To lift the margin of the eyelid, or to ensure the eyelid does not drop or retract post surgery, a ‘canthopexy’ (a stitch in the corner of the lid) is often performed. This approach will be used on both eyes during lower eyelid surgery.
Over time, pockets of fat may develop under the lower eyelid, producing bags. Other noticeable signs of ageing that can benefit from surgery include: tear trough (a groove under the eyelid where it joins the cheek); malar bags (fluid-filled pouches under the eyelid); lateral canthal descent (the outer part of the eye drops downwards); loss of facial fat revealing bones around the eye area; loose, floppy eyelids; and lengthened eye area when the cheek tissue drops.
A number of different operations can be performed to correct these issues, depending on your individual circumstances.
A transconjunctival blepharoplasty will remove or reposition prominent fat bags from under the eyes via a cut on the inside of the eyelid. It is popular surgery as it leaves no scar on the skin and recovery is usually quite quick.
To remove excess skin on the lid, the subciliary approach is used. This requires cutting along the margin of the eyelid.
Instead of removing excess fat, the surgeon may suggest repositioning the fat and lifting and re-draping the muscles of the eyelid and cheek area. It is a more complex operation, but can be very effective when performed by a specialist.
Laser or chemical peels can tighten excess skin in the lower eyelid area. However, these techniques may cause hypopigmentation (lightening of the skin) or hyperpigmentation (darkening of the skin).
When the ageing of the lower lid is the result of sagging cheek tissues, lifting the cheek or mid-face may be required. In this instance, surgery is likely to be much more intensive and extensive and can involve lengthy recovery.
The early signs of ageing are often marked by the appearance of hollow or dark rings under the eyes. Injecting the patient’s own fat (or synthetic filler) is often very successful in smoothing and plumping any grooves or hollows.
Lower eye surgery is more complex than upper eye surgery. The recovery time is longer and it is almost always combined with upper eyelid (blepharoplasty) surgery.
Surgery is carried out under general anaesthetic. Procedures are usually performed on an outpatient basis but may occasionally require an overnight stay in hospital.
Recovery times vary but it advisable to limit strenuous activity for the first six weeks.