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Archive for the ‘eyelid lift’ Category

Case Study – Natural Blepharoplasty Results

Saturday, September 13th, 2014

 

Background: Aging is an inevitable consequence of living and its most recognizable effects are on the face. The first place affected on the face by aging is around and on the eyes. The near constant motion of the eyelids and its thin overlying skin are a set up for wrinkles, loose skin and bags and puffiness caused by extruding fat from under the eye. Given that the eyes more than any other facial feature reveal one’s ‘character’ and are a reported ‘mirror of the soul’,  aging changes of them reflect what most would not want others to see.

Beginning in the late 30s and early 40s, the signs of periorbital (around the eye) aging begins. Botox and other neuromuscular modulator injections do a good job of slowing down this process by decreasing the formation of crow’s feet, but it can not prevent the development of loose skin on the eyelids and the herniation of fat on the lower eyelids. These aging eye effects can be quite variable with some people more genetically prone to developing them sooner and more extensively than others. But inevitably everyone will have more of these eye aging signs than they want.

Eyelid (blepharoplasty) surgery is well known and has been around for almost a century in various forms and techniques. Most patient’s biggest fear about blepharoplasty surgery is that they will look like a different person or will look unusual or very obvious that they have had plastic surgery. They can even point to numerous celebrity examples who show exactly what they fear. How is such a result avoided? Will everyone look like they have had surgery? After all, the eyes are seen by everyone and won’t all changes be seen?

Case Study: This 58 year-old female was tired of her tired looking eyes. She wanted to look less fatigued but was afraid that she might look ‘surgical’. She had a large amount of upper eyelid skin with significant hooding. (skin laying on or near the eyelashes) Her lower eyelids show multiple redundant skin rolls and bags. Here eyebrows were not especially ptotic or has any significant sagging.

Upper and Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, upper blepharoplasties was performed removing 12mms of skin centrally and sparing the underlying orbicularis muscle. Medial fat pockets were also removed.  Lower blepharoplasties were done using a skin-muscle flap technique. A three pocket fat removal, 5mms of tapered skin removal at the lateral canthus and a lateral orbicularis muscle suspension was done.

Upper and Lower Blepharoplasty result oblique view Dr Barry Eppley IndianapolisHer recovery took about ten days to look ‘non-surgical’ and three weeks to fairly normal. Many blepharoplasties will look a little tight for a period of time but by six weeks after surgery this has usually passed. Her results at six months show significant improvement but a result that retained her natural look.

An overdone or unnatural result from periorbital rejuvenation surgery is caused by numerous factors including aggressive tissue removal and an over elevated or exaggerated browlift. It is the browlift that is often at fault for a perceived abnormal eye look after plastic surgery. The effects of aggressive tissue removal, particularly that of fat, are often not seen until much later when the eye may look skeletonized or more hollow. The key to a natural blepharoplasty result is to not try and work out every excess bit of tissue or get rid of all wrinkles. While patients want the best result possible, they also d not want an over operated look either.

Case Highlights:

1) Aging of the eyes is the first facial area affected and is commonly treated by blepharoplasty surgery.

2) Four lid blepharoplasty (upper and lower eyelid surgery) is the most effective method of partially reversing the effects of aging on the eyes.

3) Natural blepharoplasty results occur when the amount of skin and fat removal is not overdone and lid function is not affected.

Dr. Barry Eppley

Indianapolis, Indiana

The Effect of Upper Blepharoplasty on Eyebrow Position

Thursday, June 5th, 2014

 

One of the most facial aging surgeries is that of blepharoplasty or the removal of excessive eyelid skin. It is most common because everyone develops redundant skin of the eyelids with enough age and everyone has four eyelids. Even for those patients not driven by a desire for an aesthetic improvement, an upper blepharoplasty is more common than a lower blepharoplasty because it can cause functional symptoms. The weight and hanging of excessive upper eyelid skin can push down on the lash lines, making the upper eyelids heavy and causing upper visual field impairment.

