Eyelid Rejuvenation (Blepharoplasty)
Eyelid cosmetic surgery, or blepharoplasty, can be done many different ways because there is no one operation that will suit all patients.
The simplest eyelid procedure is called a transconjunctival blepharoplasty. This procedure involves an incision on the pink skin on the inside of the eyelid and therefore there is no scar and no stitches. The transconjunctival blepharoplasty ONLY removes the puffiness under the eyes. It does not tighten the skin; in fact if the lower eyelid skin is loose, it may leave it a bit looser. Therefore if you have large puffs of fat under your eyes, you may have a few extra lines or wrinkles under your eyes after the fat is removed. Usually patients are very happy with this procedure because it is a small operation and if the puffiness is significant, the results of the surgery are very pleasing. A non-surgical procedure can be done at the same time as this surgery such as a chemical peel to smooth the skin.
For patients who have puffiness and significant extra skin, the procedure will involve an incision on the skin of the lower eyelids just under the eyelashes and extending outward in a smile lines. This incision allows for removing the extra skin and is usually made when the skin needs to be tightened and a chemical peel or laser peel will not suffice. For many patients who have extra skin and puffiness of the lower eyelids, the best approach is to remove the extra skin with an incision under the eyelashes and to remove the fat either from the inside or the outside.
Some patients have hollowing under the eyes. This is usually the result of the cheek falling down to a lower position with age. Simple surgery of the lower eyelids will not make this better in most cases. For patients with this problem there are three possible procedures (three variations of lower eyelid surgery).
The simplest way to treat the hollowing is to transpose the puffiness from the lower eyelid onto the top of the cheek. This is different from fat injection because by simply moving the fat downward and securing it, all the fat stays alive. With fat injection which is a grafting procedure, not all the fat survives.Sometimes it is necessary to use an implant to fill the hollowing, for example if the patient has little or no fat to be moved. The implant can be put in through the lower eyelid surgery incision. Doctor Gerut rarely uses this type of implant.A cheek lift is an extensive procedure that pulls the entire cheek upward to fill the hollowing under the lower eyelids. This procedure is only for patients that have severe hollowing and/or cheek dropping as part of their aging issues.
Many patients seeking eyelid rejuvenation have looseness not only of the skin but of the eyelid itself. This looseness can run in families, does develop with age and if not treated at the time of surgery, the drooping of the lower eyelid can be severe. To treat and/or avoid this problem, a procedure called canthopexy may be necessary at the time of lower eyelid surgery. In unusual cases, something more extensive than canthopexy may be needed.
Whichever procedure would suit you best based upon your desired appearance as well as the level of complexity of surgery you wish to undergo will be discussed with you during your consultation with Dr. Gerut.