Thirty years ago most lower eyelid lifts were done in more or less the same way: An incision was made through the skin just below the eyelashes, fat was identified and some removed, excess skin and muscle were trimmed, and the skin incision was closed. The results were mixed – some patients had a good result, others had a hollowed out look, and others developed a pulling down of the eyelids.

Over the past 30 years things have changed dramatically. No longer is the incision made through the skin, but is made on the inside of the lower eyelid. In many cases, skin is no longer removed, but it is tightened with a laser or a chemical peel. The fat is frequently left in place, and in many cases fat or fillers like Juvederm are added. We’ve now gone from eyelids that are hollowed out to eyelids that look as though they need to go on a new year’s diet!

So which is the correct operation? As with all operations in plastic surgery the right one is the procedure that gives the result that patients want, and for most patients that result is a natural looking lower eyelid with minimal puffiness and smooth skin. The lower eyelid should transition smoothly into the cheek. To achieve this look, it’s sometimes necessary to remove fat and in other cases to leave the fat alone, move it around, or add something to plump out any sunken areas. In other words, individualize the operation for each patient. A cookie cutter approach doesn’t work!

A smooth look may also require something more than lower eyelid surgery. The cheek fat may have fallen under influence of gravity, leaving behind a groove where the lower eyelid meets the cheek. By lifting the cheek fat back to its correct position with a cheek lift, a smooth lower eyelid-cheek junction can be obtained.

On a final note, I mentioned the possible need to add something to the lower eyelid to plump out a sunken area. Some doctors will use fat injections. Unfortunately, I have seen many unhappy patients who have lumps from that procedure and that no amount of further treatment can undo. In my experience it is far safer to add Juvederm or Restylane. These take a few minutes to inject, a smooth contour is obtained, and the results tend to last 1 or 2 years.

For further information, please contact my office.