When evaluating each patient, Dr. Zoumalan examines for the followingAmount of excess lower lid fat (also termed ‘prominent orbital fat’). Excess fat will likely have to be removed in order to rejuvenate the lower lid’s appearance. The type of surgery that Dr. Zoumalan performs to remove the excess lower lid fat is called a lower lid blepharoplasty.
Volume loss along the lower lid and cheek area. Volume loss appears as hollowing, which is usually seen along the infraorbital rim, which is the bone below the lower eyelids. This hollowing is located below where the prominent lower lid fat occurs.
This is a patient with BOTH prominent lower lid orbital fat and infraorbital rim hollowing. Black dotted line denotes the infraorbital rim. Prominent fat pockets are seen above that. Double asterisks denote the “tear trough deformity,” and single asterisk denotes the “lid-cheek junction.”Both the tear trough and the lid-cheek junction are part of the infraorbital rim.
Patients that have both excess lower lid fat AND hollowing along the infraorbital rim can benefit from a lower lid blepharoplasty with fat repositioning.
Amount of excess skin. In addition to remove excess lower lid fat pockets, lower lid blepharoplasty should also address the excess lower lid skin. Some patients may have mild excess skin which often ablative resurfacing through a chemical peel or laser resurfacing can help tighten the skin and improve the appearance. Patients that have significant amount of skin will likely require excision of the skin through either a skin pinch or a skin-muscle flap blepharoplasty approach. Dr. Zoumalan will examine you and determine what you are a best candidate for.
Transconjunctival versus transcutaneous lower lid blepharoplasty
Dr. Zoumalan performs his lower lid blepharoplasty through either a transconjunctival approach OR a transcutaneous approach. Dr. Zoumalan will perform a complete Oculoplastic examination and determine what approach will better serve you and your surgery goals.
This is an advanced scarless technique that Dr. Zoumalan uses in many of his patients. The incision is carefully made inside the lower lid so that the skin is not directly cut and hence no visible scars. The transconjunctival approach allows for direct access to the prominent fat pockets. Excess fat pockets can be removed or repositioned through this approach. Fat pockets are removed through heat-induced sculpting while repositioning actually involves moving the excess fat to help fill in the under eye hollows that people have with aging. Dr. Zoumalan will determine if you are a candidate for fat repositioning.
The fine wrinkles or excess skin cannot be improved with a transconjunctival procedure alone; usually Dr. Zoumalan will recommend either a chemical peel or a laser to help improve the fine wrinkles or excess skin underneath the eyes. Both are effective and can provide a tightening effect to the skin and also help reduce the fine wrinkles. Either laser or a chemical peel can be applied to the lower lids at the same of your transconjunctival lower lid blepharoplasty.
This is a well-described lower lid cosmetic surgery procedure, which involves directly removing excess lower lid skin at the same time as removing excess fat. A transcutaneous blepharoplasty is performed in cases where there is excess skin and weakened muscle in the lower lids that a chemical peel or a laser alone may not adequately treat. Excess fat pockets can still be removed or repositioned with this procedure
This procedure not only rejuvenates the lower lids by removing the puffiness and dark circles, but can also help tighten the lower lid muscle and skin where a laser or chemical may not do as well. Dr. Zoumalan specializes in skin muscle flap blepharoplasty, which is an advanced, minimally invasive transcutaneous technique that tightens the excess skin and underlying weak muscle. Dr. Zoumalan will examine you and determine if you are a candidate for this procedure. Dr. Zoumalan has published his latest findings in advanced lower lid blepharoplasty and continues to speak at conferences about his expertise in this topic.
Fat repositioning is a technique that Dr. Zoumalan performs in patients that have BOTH excess lower lid fat pockets and hollowing along the infraorbital rim. The excess fat pockets are identified at the time of surgery and carefully prepared as fat pedicles. They are then trimmed to the desire size and repositioned into the areas along the infraorbital rim where hollowing is noted.Fat repositioning allows for a more natural looking appearance while preserving the patient’s volume during surgery. Fat repositioning can help prevent hollowing after lower lid blepharoplasty. However, some patients may still have hollowing despite lower lid fat repositioning, and in that case, Dr. Zoumalan will recommend if you may need further procedures such as injectable fillers to better improve the hollowing after surgery. The injectable fillers that Dr. Zoumalan uses around the eyelid area are composed of hyaluronic acid and can be performed in the office using topical numbing cream.
