December 5, 2024 • 13 mins
Ever caught your reflection and wondered why you look so tired or down, even after a solid night’s sleep? You’re not alone. I'm Dr. Jason Hall, and this week on The Trillium Show, we're diving into the world of lower lid blepharoplasty—often just called lower eyelid lifts. We’ll explore how this procedure can help lift those droopy, sad puppy dog eyes and give you a fresher, more vibrant look. But it’s not a cure-all—I’ll break down the realistic outcomes, from what it can do to refresh your appearance to the limitations you should be aware of, like not being able to remove all wrinkles or dark circles.
We'll also get into the nitty-gritty of modern techniques like fat grafting, the recovery process, and potential complications such as chemosis and eyelid malposition. Plus, I’ll share crucial pre-surgery considerations you need to think about, like under-eye fillers and managing dry eyes. Tune in to get a clear picture of what lower eyelid surgery can (and can’t) do for you, so you can make an informed decision about whether it’s the right move for your beauty goals.
Subscribe to The Trillium Show and follow @drjasonhall on Instagram to join the conversation!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Jason Hall (00:00):
All right, you ever looked in the mirror and
(00:01):
felt like you look just sad ortired, even though you've had a
full night's sleep, or kind ofhave like droopy, sad, like
puppy dog eyes? Both of thosethings are reasons that people
come and see me for lower lidblepharoplasty or lower eyelid
lips. Today, we're going to talkall about them.
(00:22):
You welcome to the Trilliumshow, where each week we discuss
different tips to help youimprove your mind, your body and
your life. I'm your host, boardcertified plastic surgeon and
medical director of Trilliumplastic surgery and Trillium
esthetics. Dr Jason Hall, solower lid blepharoplasty is one
of these operations that a lotof people come in asking about,
(00:45):
they want lower lid bagsremoved. They don't like the
crepiness or the crinkliness oftheir lower eyelid skin. And so
lower lid blepharoplasty isoften thing that we talk about
to help improve that. In thisshow, what we're going to do is
kind of go through lower lipbuffer plastic from soup to
(01:05):
nuts, and you can tell it's kindof hard to say left for row
plastic eyelid lift. So what arethe goals? Because it's
important before we starttalking about treatments, to
understand what the goals are.
Goals of a lower lip bufferplastic are three fold. One is
to get rid of the sad, tiredpuppy dog eye look. Number two
is to remove or smooth excesswrinkly skin. Number three is to
(01:26):
remove and contour the hollowthat develops in our lower eyes
with time. But just important,as important as it is to know
what things can do. It'simportant to know what things
can't do. So what doesn't alower lid blepharoplasty do?
Well, first of all, while iteliminates some of the
(01:49):
crinkliness under your eyelids,it doesn't eliminate all of it,
and certainly doesn't eliminatewrinkles and crows feet out to
the sides. Those are things thatthings like Botox and Juve and
disport will still be needed toreally get rid of those crows
feet. The other thing that itwon't do is it won't take away
(02:09):
completely the dark circles.
Now, we could do a whole nothershow about dark circles under
the eyes and what causes thosebut a lot of times, people get
pigment that gets deposited herein the lower eyelid that occurs
over time. A lower lidblepharoplasty will not address
(02:33):
that by itself. Now, there areother things that we can do with
our lower lid buffer plastic,but a blepharoplasty itself
won't get rid of the darkcircles 100% and the pigment
that's under the eyes. Now it'sreally important, when we talk
about lower eyelid surgery, tounderstand why we're seeing what
we're seeing. If you've listenedto my facial aging podcast,
(02:56):
which we'll link right up here,the facial aging happens as a
result of three main components,skin changes, volume loss, and
then gravity. The volume loss issomething that around the eyes
shows up typically, you know,different strokes for different
folks, typically start seeingthat late 30s, early 40s, and is
(03:21):
what contributes to that teartrough or that eyelid hollow.
