What to ask about lower eyelid surgery

Blepharoplasty is defined as "any operation which corrects a defect in the eyelids." This can be an upper eyelid procedure or a lower eyelid procedure. While it is important to know about both, lower eyelid surgery poses a greater challenge. Lower eyelid blepharoplasty usually aims to get rid of bags under the eyelids and produce a less tired look. It is important to consult with a qualified surgeon before undergoing any surgical procedure and this article poses a few questions to ask the surgeon during a consultation.

What type of incisions will you use?

There are several approaches that can be used to access the lower eyelid. Some incisions are made on the inside of the lower eyelid and are not visible. Others are made just below the lash line and when healed, are nearly imperceptible. The approach used depends on many factors and the surgeon can discuss these thoroughly.

Is my lower eyelid loose?

When performing lower eyelid surgery, it is important to ensure that the lower eyelid is tight enough. If the eyelid is not tight enough, there is a greater risk of pull down of the eyelid after surgery and resulting dry eyes and eye exposure. To test if the lower eyelid is loose, the surgeon will pinch the lower eyelid and pull it out. If it takes a long time to retract or requires a blink or two to return to a position against the eye, the lower eyelid is loose. If the lower eyelid is loose, a procedure can be performed to tighten the lower eyelid. This can be performed at the same time as lower eyelid surgery and should be discussed before proceeding with surgery.

Will this surgery take away the bags and lines under my eyes?

Most patients who have bags under the eyes have what is called pseudoherniation of fat. This means that the fat that normally exists around the eyeball has pushed out past the edge of the bone of the eye socket, producing the bags. In some patients, the bags under the eyes are actually on the cheek and lower eyelid surgery will not fix this. In addition, if discoloration of the skin is a concern, it is important to ask the surgeon if just operating on the lower eyelid will fix the discoloration. Most of the time, the dark circles under the eyes are due to shadows from the fat. At times though, this discoloration is due to pigment in the skin. If pigment is the problem, additional procedures may be required to address just the discoloration below the eyes.

What is my recovery time?

While every patient is different, bruising, swelling, and bleeding are generally the limiting steps for return to normal activities. Different approaches to the lower eyelid will produce different amounts of bruising and swelling. Be sure to consult with your surgeon about expected time away from normal activities.

Above all, research the procedures you are thinking of having and research the credentials of the surgeon you are considering. While this is not a complete list of questions you might want to ask, it is a starting point. It is of utmost importance to discuss your expectations with your surgeon to ensure that your goals can be reached.

D.J. Verret, MD Facial Plastic & Reconstructive Surgery www.innovationsfps.com
by D.J. Verret, MD