Combined cosmetic procedures
Eyelid surgeries and Brow lifting procedures
A lower lid blepharoplasty can be performed with other cosmetic surgeries at the same time. The most common combined procedure with a lower lid blepharoplasty is an upper lid blepharoplasty, where excess skin and fat pockets in the upper lid are removed. Dr. Zoumalan commonly performs both procedures at the same setting. Endoscopic brow lift or a temporal-based brow lift can also be performed at the same time to help rejuvenate the brows in patients that have droopy and low set eyebrows.
Preoperative Diagnosis: Lower lid fat pockets, dark circles.
Procedure performed: Lower lid blepharoplasty using Natural Looking Blepharoplasty® Technique
Other combined surgeries with other specialty plastic surgeons
Dr. Zoumalan routinely works with his colleagues in combined cosmetic surgeries to help achieve his patients’ comprehensive cosmetic goals. If you desire to undergo other cosmetic surgeries to be performed at the same time as your lower lid blepharoplasty such as Rhinoplasty, Facelift, Necklift, Breast or Body work, Dr. Zoumalan and his staff will help you in achieving your goals. Dr. Zoumalan exclusively performs eyelid surgery, but he works with a multi-specialty plastic surgery team comprised of board-certified plastic surgeons and facial plastic surgeons, which all together can help address your cosmetic needs.
Preoperative diagnosis: Mild upper lid excess skin, lower lid fat prolapse.
Procedure performed:Upper and lower lid blepharoplasty, periorbital and lower lid fat grafting.
*Individual results may vary
All before and after pictures displayed are real patients who have consented to having their pictures published on our site. Individual results will vary with each patient and Dr. Christopher Zoumalan does not guarantee any outcomes of procedures shown. All pictures are meant for reference and illustrative purposes only.
Lower lid blepharoplasty Recovery
IMMEDIATELY AFTERSwelling and some bruising usually start to occur immediately after surgery, and icing can be very helpful. It is normal to have some dry eye sensation during the first week of surgery.
1 WEEKYour stitches from your upper lids are removed one week after surgery. You should be able to start reading, watching TV, and doing small activities around the house for longer periods of time.Most of your swelling and bruising improves by the second week.
2 TO 3 WEEKSIt is still normal to have some asymmetry between the two lids. You should be able to resume most if not all your routine day to day activities.
1 MONTH TO 6 WEEKSSome minor amounts of swelling may still persist, which should improve over the next several months after surgery. The incisions in the upper lids usually heal well but can take time, sometimes up to several months. The doctor may inject steroid injections or provide a scar cream to help improve your scars.
What do we usually see with aging eyelids?Excess fat pockets occur as a result of herniated fat pockets. They result in the appearance of having under eye bags or dark circles. Excess skin or wrinkles are also commonly seen. Volume loss around the eyelids can also result in a hollowing effect. All these can be addressed with lower lid surgery. You and Dr. Zoumalan will sit down and go over your wishes and desires. Dr. Zoumalan will then perform an in-depth eyelid examination and determine the best recommendation for you that fits your desires, the doctor’s goals, while maintaining a natural and rejuvenated result.
How does Dr. Zoumalan perform his lower lid cosmetic surgeries?There are several advanced surgical techniques that Dr. Zoumalan uses to effectively rejuvenate the lower lids. After a careful and thorough examination, Dr. Zoumalan will recommend you the best option that fits your desires and your eyelid and facial appearance. Dr. Zoumalan uses the latest techniques to promote rapid recovery.
Where is the incision made in the lower lids if I need a transcutaneous bleopharoplasty?Dr. Zoumalan makes a hairline incision right below your eyelashes and will carefully close the wound using very fine sutures which are removed usually in 5-6 days. The incision heals very well since it is right below the eyelashes. The corner incision is tucked into your crows feet and heals within your natural crow’s feet.
- What should you expect on the day of your pre-op visit?
- What should you expect on the day of your surgery?
- What should you expect after undergoing upper eyelid surgery in terms of recovery and pain control?
- What are the risks and complications to my upper eyelid surgery?
- Does insurance cover lower eyelid surgery?