Blepharoplasty (Eyelid Tuck) Dr Barry Eppley IndianapolisBecause skin is taken away from the upper eyelid, and sometimes very aggressively to really get rid of it, the question is often asked if by doing so the eyebrow will be pulled down. Since it is common with heavy eyelids that one use their forehead muscle to lift the eyebrow and help take the weight off of the eyelids (so one can see better), does eliminating the skin reduce this habit which could also cause a drop in eyebrow position? (unmasking the real eyebrow level)

In the May 2014 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, an article was published entitled ‘The Effect of Upper Eyelid Blepharoplasty on Eyebrow Position’. In this paper, a total of 140 consecutive patients who had upper blepharoplasty due to superior visual field obstruction were studied with before and after measurements of their eyebrow position. In addition, horizontal forehead lines were classified by degree. Their results showed that there was an average very slightdrop in eyebrow position by measurement. (less than 1.5%)  This was not visibly detectable with the exception in some men. In men, one of of six displayed a significant lowering of the eyebrow position. The sample size of men was small (14) compared to that of women. (126) Before surgery lifting of the eyebrows by means of frontalis muscle activity did not influence the position of the eyebrows after surgery, although forehead horizontal lines did seem to diminish significantly afterwards.

Male Blepharoplasty result front view Dr Barry Eppley IndianapolisTo some degree it us understandable why, in most cases, even an aggressive upper blepharoplasty does not pull the eyebrows down. Upper eyelid skin is very elastic and stretchy and allows for large resections of skin. It is not apparent at all during surgery that the position of the eyebrow moves down at all. However, it may have an eyebrow dropping effect in some men because men usually appear later for upper blepharoplasty surgery (they simply wait longer) and may have a strong and well established compensatory frontalis muscle compensation. Once their upper visual field is improved, the real natural position of their eyebrows becomes unmasked (lower) as the lifting effect of the frontalis muscle is no longer needed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Eyelid Lifts (Blepharoplasty) in the Older Male

Monday, February 10th, 2014

 

Background: Aging begins around the eyes early in life and continues unabated up through one’s senior years. This periorbital aging is manifested by the creation of extra eyelid skin which is caused by the stretching of the thin eyelid skin due to frequent movement. As the redundant eyelid skin becomes excessive it weighs down the upper eyelid. Known as hooding it essentially creates folds of skin that lie on the eyelashes pushing the lid margin downward.

Older Male Eyelid hooding Dr Barry Eppley IndianapolisBetween of the weight of the eyelid skin and its folding over the lashline, an obstruction of the upper visual field results. This is often not even noticed by the individual because the visual field loss is so gradual. Getting lower and lower over the years, the loss of incoming light from a gradually smaller visual field is just credited to a naturally weakening vision with age.

With this upper eyelid hooding and visual field obstruction comes accompanying forehead wrinkles. While some of these horizontal forehead wrinkles are due to lifelong facial expressions, some of them are due to a constant holding of the eyebrows upward to lift some of the skin off of the eyelids, making one able to see better. Such browlifting is often inadvertent and unnoticed by the individual.

Case Study: This 76 year-old male wanted to improve the appearance of his eyes. He said he was frequently told he looked like he was squinting all the time. He felt he looked old and that some eyelid surgery may be beneficial. He wore glasses and had no symptoms of dry eyes.

Older Male Eyelid Lift Results front view Dr Barry Eppley IndianapolisUnder general anesthesia, a large excisional skin-only upper blepharoplasty was done. No orbicularis muscle was taken. The lower eyelids were treated by the raising of skin-muscle flaps, excision of protruding fat pockets, lateral canthopexies, conservative skin removal and orbicularis muscle suspension suturing.

Older Male Eyelid Lift results oblique view Dr Barry EppleyAfter surgery he had excellent improvement in appearance of both upper and lower eyelids. He felt he could ‘see’ better and that there was more light wherever he went. He did have a minor complication of some lower eyelid irritation and lower eyelid sag at the corners which took about two months after surgery to completely resolve.

Older Male Eyelid Lift results side view Dr Barry Eppley IndianapolisBlepharoplasty (eyelid lifts) in older patients can offer great improvement in appearance and even function. But the lower eyelid must be handled very carefully as it is at high risk for after surgery lid malpositioning. (ectropion) Even when handled well (limited skin removal, tendon tighening and muscle suspension), many older patients will experience  temporary period of lower eyelid lag symptoms.

Case Highlights:

1) Advanced aging around the eyes creates severe upper eyelid hooding, upper visual field obstruction and redundant lower eyelid skin with sagging.

2) When the amount of excessive eyelid skin is considerable, the eyes can look small and one can appear to be continuously ‘squinting’.

