Treatment of Lower Eyelid Changes: Lower Eyelid Cosmetic Surgery

The changes that occur under the eye vary from person to person; the cause may be the protrusion of the fat surrounding the eye, or sagging skin, or the appearance of a noticeable depression between the lower eyelid and the cheek. In some cases, more than one problem may occur at the same time.

Therefore, there is no one-size-fits-all approach, but the choice of treatment depends on the nature of the changes present, the condition of the skin and eyelid, and the extent of the tissue's strength that helps to keep it in its natural position.

When the cause is protrusion of fat under the eye

If the bulge is primarily due to the protrusion of fat, without excess skin or noticeable sagging, transconjunctival lower blepharoplasty may be a suitable option. This method allows access to the protruding fat and dealing with it without the need for an external incision in the eyelid skin.

Dealing with fat does not necessarily mean removing it entirely; it may be more appropriate to remove part of it or redistribute it, depending on the shape of the area and the needs of each case.

When there is excess skin or sagging in the eyelid

If the bulge is accompanied by excess skin or noticeable sagging, transcutaneous lower blepharoplasty may be the most suitable option. This method allows for dealing with fat when needed, in addition to removing excess skin as appropriate for each case.

If the examination shows lower eyelid laxity or weakness in the tissues that support it, we may need to perform an additional procedure to tighten the eyelid and strengthen the supporting tissues (Lower Eyelid Tightening). This helps to maintain the natural position of the eyelid and reduce the risk of it moving away from the eye or turning outward after the procedure.

Not everyone with fat protrusion needs skin removal or eyelid tightening; it depends on the examination and determining what the case actually needs.

When fat protrusion is combined with a depression under the eye (tear trough)

The problem may not be limited to fat protrusion, but a depression or tear trough may appear between the lower eyelid and the cheek, known as the tear trough. This depression can make the transition between the eyelid and the cheek more noticeable, increasing the appearance of fatigue under the eye.

In these cases, it may be more appropriate to redistribute the fat present around the eye instead of removing it entirely, so that part of it can be used to fill the depressed area and reduce the difference between the bulge and the depression.

In some cases, there may be a need for other options to address volume loss in this area, depending on the nature of the case.

How do we determine the appropriate procedure?

The choice of the appropriate procedure depends on several factors, including:

• • The amount of fat protrusion under the eye.
  • The presence of excess skin and its degree of sagging.
  • The stability of the lower eyelid and its adhesion to the eye.
  • The presence of a depression between the eyelid and the cheek.
  • The nature of the tissues surrounding the eye and the shape of the face.

Some cases may require a single procedure, while others may require a combination of more than one procedure to achieve a balanced result.

The goal of lower blepharoplasty surgery is not to change the shape of the eye, but to treat the existing changes in a way that is suitable for each case, to achieve a natural appearance that is consistent with maintaining the integrity and function of the eyelid.