Lower Eyelid Upper Cheek Surgery
When considering surgery of the lower eyelid also consider the upper cheek since the two are in continuity with each other. Aging conditions of just the lower eyelid that can be corrected may include: puffiness of the lower eyelid, wrinkling or even folds of excess skin, and looseness or horizontal laxity of the lower eyelid margin. The upper cheek fat tends to descend with age. This can leave a hollow under the inner half of the eyelid. Laterally the cheek fat descends and bunches over the cheekbone sometimes even collecting a pocket of fluid where it bunches. Each of these problems can entail a different procedure to correct them.
Lower Eyelid Transconjunctival Blepharoplasty
This surgery is used to correct puffiness or bags of the lower eyelid. This puff is orbital fat which has prolapsed forward due to a weakening of the septum of the eyelid, a membrane that normally would hold the fat back. This fat can be removed with no skin incision. Instead the eyelid is retracted downward, an incision is made on the back side of the eyelid, the fat is gently pulled out and separated from any delicate blood vessels and nerves, and then the fat is removed. The eyelid is placed back in normal position flat with the puff removed. No sutures are needed.
Lower Eyelid Fat Transfer
If the cheek has dropped leaving a hollow below the lower eyelid, then the patient might want to consider a fat transfer. This procedure is performed similar to a transconjunctival blepharoplasty. However, instead of removing the excess fat some fat is transferred into the hollow to fill it out.
Lateral Mini Cheek Tuck
This procedure is used to treat the drooping fat pad of the upper cheek. The fat pad is normally at the upper edge of the cheekbone and due to time and gravity and loosening of tissues it falls down over the lower part of the cheekbone often bunching and sometimes collecting fluid with it. This fat pad and some of the tissues that support it can be pulled upward smoothing out the bunching and moving the fat of upper cheek somewhat upward. This is done through an incision in one of the pre-existing smile lines at the outer corner of the eye.
If it is done in conjunction with an upper eyelid blepharoplasty, the upper eyelid incision can be continued into one of the smile lines and then the cheek tuck can be performed through that incision.
Full Mid-Face Cheek Lift
This procedure is often referred to as a SOOF lift. (A sub-orbicularis oculi fat pad lift.) This procedure is used to correct a condition where the cheek and lower eyelid drop down together. Usually there is no excess skin, sometimes because of previous blepharoplasty or from some other skin tightening condition. Therefore, when the cheek drops it pulls the eyelid down with it. To correct this, an incision is made through the back side of the eyelid and the upper cheek fat pad is pulled up. This elevates the cheek and takes its weight off the eyelid, allowing the eyelid to return to its normal position.
Canthoplasty (Tighten at Outer Corner)
A normal healthy lower eyelid margin rests at the lower edge of the cornea, or colored portion of the eye. With time, most eyelids stretch horizontally, lose their elasticity and get loose In its healthy position the eyelid is best able to protect the eye, keep the cornea moist, and to help tears drain in a normal fashion. When the eyelid is horizontally loose it may sag down out of the ideal position, often resulting in an irritated tearing eye. This risk of this is increased when someone has had surgery or a procedure on the skin of the lower eyelid.
Therefore, a canthoplasty and prophylactic tightening of the eyelid at the outer corner is advisable in a patient who is planning on having a procedure on the lower eyelid skin which already has a horizontally loose lower eyelid. Of course, the surgery is necessary if the eyelid is sagging so as to be unsightly or to irritate the eye. In this procedure a small incision is made at the outer corner of the eye extending less than a cm into a smile line. The eyelid is shortened and reattached to its previous attachment place at the lateral orbital rim. It usually heals with minimal evidence of a previous incision.
Lower Eyelid Blepharoplasty with Skin Incision
If a patient has excess skin on the lower eyelids, some skin may need to be removed and this can be excised using an incision just below the eyelashes. The incision can be hidden where there is normally a crease and does not show. Although this procedure used to be the common way lower eyelid surgery was performed, it is much more rarely performed nowadays. It is needed if there are folds of skin, not just wrinkles. This procedure does have a greater risk of pulling the eyelid down and out of position; more often than not, the patient will also need to have a lateral canthoplasty performed to tighten and hold the eyelid margin in position during healing.