Some people that happens muchearlier. Some people have them
their whole lives because of theway that their eye sockets their
facial skeleton are puttogether. But it's important,
and one of the things that hasreally changed in lower
blepharoplasty surgery sinceI've been in training and
(03:44):
learned how to do this 15 yearsago was we now know that volume
replacement is just as importantas volume removal. The bag that
you see under your lower eyelid,really is the result of the
(04:05):
covering of some fat that's inyour eye weakening, and that
causes that lower eyelid fat tobe to protrude out and be a
little bit more prominent. Atthe same time, we lose volume in
our cheeks, overlying it. And sogood analogy for this is it's
like the tide going out at thebeach. You know this that volume
(04:26):
loss is like the tide going outand exposes the stuff that's
underneath. And so bringing thetide back, replacing some of
that volume is really importantto help smooth the contour
between your cheek and yourlower eyelid. And so every
single lower blepharoplasty thatI do, we talk about bringing
(04:46):
some fat back into the uppercheek to help soften that
transition between the lid andthe cheek. The other thing that
has really changed a lot since Ilearned how to do this is that
the concept. Kind of openingeverything up and and really
weakening the lower eyelid haslargely been replaced with non
(05:10):
invasive, or less invasiveapproaches where we go in
through the inside of the lowereyelid and we avoid the support
that is in the lower eyelid, andwe'll talk about that here in
just a second. That improves.
But by avoiding that, we stillhave to address the skin of the
lower eyelid, and we I do thatnow in two ways. I either use
(05:32):
what's called a skin pinch,where we just do exactly what it
sounds like, remove a littlepinch of skin at the end of the
procedure, or what I do most ofthe time now is use a laser to
help resurface that under eyelidskin. And that is, that is by
far the most common thing that Ido, and we'll get into that here
in just a second. So what does alower blepharoplasty procedure
(05:53):
look like? Most of mine aretrans conjunct, or going in
through the inside, and that's ahard word to say, trans
conjunctival. So go in throughthe inside, and then contour
some of that delicate fat thatsits underneath your your lower
eyelid. Once that is done, thenon the outside, will either take
(06:15):
a little skin pinch through alittle incision right underneath
your eyelashes that hidesbeautifully, or we use a laser
to help resurface that lower lidskin. At the same time, we'll
use some fat and inject somefat, take a little bit of fat
from your abdomen, take a littlefat from your thighs and inject
that in to fill in some of thathollow the final thing, and I'm
(06:37):
very conservative in doing this,is using what's called cancel
support. So supporting that yourlower eyelid, in the corner of
your eye, which is really isless a cosmetic thing, if you
really think about it, we're notreally changing the shape of
(06:58):
your lower eyelid. What we'redoing is helping to kind of
tighten that lower lid, whichtends to get loose over time,
and prevent it from draggingdown. You've seen people who
have had lower lids that kind ofwalk around like this, not a
good look, and very, verydifficult to treat. So kind of
like most things we talk aboutin in facial surgery, ounce of
prevention is worth a pound ofcure. And so what's called a
(07:21):
canthopexy, or a little suturethat helps to tighten that from
the inside, is used a lot inlower lid surgery. In terms of
recovery, really swelling forlower lid surgery is the main
issue. Typically, like mostfacial surgeries, I recommend
people kind of hide out forabout two weeks to make sure
(07:41):
that that swelling is gone. Ifthere's a little bit of
bruising, a lot of that stuff,we can treat with a laser here
in the office right aftersurgery. And for the fat
grafting, the fat transfer,especially in patients who have
very thin skin, that swellingunder the eye can be noticeable
for about six weeks. And that'swhy I have people I just tell
(08:01):
patients, pause your workoutsfor about six weeks, because the
more you exercise, the more youget your heart rate up, your
head sees a lot of that bloodflow. You're going to worsen
your swelling and make it stayaround even longer. The other
question we get, especially withlower lid surgeries, for people
who wear contacts. You want toavoid contacts for about 10 days
after the surgery is over. Wedon't want to lose a contact in
(08:24):
an incision. That's a bigproblem. Never had it happen,
but we don't want you to be thefirst person. So what are the
what are the procedures? Can wedo with a lower libroplasty?
Well, pretty much any facialsurgery can be done at the same
time we do a lower lid bufferplastic. It's very oftentimes
combined with brow lift andupper blepharoplasty surgery.
(08:45):
Because we've got the laser outand are using it, we will often
do full face laser resurfacingto varying depths, depending on
kind of what skin problems we'relooking to treat. And a lot of
times, a deep plane face andneck lift is done in conjunction
with our lower lipblepharoplasty surgery. Few
things to watch out for ifyou've ever had filler in your
(09:09):
under eyes and tear troughfiller is really common these
days. If you've ever had fillerin your under eyes, we have to
know about that on the front endso that we can dissolve it first
under eye filler and surgerydoesn't typically go well
because of swelling you can havethat filler tends to obstruct
(09:30):
the fluid drainage, thelymphatic channels under your
eyes, and can cause prolongedswelling. So if you've got
filler under your eyes, it'simportant that we know about
that so we can dissolve itbefore surgery. It's also
important so we know kind ofwhat we're dealing with in terms
of volume replacement beforesurgery. If you have dry eyes,
(09:51):
lower libroplasty surgery willmake this worse, at least
temporarily, and. If you've gotreally dry eyes, that it could
even be something that will makelower lid Bleu prostate surgery,
not something we want to dealwith. So it's important to kind
of we talk through this beforesurgery. The other thing that
(10:12):
can happen after surgery issomething called chemosis, which
is swelling of the white part ofyour of your eyeball itself.
