Aging begins to occur on the face around the eyes first. Often the lower eyelid is affected more than the upper eyelid. It begins initially by the development of some loose eyelid skin and wrinkling in the crow’s feet area. As it progresses, more wrinkles appear and the lower eyelid may begin to bulge as fat herniates outward. This aging progression is subtle in the late 30s and early 40s and becomes much more prominent in the late 40s and early 50s.
A lower eyelid tuck or blepharoplasty is a common plastic surgery procedure to improve the appearance of the aging lower eyelid. In its fullest extent, the skin and muscle are lifted up and trimmed and bulging fat is removed. However, the lower blepharoplasty operation can be tailored to the extent of the lower eyelid aging. Early onset eyelid aging does not usually require the full blepharoplasty operation.
Limited lower blepharoplasty procedures are ideal for younger patients. In such ‘mini’ lower eyelid surgery, several millimeters of lower eyelid skin are pinched up with a special instrument rather than making an extended incision and dissection under the eyelid skin down to the orbital rim bone. The pinched up skin is simply trimmed off and the blood supply to the remaining lower eyelid skin is unaffected. This then allows a moderate depth chemical peel to be done using either a 25% or 35% TCA (trichloroacetic acid) solution. The combination of some skin removal and skin tightening helps fresh up the lower eyelid and reduce wrinkling. Because it is a more limited lower eyelid procedure, recovery (looking good with no telltale signs of having had surgery) is usually complete in one week.
When herniated fat is also present, this can be removed by an incision on the inside of the lower eyelid (transconjunctival) This also does not disrupt the blood supply to the eyelid skin so a chemical or laser peel can still be done.
This pinch and peel lower eyelid technique can be done in several variations as well. How much skin is pinched up, whether fat is removed, and the strength of the chemical peel solution are all variables that can be altered and mixed and matched. In the office, pinches of lower eyelid skin and chemical peels can be done under local anesthesia. When fat removal is needed, this then requires a trip to the operating room with an anesthetic.
Dr. Barry Eppley
Indianapolis, Indiana