Blepharoplasty – Lower
When it comes to fat pockets under the eyes, the only permanent solution is surgery.
The surgery can now be done without any visible scars. It is called “scarless” or transconjunctival blepharoplasty. During this procedure, an incision is made on the inside of the eyelid, and the puffy fat is removed with the scar on the inside of the eyelid where it cannot be seen. Patients heal very quickly from this surgery, and some have no bruising and very little swelling at all.
The limitation of this operation is that excess skin from the eyelids can’t be removed. Many people have excessive crepey, wrinkled skin in addition to the excess fat. This surgery doesn’t do anything for the excess skin. The operation takes about an hour, and has very little pain in the recovery. You may take a pain pill or two, but that’s usually it.
If you have both puffiness and excess, crepey skin, then I typically recommend a “pinch blepharoplasty,” where both puffy fat and crepey skin are removed. The fat is removed via an incision inside the eyelid, like in a scarless blepharoplasty, and the skin is removed by cutting it out from the front of the eyelid. The surgery leaves a tiny, usually imperceptible scar right underneath the eyelashes, and costs about the same as a scarless blepharoplasty.
I think both the scarless and pinch blepharoplasty procedures are quite effective for under-eye fat pockets, but there are some surgical techniques that I’m not a big fan of.
One is called a fat-repositioning blepharoplasty. Instead of removing the fat from the lower eyelids, some doctors will redistribute it along the tear trough (the groove that extends diagonally down the front of your cheek) or along the crease under your eye along the bone. Ideally this can decrease these grooves, but in worst-case scenarios, it can make the area look lumpy and unnatural.
A canthopexy is a procedure to tighten the lower eyelids when they are loose or droopy, and often to tilt the lower eyelids up, creating more of a cat-eye appearance. It’s also similar to the look when women pull their hair back really tightly and their eyelids tighten and tilt up. In inexperienced hands, this procedure can make you look like a villain from a Disney cartoon. In select cases, however, this procedure can really help people in their 60s and 70s with saggy lower eyelids. I typically refer these types of patients to an oculoplastic surgeon, or an ophthalmologist with specialized training in plastic surgery of the eyelids.
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