It's benign, but it can be apain in the butt and needs to be
treated. So we have some steroideye drops. Sometimes we'll have
to patch for a couple of days toget that swelling to go down.
(10:35):
And if it's really severe, weactually need to drain that
fluid out in the office, whichsounds horrible, but really,
isn't we just put a littlenumbing drop in, make a little
snip in the in the coveringheals uneventfully, but we
that's kind of a last ditcheffort. The other thing that can
(10:55):
happen, you can have some subconjunctible hemorrhage. So in
the in the white part of youreye can get a little bit of
bleeding doesn't happen often.
It's impressive looking, butisn't because that part of your
eye turned to red. But isn'tdangerous. So speaking of
dangerous, can't talk aboutsurgery without talking about
complications. What's the worstpossible thing that can happen?
You could go blind. Now this isexceedingly rare. The quoted
(11:17):
rate is one in 10,000 it'sprobably even more rare than
that, to the point that most ofus who do this have never seen
that. Knock wood eyelidmalposition is the other big
problem. You know, your lowerlid getting dragged down by the
swelling after surgery. That's areason for doing the
(11:40):
transconjunctible approach, sowe're staying away from the
support. It's also a reason thatwe use canthopexy sutures
routinely to help support thatand prevent that mal position.
Corneal abrasions are anotherissue. Those are really rare
kind of eyes scratchy. You haveeye shields in during surgery to
protect your eyes, but you canget a little scratch, which is
(12:03):
painful, but heals withoutissue. And then, obviously, with
any surgery, there's a chancethat things couldn't look
exactly like we wanted to, andwe would have to go back and
revise that. So this has beenlower lid blepharoplasty in a
nutshell. I hope this gives yougood information, kind of about
(12:25):
how the procedure works, whattypes of things that this can
treat, and, more importantly,what types of things it can't
treat. I would recommendeverybody go back and in look at
the facial aging show that Idid. It is a good resource if
you're contemplating any facialrejuvenation surgery, to kind of
know why you're seeing whatyou're seeing first. But thanks
(12:45):
for listening. If you enjoy theshow, please leave me a review
on Apple podcast. Please commentdown below if you have an idea
you'd like to see made into ashow. Have a question you want
answered, send me an email mediaDr Jason hall.com, drop me a DM
on Instagram or x at Dr. JasonHall, thanks again, and we'll
see you guys soon. You.
All right, you ever looked in the mirror and
(00:01):
felt like you look just sad ortired, even though you've had a
full night's sleep, or kind ofhave like droopy, sad, like
puppy dog eyes? Both of thosethings are reasons that people
come and see me for lower lidblepharoplasty or lower eyelid
lips. Today, we're going to talkall about them.
(00:22):
You welcome to the Trilliumshow, where each week we discuss
different tips to help youimprove your mind, your body and
your life. I'm your host, boardcertified plastic surgeon and
medical director of Trilliumplastic surgery and Trillium
esthetics. Dr Jason Hall, solower lid blepharoplasty is one
of these operations that a lotof people come in asking about,
(00:45):
they want lower lid bagsremoved. They don't like the
crepiness or the crinkliness oftheir lower eyelid skin. And so
lower lid blepharoplasty isoften thing that we talk about
to help improve that. In thisshow, what we're going to do is
kind of go through lower lipbuffer plastic from soup to
(01:05):
nuts, and you can tell it's kindof hard to say left for row
plastic eyelid lift. So what arethe goals? Because it's
important before we starttalking about treatments, to
understand what the goals are.
Goals of a lower lip bufferplastic are three fold. One is
to get rid of the sad, tiredpuppy dog eye look. Number two
is to remove or smooth excesswrinkly skin. Number three is to
(01:26):
remove and contour the hollowthat develops in our lower eyes
with time. But just important,as important as it is to know
what things can do. It'simportant to know what things
can't do. So what doesn't alower lid blepharoplasty do?
Well, first of all, while iteliminates some of the
(01:49):
crinkliness under your eyelids,it doesn't eliminate all of it,
and certainly doesn't eliminatewrinkles and crows feet out to
the sides. Those are things thatthings like Botox and Juve and
disport will still be needed toreally get rid of those crows
feet. The other thing that itwon't do is it won't take away
(02:09):
completely the dark circles.
