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Blepharoplasty surgery, also known as eyelid lifts, is one of the most common surgical facial rejuvenation procedures to counteract the effects of aging. Loose skin, protruding fat pads and wrinkles are all common aesthetic concerns that occur on the eyelids which are frequently treated by both surgical and non-surgical methods.

Lower blepharoplasty surgery has some different considerations than that of the upper eyelids given that it is a suspensory structure across the eyeball. How does surgical manipulation of the lower eyelid hold up over time before significant age changes recur?

In the November 2018 issue of the Aesthetic Surgery Journal a paper was published  entitled ‘Lower Eyelid Blepharoplasty: Does the Literature Support the Longevity of this Procedure?’ In this paper the authors use the surgical literature to determine the time nature of the aesthetic benefits of lower blepharoplasty. To do so they reviewed almost fifty (50) articles which included over 10,000 patients. Many often these studies had followups that were greater than one year. (aveage 14 months) Overall complication rates were in the range of 2.5 %. These included reoperation, scleral show, lid malposition and ectropion.

Near 90% of the studies had after surgery pictures which averaged 15 months. In all of the studies only a minute fraction (0.01%) of the patients had pictures being two year followup.

It is fairly clear that the surgical literature provides limited long-term followup of the aesthetic outcomes and stability of lower blepharoplasty surgery. Longer term reports would help provide improved patient counseling.

One of the questions patients may ask before surgery about aesthetic blepharoplasty is how long can one expect the results to persist. Most realize that the results are not permanent since the surgery does to treat the root of the problem. (aging and gravity) Plastic surgeons must rely on their own observations to provide these answers. In my experience patients can expect results to persist for years, often up to ten years, before significant loose skin and wrinkles return that approximate the original problem. Lower lid fat removal is different in which some patients may remain ‘fat-free’ permanently.

It should also be noted that the duration of the aesthetic improvements will be influenced by the type of lower blepharoplasty performed. (for example laser resurfacing, pinch and peel or full lower blepharoplasty)

Dr. Barry Eppley

Indianapolis, Indiana

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