3) Upper and lower eyelid lifts (blepharoplasties) can create considerable improvement, opening up the eyes and making them feel less heavy.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonial: Upper Blepharoplasty (Eyelid Lift) Surgery

Tuesday, December 24th, 2013

 

Blepharoplasty (Upper Eyelid Lift)

Upper Blepharoplasty Eyelid Lift Dr Barry Eppley Indianapolis‘I never thought I would ever have plastic surgery for any cosmetic reason. I had worn glasses for many years but when I retired at age 65 I started to have more trouble seeing because of what was happening around my eyes. Everything just seemed a little more dim and I just can’t see as well. After seeing Dr. Eppley I realized that the skin on my forehead, brow and around the eyes had loosened and fallen to partially obstruct my vision. Trying to strain to see even gave me some issues with headaches. Having having my eyelid surgery by Dr. Eppley I could not only see better but I actually like the cosmetic improvements as well. I was not initially concerned with any cosmetic enhancement but I now see that as a pleasant bonus! Thank you Dr. Eppley for your surgical expertise and kind encouragement to go through the procedure. You were right, it was not as bad as I thought it would be.’

Bill

Carmel, Indiana

Commentary

There is probably no plastic surgery procedure that is more satisfying to a patient than an upper blepharoplasty procedure, also known as an eyelid tuck or an eyelid lift. This is so not only because of its aesthetic effect but because of the removal of the heavy feeling on the upper eyelid and an improvement in one’s visual field if the excessive skin is significant enough. It is its combined aesthetic and functional benefits that makes the upper blepharoplasty a winning procedure for those that undergo it. It is also a fairly ‘simple’ plastic surgery procedure to undergo with minimal pain afterwards albeit with some swelling and light bruising that takes about 10 days to go away completely.

Dr. Barry Eppley

Indianapolis, Indiana

Five Things You Didn’t Know About Eyelid Lift (Blepharoplasty) Surgery

Thursday, October 31st, 2013

 

Eyelid lifts or tucks are one of the most successful and commonly performed of all the anti-aging or facial rejuvenation procedures. While the number of eyelids outnumber any other facial structure, the number of eyelid surgeries performed is also due to the early onset of bothersome and visible aging which takes its earliest effect on the eyelids with the deveopment of extra skin, herniated fat and wrinkles.

While cosmetic eyelid surgery is common, there are numerous aspects of it that are not know or frequently misunderstood. Here are five things about blepharoplasty you may not know.

The Formal Name for Eyelid Surgery is Blepharoplasty. Coming from the Greek words, Blepheron (eyelid) and Plassein (to form), reshaping surgery of the eyelids is formally known as a blepharoplasty. Many times the procedure is simply known as having a ‘bleph’.

Upper and Lower Blepharoplasty Surgery Is Very Different. Upper eyelid surgery is the ‘simpler’ form of blepharoplasty with lower risks. It is largely a skin removal surgery and there are no concerns about the support or suspension of the eyelid which is largely responsible for the blink reflex and eyelid closure. Conversely, lower eyelid surgery involves removing tissue and tightening a structure that is suspended across the eyeball and largely does not move but must remain tight up against the eyeball. Thus risks of lower blepharoplasty with skin and fat removal are disruption of the lid position (pulling away from the eyeball) and prevention of this potential problem must be factored into the surgical technique used.

Laser Blepharoplasty Is Not Better. Laser blepharoplasty is simply using a laser beam to cut the eyelid skin or remove orbital fat instead of a ‘cold steel’ scalpel. Because of its high tech nature and the magical properties that have been given to anything associated with a laser, it is assumed that a laser blepharoplasty heals faster and gives a better result with less scarring than traditionally performed eyelid surgery. The reality, however, is exactly the opposite. The burn injury sustained by the skin edges from a laser actually increases the risk of visible scarring and heals slower…at the least it does not offer a better result.

Mini-Blepharoplasties Do Exist. Like all facial rejuvenation procedures, the scope of the operation should be based on the extent of the problem. For younger patients, the extent of the blepharoplasty surgery needs to be less. Such mini-blephs are known as pinch blepharoplasties where just a ‘pinch’ of skin is removed. This is often done using a special instrument to remove the smaller amount of eyelid skin. These pinch blepharoplasties are really helped by the concomitant use of skin resurfacing and Botox injections to improve the extent of their results.

Non-Surgical Blepharoplasty Can Offer Some Improvements. There are a variety of non-surgical treatment options for the periorbital region. Botox injections, laser resurfacing, chemical peels, injectable fillers and fat injections can be used to lessen wrinkles around the eyes, improve its skin texture as well as volume enhancement. While effective, such treatments are not technically a true blepharoplasty and certainly don’t create the same effect. While calling these treatments non-surgical is certainly appropriate, it is also important to realize they are adjunctive treatments that can benefit a surgical blepharoplasty or can be used alone.

