Aging of the lower eyelids can occur in different ways:

• skin wrinkling
• lid bulging, or
• drooping of the lid

The approach to surgical correction than depends on not only the evaluation of the lower lid but also of the cheek region.  Typically younger patients can have lower lid bulging without excess skin wrinkling.

As aging and sun damage occurs skin wrinkling increases with or without lid bulging.  In addition the cheeks will fall resulting in a significant pronouncement of the lid/cheek junction.

The most important issue in lower lid cosmetic surgery is dealing with the fat.  Fat is youth and in the past removal of fat was extensive leading to a hollow look as the patient aged.  So now the object is to retain as much fat as possible.  When patients have lid bulging but no wrinkles and good cheeks a small amount of fat can be removed through an incision inside the lower lid.  This permits a nice correction without visible scars.

When patients have lid bulging and a pronounced lid/cheek junction than removal of the fat will only worsen the outcome.  In this circumstance the fat from the lower lid can be repositioned over the orbital rim improving both the lower lid and the lid/cheek junction.  If skin needs to be removed the entire procedure can be done from one incision under the eyelashes.  In addition lid tightening can also be performed if there is lid sagging.  Even this incision is difficult to see to the casual observer.

Cosmetic correction of the lower lids must is often more complicated than most surgeons realize.  Undercorrection or failure to recognize problems is not uncommon.  If you desires rejuvenation of your eyes and a return to youth click here or call our office at 703.752.6608 for your complementary consultation and thorough discussion of facial rejuvenation.

• Read more about blepharoplasty
• See more of Dr. Hess’ before and after photos of eyelid surgery

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