. This has the effect of pulling the eyelid down, which is not the intended goal of the surgery. In some cases, the surgeon can successfully manage the lower eyelid weakness by supporting the corner of the eyelid with a support stitch called a lateral canthopexy.
Resolving the Underlying Problem
When the motor nerves and the function of the orbicularis oculi muscle are compromised, the lower eyelid can heal permanently in a compromised position leading to inferior scleral show and a pulled down lower eyelid look. When this happens, no amount of eyelid massage or steroid injections will remedy the situation. Since this does not get better as the eyelids heal, a surgical repair is necessary to correct the situation. The solution must address the underlying cause of the problem. This seems intuitive, but there are purported “fixes” that don’t work. As mentioned, massage and steroid injections do not fix the problem. Lateral canthoplasty can’t fix the problem either. The answer lies in designing a more comprehensive surgery that will support the cheek and restore the eyelids to their natural shape and position.
The Vertical Midface Lift
To fix the lower eyelid, it is necessary to lift the cheek vertically to recruit skin into the eyelid and also take the weight of the cheek off of the eyelid. Often the eyelid margin shape is also compromised, and to repair this, a spacer graft is sewn into the back of the eyelid to provide permanent control of the eyelid contour. The best material for this purpose has proven to be tissue from the roof of the mouth (hard palate graft).
To provide long-term support for the lifted cheek, Dr. Steinsapir developed an ePTFE rim implant that is placed on the orbital rim. You may be familiar with the material Gore Tex, which is a particular brand of ePTFE. This material is used surgically in many applications. It is FDA approved for deep facial implantation. The ePFTE rim implant is custom-carved by Dr. Steinsapir for the unique anatomic features of your face – which is never, ever “one-size-fits-all,” and then carefully placed to correct the lower eyelid position at the time of surgery. By following this technique, a well-planned and highly detailed surgery can correct the blepharoplasty and address the contouring issues for which you originally sought treatment. If it sounds complicated, it is. Yes, it is far better to avoid this complication in the first place. However, there is help for those who have not been so lucky.
Schedule a Consultation
Dr. Steinsapir is an oculoplastic surgeon who specializes in correcting eyelid surgery. Patients from across the world consult with him after disappointing results. Dr. Steinsapir can customize a detailed eyelid surgery that addresses your unique anatomic issues. Please schedule a consultation to meet with Dr. Steinsapir, ask questions, and consider customized surgery to restore your appearance.