Dr. Barry Eppley

Indianapolis, Indiana

The Goal and Effectiveness of Asian Blepharoplasty (Double Eyelid Surgery)

Wednesday, September 18th, 2013

 

A plastic surgery story appeared on the internet and other news venues in regards to TV anchor Julie Chen having had eyelid surgery when she was younger. Other than the fact that she had it and she is highly visible, Asian eyelid surgery or Asian blepharoplasty is very common. It is estimated that ten of thousands of such eyelid procedures are performed each year around and is the most common cosmetic surgery in numerous Asian countries.

The Asian eyelid has some very significant differences from the Western eyelid due to the amount of fat in the upper eyelid and the frequent lack of a well defined eyelid crease. The upper eyelid crease is formed by the levator muscle, which lifts the eyelid, but in the Asian eyelid the fold may be missing due to the fat. This creates a flat appearance from the lashline to the brow and makes the eye looks heavy or partially closed. In addition, there is a fold of skin at the inner edge of the eyelid close to the nose known as an epicanthal fold which makes the eye look smaller and also pushes the eyelashes down.

The Asian double eyelid surgery is done to create the appearance of a fold on the upper eyelids if it does not exist or to adjust the height of the fold that is present in cases of eyelid asymmetry. Even though the procedure just creates an eyelid crease, its effects can be dramatic as it opens up the appearance of the eyes and makes them look bigger.

There are a wide variety of double eyelid surgery techniques, which have varying success at creating a permanent fold by attaching the skin to the deeper tissues. Despite the many nuances between these eyelid procedures they fundamentally break down into either suture techniques or open incisional methods. The suture technique (known as DST) does not use an incision and relies on sutures to cause the tissues to scar together to form a permanent crease. Its main disadvantage is that the result may be lost if the sutures break or they degrade over time. The incisional method is permanent and allows better customization of the lid crease but is more involved with a longer recovery. With either technique it requires precise marking before surgery and great attention to detail in executing it during surgery.

In admitting that she had the procedure, Julie Chen discussed the reason she had it done which is both revealing and consistent with the known motives amongst Asians for getting the double eyelid procedure. Because she was once told she would never be a TV anchor because she was Chinese. Her intention was to simply have bigger eyes so she didn’t look sleepy or angry in her interviews on camera…not to look less Chinese or Asian. This was not about trying to look more Western but to have a more alert eye look.

Dr. Barry Eppley

Indianapolis, Indiana

Techniques for Fat-Preserving Lower Blepharoplasty

Sunday, August 25th, 2013

 

The lower eyelids are just one component of the management of the peri-orbital facial area. While browlifts and removal of excessive skin from the upper eyelids (upper blepharoplasty) are well known and established anti-aging treatments, lower eyelid surgery has evolved in its techniques over the past decade.

Traditionally, lower blepharoplasty was all about the removal of skin and compartmentalized fat to get rid of bags and loose skin. While immediately effective, some patients suffer long-term consequences of this substractive approach to the lower eyelid with a more aged and skeletonized appearance. Thus such tissue removal does not always create the appearance of youth.

As a result a different approach to the lower eyelid has evolved towards tissue sparing methods, preserving fat and removing less skin. Rather than aggressively removing fat from the three lower eyelid fat compartments (medial, middle and lateral), it is preserved and used as soft tissue fill for the tear troughs and elimination of the lid-cheek junction.

Conversely another approach is to harvest fat from elsewhere in the body and use it as a fat injection technique for filling in the tear trough and eliminating the lid-cheek junction. Because an open lower blepharoplasty technique does not allow for containment of injected fat one, does not see open blepharoplasty combined with fat injections unless it is with a transconjunctival (closed) lower eyelid approach.

The basic manuevers of a fat-repositioning lower blepharoplasty is based on moving vascularized pedicles of fat from the inner (nasal) and middle (central) protruding fat compartments. These stalks of fat are teased out and moved over and below the lower eye socket rim. (inferior orbital rim) They are used to fill in the hollows and lines of the lower eyelid-cheek region. When done through an open approach, the release of the tear trough and orbicularis retaining ligaments can also be done creating a two-pronged treatment of the tear troughs and the line of the lid-cheek junction.

