Eyelid skin is the thinnest skin on the body, and it is here that most of us will show the signs of aging first. The lower lids can be especially problematic, because the skin not only becomes thin and wrinkled, but the fat around the eyes can move downward into the lid to produce the swollen â€œbagsâ€. These fat pads will create a dark shadow on the lid, and people will complain of the dark â€œcircles.â€ This dark shadow is also called the tear trough.
In a traditional lower lid blepharoplasty, excess skin and fat are removed. While this initially produces a smooth contour to the lid, with time, most people will start to look hollow from the lack of fat, and the lid can start to look very hollow and dark again. In a newer technique called fat repositioning, instead of removing that fat, we reposition the fat over the cheek bone, to fill in the tear trough, smooth out the contour of the lid and decrease the appearance of the dark circles. It is much more rejuvenating to preserve the fat here than to remove it.
In our office operating suite, we have a CO2 laser which we use for this procedure. Using the laser helps to decrease bleeding and subsequent bruising and swelling. This surgery is usually done with IV sedation and local anesthesia. We make a small incision inside the lid to allow direct access to the fat pads, which can then be moved down into the tear trough. Once the fat has been repositioned, any loose skin is addressed. If there is a lot of excess skin, some of this can be excised with an incision that is directly under the lashes, and extending out in one of the wrinkle lines on the side of the eye. Laser resurfacing can also be done on the lids to help tighten and improve the texture of the skin. This is done with one of several lasers, depending on the degree of tightening needed, and the color of the skin.
There is little or no pain post-operatively, but the lower lids have a lot of blood vessels, so most patients will have bruising and swelling after a blepharoplasty. You will use ice packs over the eyes for the first 2-3 days, and then warm compresses. After a fat repositioning blepharoplasty you can expect a fuller, more youthful under-eye appearance.