Now, we could do a whole nothershow about dark circles under
the eyes and what causes thosebut a lot of times, people get
pigment that gets deposited herein the lower eyelid that occurs
over time. A lower lidblepharoplasty will not address
(02:33):
that by itself. Now, there areother things that we can do with
our lower lid buffer plastic,but a blepharoplasty itself
won't get rid of the darkcircles 100% and the pigment
that's under the eyes. Now it'sreally important, when we talk
about lower eyelid surgery, tounderstand why we're seeing what
we're seeing. If you've listenedto my facial aging podcast,
(02:56):
which we'll link right up here,the facial aging happens as a
result of three main components,skin changes, volume loss, and
then gravity. The volume loss issomething that around the eyes
shows up typically, you know,different strokes for different
folks, typically start seeingthat late 30s, early 40s, and is
(03:21):
what contributes to that teartrough or that eyelid hollow.
Some people that happens muchearlier. Some people have them
their whole lives because of theway that their eye sockets their
facial skeleton are puttogether. But it's important,
and one of the things that hasreally changed in lower
blepharoplasty surgery sinceI've been in training and
(03:44):
learned how to do this 15 yearsago was we now know that volume
replacement is just as importantas volume removal. The bag that
you see under your lower eyelid,really is the result of the
(04:05):
covering of some fat that's inyour eye weakening, and that
causes that lower eyelid fat tobe to protrude out and be a
little bit more prominent. Atthe same time, we lose volume in
our cheeks, overlying it. And sogood analogy for this is it's
like the tide going out at thebeach. You know this that volume
(04:26):
loss is like the tide going outand exposes the stuff that's
underneath. And so bringing thetide back, replacing some of
that volume is really importantto help smooth the contour
between your cheek and yourlower eyelid. And so every
single lower blepharoplasty thatI do, we talk about bringing
(04:46):
some fat back into the uppercheek to help soften that
transition between the lid andthe cheek. The other thing that
has really changed a lot since Ilearned how to do this is that
the concept. Kind of openingeverything up and and really
weakening the lower eyelid haslargely been replaced with non
(05:10):
invasive, or less invasiveapproaches where we go in
through the inside of the lowereyelid and we avoid the support
that is in the lower eyelid, andwe'll talk about that here in
just a second. That improves.
But by avoiding that, we stillhave to address the skin of the
lower eyelid, and we I do thatnow in two ways. I either use
(05:32):
what's called a skin pinch,where we just do exactly what it
sounds like, remove a littlepinch of skin at the end of the
procedure, or what I do most ofthe time now is use a laser to
help resurface that under eyelidskin. And that is, that is by
far the most common thing that Ido, and we'll get into that here
in just a second. So what does alower blepharoplasty procedure
(05:53):
look like? Most of mine aretrans conjunct, or going in
through the inside, and that's ahard word to say, trans
conjunctival. So go in throughthe inside, and then contour
some of that delicate fat thatsits underneath your your lower
eyelid. Once that is done, thenon the outside, will either take
(06:15):
a little skin pinch through alittle incision right underneath
your eyelashes that hidesbeautifully, or we use a laser
to help resurface that lower lidskin. At the same time, we'll
use some fat and inject somefat, take a little bit of fat
from your abdomen, take a littlefat from your thighs and inject
that in to fill in some of thathollow the final thing, and I'm
(06:37):
very conservative in doing this,is using what's called cancel
support. So supporting that yourlower eyelid, in the corner of
your eye, which is really isless a cosmetic thing, if you
really think about it, we're notreally changing the shape of
(06:58):
your lower eyelid. What we'redoing is helping to kind of
tighten that lower lid, whichtends to get loose over time,
and prevent it from draggingdown. You've seen people who
have had lower lids that kind ofwalk around like this, not a
good look, and very, verydifficult to treat. So kind of
like most things we talk aboutin in facial surgery, ounce of
prevention is worth a pound ofcure. And so what's called a
(07:21):
canthopexy, or a little suturethat helps to tighten that from
the inside, is used a lot inlower lid surgery. In terms of
recovery, really swelling forlower lid surgery is the main
issue. Typically, like mostfacial surgeries, I recommend
people kind of hide out forabout two weeks to make sure
(07:41):
that that swelling is gone. Ifthere's a little bit of
bruising, a lot of that stuff,we can treat with a laser here
in the office right aftersurgery. And for the fat
grafting, the fat transfer,especially in patients who have
very thin skin, that swellingunder the eye can be noticeable
for about six weeks. And that'swhy I have people I just tell
(08:01):
patients, pause your workoutsfor about six weeks, because the
more you exercise, the more youget your heart rate up, your
head sees a lot of that bloodflow. You're going to worsen
your swelling and make it stayaround even longer. The other
question we get, especially withlower lid surgeries, for people
who wear contacts. You want toavoid contacts for about 10 days
after the surgery is over. Wedon't want to lose a contact in
(08:24):
an incision. That's a bigproblem. Never had it happen,
but we don't want you to be thefirst person. So what are the
what are the procedures? Can wedo with a lower libroplasty?