As the technique of fat-repositioning lower blepharoplasty evolved, it was applied through a transconjunctival rather than an open blepharoplasty approach. The desire to not disrupt the orbicularis muscle and decrease the risk of lower lid ectropion was the primary motivation. But not exposing the transferred fat presumably improves their chance of survival as well. But the limited exposure through the inside of the lower eyelid and the difficulty in releasing the orbital ligaments may lead to persistence of the tear trough groove.

While technically challenging, fat repositioning with the transconjunctival approach can be successfully done and encompasses several important technical steps. The plane of dissection is between the orbicularis muscle and the orbital septum, meticulous release of the tear trough and orbicularis retaining ligament, septal windows for nasal and central fat pedicle release and repositioning, securing the fat pedicles over the orbital rim with transcutaneous sutures, free fat graft (from lateral pocket) placed between the two fat pedicles and a pinch external blepharoplasty and skin resurfacing (laser vs peel) if needed.

Lower eyelid rejuvenation that preserves fat produces a better aesthetic result than a traditional subtractive lower blepharoplasty in many cases. Fat transposition through the lower eyelid is technically challenging and can also be done by transconjunctival fat removal combined with external fat injections with comparative results in many cases.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Upper and Lower Blepharoplasties with Endoscopic Browlift

Sunday, July 7th, 2013

 

Background:  Changes around the eyes is the first part of the face that shows signs of aging. The development of excess skin on the eyelids and protruding eyelid fat makes the eyelids heavy and tired looking. But the eyes do not age in isolation, above them sits the eyebrows which are not immune to the effects of time. Aging of the eyebrows is primarily seen as they fall lower, often off of the bony brow ridges.

When considering corrective eyelid surgery, the standard and very effective approach are blepharoplasties. (eyelid lifts) While effective, the best result may not be obtained if the consideration of the brow position is overlooked. Whether a browlift is also beneficial can be tested before surgery by lifting the eyebrows and seeing if it also makes the eyes and the forehead look better. If a browlift is going to be performed with the blepharoplasties, this necessitates a smaller amount of skin removed from the upper eyelids. (a browlift recruits eyelid skin upward)

Browlifts have many different options than blepharoplasty surgery. They can be done from behind the scalp through a long open incision (coronal type), small incision scalp approach (endoscopic type), at the hairline (pretrichial type) and through the upper eyelid. (transpalpebral) Which technique is used depends on how much browlifting is needed, the vertical length of the forehead skin and how much muscle deanimation of the forehead is needed. The endoscopic browlift is one of the most common methods due to its smaller incisions but still having a powerful upward lifting effect.

Case Study: This 52 year-old female was tired of people telling her she looked tired or mad. Her eyes had a lot of excessive skin and herniated fat. But her brows were also heavy, low hanging and were asymmetrically positioned. She had very thick and heavy skin throughout her face.

Under general anesthesia, the first procedure done was an endoscopic browlift. Through four small incisions in the central and temporal scalp, the periosteum over the brows and across the nose was released through an endoscope. Muscle was removed from the supraorbital and supratrochlear neurovascular bundles and the brows lifts and secured to the outer cortex of the cranial bone by resorbable Lactosorb screws and sutures. The upper eyelids were done next, removing less skin than originally marked to prevent any potential risk of incomplete eyelid closure. The lower eyelids had skin and fat removed and the orbicularis muscle resuspended during closure.

The time required for all swelling and bruising around the eyes to completely go away after surgery was three weeks. By one month after surgery she showed a significant improvement with more open and refreshed eye look…no longer having a mad or angry appearance.

Combining a browlift with blepharoplasties creates the most complete amount of periorbital rejuvenation. While the change can be dramatic, the patient should anticipate a significant period of time for a complete recovery as the eyes are visible to all and even small amounts of swelling or bruising may be noticeable.

Case Highlights:

1) Aging of the eye area must not only consider the eyelids but the position of the eyebrows as well. Some of the excess skin on the upper eyelids can be due to yhe downward push of the eyebrows as well.

2) Total periorbital rejuvenation consists of upper and lower blepharoplasties as well as a browlift.

3) If the forehead is not vertically long, an endoscopic browlift can raise the eyebrows without making the forehead too long.

Dr. Barry Eppley

Indianapolis, Indiana

Blepharoplasty with Fat Injections

Tuesday, July 2nd, 2013

 

The most common procedure for rejuvenation of the periorbital area is surgical blepharoplasty. Removing skin from the upper and lower eyelids as well as fat mainly from the lower eyelid can make the eyes appear refreshed and more open. But tissue excess is not the exclusive problem that occurs around the eyes as they age. Volume loss of the eyelids as well as in the adjoining cheeks is now known to be a significant part of the aging process that occurs around the eyes.

