Why Lower Eyelid Surgery Should Include Anatomical Support to Prevent Complications

A 46-year-old woman is concerned about her lower eyelid. She wants to know if she will benefit from a blepharoplasty procedure.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon explains that lower eyelid blepharoplasty addresses puffiness, eyelid position and excess skin. If someone has puffiness under their eyes like this woman, then addressing the lower eyelid area with a blepharoplasty makes sense.

At 46-years-old, this woman probably noticed that there’s been some volume loss under her eyes. In Dr. Prasad’s practice, most of his patients are confused between a filler versus surgical procedures to address this area. A few years ago, he wrote a book “The Fine Art of Looking Younger” where he explained the issues of facial aging. Facial aging has two essential principles: first is volume loss where there is loss of bone, muscle and fat; second is laxity. For example, the lower eyelid tendon becomes looser and the obicularis muscle gets a little more lax. Overall, there’s a support issue that may be part of the whole lower eyelid rejuvenation process.

When Dr. Prasad does an evaluation for lower eyelid blepharoplasty, he looks at the tone of the lower eyelid. He does a snap test by pulling the eyelid down and sees how well it comes back up. In addition, he thinks it is important to address the fat pockets as well as lifting or tightening the lateral canthal tendon. Looking from different perspectives, he also assesses if there’s a relative prominence of the eye to deal with any type of support structure in the lower eyelid.

Dr. Prasad also wrote an article many years ago called, “Ethnic Considerations in Eyelid Surgery” to cater patients who were not Caucasians and were embracing and exploring cosmetic surgery procedures. Unfortunately, traditional cosmetic procedures like an external incision lower eyelid blepharoplasty where the lower eyelid is opened up and fat and skin removed was problematic for patients of African origin as it resulted in the eyelid being pulled down. Someone with dark skin color has to be mindful of the techniques applied to lower eyelid blepharoplasty. At the same time, addressing the volume loss can be the second part of the equation. By adding volume in the cheek area through augmentation with fillers, cheek implants or through face lifting, it can have a tremendous impact in the context of how the eyes look.

The last part of this equation is skin quality. People often mistake lower eyelid surgery as a way to reduce wrinkles and dark circles.To address the skin quality issue in Dr. Prasad’s practice, he routinely uses platelet-rich plasma for lower eyelid rejuvenation. He draws the patient’s own blood, spins it and concentrates the platelets and growth factors which are the necessary for healing. He places it under the skin of the eyelids and see a qualitative improvement in the skin which including wrinkles and skin color. This gives an overall healthier glow to the skin.

Dr. Prasad thinks she should meet with experienced cosmetic surgeons who have a lot of experience with different skin types. Once she finds someone that resonates with her, she can move on with the procedures.

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