Well, pretty much any facialsurgery can be done at the same
time we do a lower lid bufferplastic. It's very oftentimes
combined with brow lift andupper blepharoplasty surgery.
(08:45):
Because we've got the laser outand are using it, we will often
do full face laser resurfacingto varying depths, depending on
kind of what skin problems we'relooking to treat. And a lot of
times, a deep plane face andneck lift is done in conjunction
with our lower lipblepharoplasty surgery. Few
things to watch out for ifyou've ever had filler in your
(09:09):
under eyes and tear troughfiller is really common these
days. If you've ever had fillerin your under eyes, we have to
know about that on the front endso that we can dissolve it first
under eye filler and surgerydoesn't typically go well
because of swelling you can havethat filler tends to obstruct
(09:30):
the fluid drainage, thelymphatic channels under your
eyes, and can cause prolongedswelling. So if you've got
filler under your eyes, it'simportant that we know about
that so we can dissolve itbefore surgery. It's also
important so we know kind ofwhat we're dealing with in terms
of volume replacement beforesurgery. If you have dry eyes,
(09:51):
lower libroplasty surgery willmake this worse, at least
temporarily, and. If you've gotreally dry eyes, that it could
even be something that will makelower lid Bleu prostate surgery,
not something we want to dealwith. So it's important to kind
of we talk through this beforesurgery. The other thing that
(10:12):
can happen after surgery issomething called chemosis, which
is swelling of the white part ofyour of your eyeball itself.
It's benign, but it can be apain in the butt and needs to be
treated. So we have some steroideye drops. Sometimes we'll have
to patch for a couple of days toget that swelling to go down.
(10:35):
And if it's really severe, weactually need to drain that
fluid out in the office, whichsounds horrible, but really,
isn't we just put a littlenumbing drop in, make a little
snip in the in the coveringheals uneventfully, but we
that's kind of a last ditcheffort. The other thing that can
(10:55):
happen, you can have some subconjunctible hemorrhage. So in
the in the white part of youreye can get a little bit of
bleeding doesn't happen often.
It's impressive looking, butisn't because that part of your
eye turned to red. But isn'tdangerous. So speaking of
dangerous, can't talk aboutsurgery without talking about
complications. What's the worstpossible thing that can happen?
You could go blind. Now this isexceedingly rare. The quoted
(11:17):
rate is one in 10,000 it'sprobably even more rare than
that, to the point that most ofus who do this have never seen
that. Knock wood eyelidmalposition is the other big
problem. You know, your lowerlid getting dragged down by the
swelling after surgery. That's areason for doing the
(11:40):
transconjunctible approach, sowe're staying away from the
support. It's also a reason thatwe use canthopexy sutures
routinely to help support thatand prevent that mal position.
Corneal abrasions are anotherissue. Those are really rare
kind of eyes scratchy. You haveeye shields in during surgery to
protect your eyes, but you canget a little scratch, which is
(12:03):
painful, but heals withoutissue. And then, obviously, with
any surgery, there's a chancethat things couldn't look
exactly like we wanted to, andwe would have to go back and
revise that. So this has beenlower lid blepharoplasty in a
nutshell. I hope this gives yougood information, kind of about
(12:25):
how the procedure works, whattypes of things that this can
treat, and, more importantly,what types of things it can't
treat. I would recommendeverybody go back and in look at
the facial aging show that Idid. It is a good resource if
you're contemplating any facialrejuvenation surgery, to kind of
know why you're seeing whatyou're seeing first. But thanks
(12:45):
for listening. If you enjoy theshow, please leave me a review
on Apple podcast. Please commentdown below if you have an idea
you'd like to see made into ashow. Have a question you want
answered, send me an email mediaDr Jason hall.com, drop me a DM
on Instagram or x at Dr. JasonHall, thanks again, and we'll
see you guys soon. You.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.