Changes such as the sinking in of the eyeball, the development of a prominent groove between the lower eyelid and the cheek and cheek sagging and flatness are the most common signs seen due to volume loss. No manuever in blepharoplasty surgery can effectively restore volume other than transposition of lower eyelid fat and this is merely a ‘robbing Peter to pay Paul’ approach.

In the March 2013 issue of the Aesthetic Surgery Journal, a paper was published on this topic entitled ‘Augmentation Blepharoplasty –  A Review of 500 Consecutive Patients’. In this report, the authors present their outcome experience in 500 patients that had fat injections around the eye at the time of blepharoplasty surgery over a three year period. Their fat injection technique was small droplet placement with small blunt cannula. Their evaluations show a natural-looking and long-lasting improvement of the treated areas by subjective evaluation. The reinflation of the midface, better blending of the lower eyelid into the cheek (orbitomalar groove effacement) and correction of hollowing of the eyelids were the major benefits of the fat injections. No complications were reported other than some expected bruising and swelling.

One of the great benefits to fat injections is their safety and lack of any significant complications as long as they are no overdone. (overfilled) This would be easy to do around the eyes because relatively small volumes are needed. Selectively adding fat injections during blepharoplasty surgery can help overcome some of the shortcomings of traditional tissue resection. They may have their greatest value in the cheek and lower-lid cheek transition as a much simpler and safer replacement to some of the midface lifting techniques which are well known to a significant incidence of lower lid malposition. (ectropion)

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Transconjunctival Lower Eyelid Bag Removal in Women

Thursday, June 20th, 2013

 

Background:  Aging of the eyes takes on many predictable changes and one of those is the development of herniated fat. As the name implies, this is fat that has been historically believed to be once was under the eye that has relocated out onto or bulges over the lower orbital rim. Known as eye bags, it is associated with an aging and tired appearance. Since most human eye contact ends up on the face, their development can not be missed and they usually make an undesired impression.

The anatomy of lower eyelid fat is perceived to be three distinct fat pads that come from an intraorbital location. Recent anatomic studies, however, have evaluated this belief and have come up with a different anatomic explanation of their origin. These cadaver studies have shown the lower eyelid pads are discrete fat compartments that are not in continuity with the more posterior intraorbital fat. Rather they may be more accurately described as being both partially intraorbital and partially extraorbital in location. This may seem like a trivial difference in anatomic description but has relevance when considering their removal.

Removal of bulging lower eyelid fat can be done from either inside or outside of the lower eyelid. The choice of approach depends on whether lower eyelid skin needs to be removed and tightened and the concurrent management, if any, of lower eyelid wrinkles.

Case Study: This 42 year-old female wanted to improve her tired looking eyes. She was bothered by the bulges (bags) that had formed on her lower eyelids. She felt they made her older and more tired than what she was. Her darker and thicker skin allowed for few wrinkles despite having the bag.

Under general anesthesia, a transconjunctival approach was taken to her lower eyelid bag problem. Through the inner eyelid, the medial central and lateral fat pockets were identified and removed. No sutures were used to close the transconjunctival incisions. No external skin or incision was used

Her recovery was very rapid with no bruising but some swelling. By two weeks after surgery all swelling was gone and improvement was seen. By six weeks after surgery, she looked great and no longer had a tired appearance.

Blepharoplasty of the lower eyelid most commonly is done through a transcutaneous approach. (external skin incision) With this exposure all contributing aging factors can be treated including skin and fat removal and, in some cases, tightening of the tendon at the outer corner of the eye. But in some younger patients or in those who have few wrinkles or excessive loose skin despite their age, this cosmetically bothersome orbital fat can be removed from inside the eyelid . By placing the incision below the tarsal plate, the fat pads can be exposed and removed. This not only eliminates any external scar but results in a faster recovery with little risk of causing a lower eyelid sag. (ectropion)

Case Highlights:

1) One of the most common signs of aging around the eyes is the development of lower eyelid protrusions or fat.

2) Lower eyelid bag are herniated fat pads that can either be removed alone or in combination with a traditional lower blepharoplasty in which excess lower eyelid skin is removed as well.

3) Removing lower eyelid bags can make a dramatic difference in making the eyes look less tired.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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