Lower Blepharoplasty

What is a Lower Blepharoplasty?

This operation is a lower eyelid lift procedure. Unlike the upper eyelid procedure, gravity is working against us with a lower blepharoplasty and therefore is rarely a skin only operation. Our knowledge of the complex anatomy of the lower eyelid means that this procedure is often combined with a canthal tightening procedure and treatment of the lower eyelid fat pads.

The lower eyelid is made up of the following structure:

Anterior lamella: skin and orbicularis occuli muscle
Posterior lamella: tarsal plate, capsulopalpebral fascia attaching to the arcus marginalis (part of the lower bony orbit), and conjunctiva.
The ligamentatous structures: the lower eyelid is like a sling including lockwood’s ligament suspended from the medial and lateral canthal ligaments which are at the inner and outer corners of the eyes.
The fat pads: there are three fat pads sitting in the lower eyelid.
The muscles surrounding the eye: these include the three parts of orbicularis occuli, the pretarsal, preseptal and preorbital. The eyelid cheek junction is defined by the capsulopalpebral fascia. With age, gravity and some genetic factors, this fascia becomes lax allowing for bulging of the fat pads.

Fat grafting

Depending on your anatomy and eyelid structure, you may benefit from adjunctive fat grafting. This is placed into the cheek area and around the lower bony orbit. 50-80% of the fat survives long term.
Where we take fat from (around the belly button, from the thigh area) should have tight bike shorts applied for a minimum of 4 weeks after.

Chemical peel

You may need this to tighten the lower eyelid skin. The skin will need to be prepared with topical creams for one month.

About the procedure

The procedure takes around 2-3 hours depending on what you need. You will need to be fasted for 6 hours before the procedure. Pre-operatively the skin is carefully marked. Local anaesthetic is then injected into the area. The excess tissue is removed and the blood vessels carefully cauterized. Sutures are then carefully placed and then tape is applied. You will then be given pain killers.

Where is this surgery performed?

Lower blepharoplasty is an operation which is done in a major accredited hospital under general anaesthetic. It is performed as day surgery and usually takes two hours. The ligaments are restored to their rightful places with treatment of the lower eyelid fat pads. The skin is minimally tightened to restore the youthful eye appearance.

How can I prepare for surgery?

You will need to see Dr Hadi twice. The first consult takes you through the operation as well as expected results. The second consult is at no extra cost to you and runs through things again. All risks and benefits will be discussed with you and treatment will be tailored to your needs and your body shape.
When you decide to proceed, there are a few things you can do to prepare.

 

  1. Eat healthily by avoid excessively fatty foods and foods high in sugar.
  2. Stop smoking as this significantly increases complications rates. You cannot smoke for 6 weeks prior and 6 weeks after surgery.
  3. Two weeks prior to surgery, stop all anticoagulants and antiplatelet medications unless previously discussed with Dr Hadi. Please stop any over the counter medications that might thin the blood, a comprehensive list will be provided during your consultation. Please check any over the counter medications to see whether they contain these ingredients.
  4. Shower the night before or the morning of surgery with anti-bacterial soap. These reduce the bacterial living on the skin and there is evidence is reduces chance of infection.
  5. Fast (do not eat anything) at least 6 hours prior to surgery. You will be given this time from Kareena Hospital.
What does this operation involve?

This is a complex operation involving tightening of the outside
When there are bulging fat pockets, this procedure is done in theatre under a general anaesthetic. In these cases, the eye lid structures are protected and these bulging fat pads are redraped with minimal removal. This allows sculpting of the tissues around the eyes while adding definition.

What is special about this operation?

The recognition that the relationship between the inner and outer parts of the eyelid are important. With time, the outer aspect of the eyelid becomes lax and droops down as it becomes stretched. This gives us a sad look. Part of the surgery is to restore the outer corner of the eyelid upwards by suturing the outer corner of the eye. This is a canthopexy procedure.
The junction between the lower eyelid and the cheek is also important. This operation is tailored to the patient. In some circumstances, the bulging fat pads are minimally resected, while in other circumstances they are redraped across the lower orbit bony margin. This allows the tear trough to be treated.

How long will I stay in hospital?

The surgery is usually performed as day surgery so you can go home the same day as long you are well enough to go home. However, you can stay overnight if you wish.
You will be given antibiotic tablets and pain relief tablets to take home so that you can be comfortable. You will be given Dr Hadi’s number to contact her if you have any concerns or questions post operatively.

What about the sutures?

Your wound is closed with a dissolvable sutures.

When can I shower?

You can shower from the next dry. The dressings can get wet, please blow dry them if needed after showering.

When can I drive?

You can drive as soon as your vision is uninterrupted. This generally takes a week.

What can you do after surgery?

Your part in the operation is essential. You can help achieve the best possible outcome by:

 

  • Immediately after the procedure, apply the gauze squares we give you dipped into iced water. Change these regularly. You can apply these that night and continue the next day. Cool compresses are beneficial for up to 24 hours.
  • Sleep on two pillows at night
  • Avoid heavy exercise and lifting for at least 2 weeks.
  • Avoid pain killers which contain anti-inflammatories, as they may increase your risk of bleeding. Please check with us prior to taking medication not prescribed by us.
  • Take the antibiotics we prescribe for you. These will last five days and help prevent infection.
  • Come back for regular review as detailed in the next section to ensure your healing is progressing at each stage.
What about post operative visits?

As a minimum, you will be seen by Dr Hadi after surgery, the next day, at six weeks, at three months and twelve months after surgery. This is so that you can have the best possible outcome.

Please call the Swan Clinic on 9526-6885 following your surgery to ensure we have booked all your follow up appointments.

As our patient at the The Swan Clinic, you will be well looked after and can always count on our honesty as we always have your wellbeing in mind.

Please feel free to contact us if you have further questions.