Lower Eyelid Correction

Baggy lower eyelids are the result of the aging process whereby the skin muscle become less tight and the orbital fat start to protrude forward.

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LOWER EYELID CORRECTION

Baggy lower eyelids are the result of the aging process whereby the skin muscle become less tight and the orbital fat start to protrude forward. The skin become wrinkled and the muscle can become so stretched that is forms large folds below the orbits (festoons). The tension on the lower eyelids can in elderly people become so weak that the eyelid moves down, turns outward and loses contact with the eye (ectropion) or turns inward and causing the eyelashes to touch the eye (entropion). In these situations there is a medical indication for a lower eyelid correction. Often at a younger age there may be too much fat bulging in the lower eyelids, making the person look tired and old. The correction of the lower eyelid with plastic surgery is called a lower blepharoplasty. Sometimes the swelling is due to fluid retention but this cannot be corrected with surgery. A lower eyelid correction is often performed together with an upper eyelid correction at the same time.

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DETAILS OF THE TREATMENT

THE FIRST CONSULTATION

Because often a combination of skin, muscle, fat and the tension of the lower eyelid need to be addressed the lower eyelid correction is more complicated than the upper eyelid. The correction can be performed under local anesthetic, with or without sedation, or under general anesthetic. The incision will be just below the eyelashes to continue lateral into the crowfeet area. Excess fat is removed or redistributed by transposing it downward and excess skin is excised. Often the lower eyelid is tightened to prevent descent after the procedure. Shortly after the procedure you can go home when you are fully awake.

THE PROCEDURE

Omdat vaak combinaties van huid, spier, vet en spanning van het onderooglid geadresseerd moet worden is een onderooglid correctie ingewikkelder dan de correctie van een bovenooglid. Correctie van de onderoogleden kunnen zowel onder plaatselijke verdoving, met of zonder sedatie, als onder volledige verdoving plaatsvinden. Na de ingreep kan u naar huis als u goed wakker bent. Een snee wordt gemaakt onder de wimpers van de onderoogleden, en loopt iets door in een rimpel net voorbij de buitenste ooghoek. Het overtollige vet van de wallen wordt verwijderd of verplaatst naar beneden en het huidoverschot weggehaald. Meestal wordt het ooglid wat strakker getrokken zodat het niet gaat zakken na de operatie. De littekens zullen na volledige genezing nauwelijks zichtbaar zijn. Wanneer er alleen wat vet verwijderd moet worden kan er soms voor gekozen worden om dit via de binnenkant van het onderooglid te verwijderen.

AFTER THE PROCEDURE

After a lower eyelid correction the eyelids will become bruised and swollen. This will eventually Cold compresses using iced water or ice glasses can be applied to the eyes for 30 minutes 3 times a day in the first 3 to 5 days. This will contain and reduce the swelling and bruising. Paracetamol normally is sufficient for pain relief. At night the head should be elevated higher than the heart by using an extra pillow. The stitches will be removed after 5 to 7 days and your appearance will be very acceptable after 2 weeks. Any residual bruising can be camouflaged with make-up and the remaining swelling will continue to subside in the coming weeks. Due to the wound healing process may feel some pulling and the scar may be slightly sensitive, especially on the sides where the eyelids have been tightened. You may experience some numbness of the eyelids for some time. This will all settle down in the week and months thereafter.

RESULTS

A lower eyelid correction will have no effect on the peripheral vision as is often the case in an upper eyelid correction. Esthetically is can make a great difference. A fresher appearance can replace a tired an older look. The scars are well hidden under the eyelashes and on the sides and normally will hardly be visible after the wound healing is complete. The results are sustainable, but the aging process will continue.

RISKS AND COMPLICATIONS

Sometimes after the correction the eyelids will be more bruised and swollen than normal. This will eventually completely resolve, but it may take a little longer than normally. After the correction the eyes may be dry for a while. Eye drops may be used until the tear production has normalized. Sometimes a swelling on the white of the eye can develop (chemosis) for which eye drops need to be taken. This swelling may take weeks to settle. When to much skin has been excised or the tension of weak lower eyelids have not been corrected an ectropion can develop. The eyelid loses contact with eht eye and this will cause irritation and tearing. To correct thisanother operation is necessary. The eyelids can always not be completely symmetric. If the difference is significant and if eye fat has not been removed sufficiently another correction may be indicated. In rare instances an inclusion cyst can develop in the scar which needs to be removed surgically. An extremely rare complication is a large bleeding behind the eye (retro bulbar hematoma), which can lead to blindness if not immediately treated aggressively.

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