Lower eyelid surgery or blepharoplasty can be a complex procedure based on your anatomy and the different options for the lower eyelids.
There are two approaches to the lower eyelids. One is through an incision 1-2mm under the eyelid margin of lashes and the skin and muscle of the lower eyelid are elevated to reveal the fat or “bags under the eyes”. The fat can be partially removed or mobilized and repositioned to the tear trough or “dark circle under the eye”. A strip of skin is resected and the eyelid is resuspended. The dissection can be extended much lower into the cheek for an extended lower blepharoplasty which will help treat malar bags and festoons.
The approach that I use 90% of the time is actually the transconjunctival approach. The incision is actually through the inside pink portion of the eyelid. The fat is accessed similarly and either partially removed or repositioned. A pinch of skin is removed under the lash line. This approach has a much lower rate of ectropion or the lower eyelid sagging.
I have found that for those patients with very hollowed out lower eyelids and cheeks, the repositioning of the fat works quite well and does not leave them looking more hollowed after lower eyelid lift.
Dr. Funk is a board certified facial plastic surgeon in Houston, TX.