Dr Greensmith has more than 20 years of experience performing aesthetic eyelid surgery/blepharoplasty to address the aging, aesthetic and visual /functional concerns of his patients. Frequently this is combined with a Brow Lift / Brow Modulations / Lateral Temporal Lift ( in over 90 % of patients ) as the cause of most patients’ concerns originate from both brow descent and eyelid issues.
The appearance of the eyelids and lower eye area changes significantly with advancing age. The eyes are often the first place to show signs of ageing. Because the skin is so fine compared with the rest of the face, the eyes are one of the first areas where people can develop wrinkles and loose skin.
Lower and upper eyelid fat bags and hollowing under or above the eyes can develop due to a number of variables, including genetics, facial shape and anatomy, and ageing changes, such as the prolapse of eyelid fat bags and progressive loss of volume in the fatty layer beneath the skin.
Evolution of Blepharoplasty
Before modern cosmetic eyelid surgery techniques became available, the traditional approaches to blepharoplasty relied mainly on the excision of skin and fatty tissues to change the appearance of the eyelids. Unfortunately, in an ill-advised attempt to treat more advanced signs of ageing, these techniques often result in excessive excision of skin and fatty tissues. This is known to significantly increase the risk of complications such as impaired eye closure, dryness of the eyes, malposition (drooping) of the lower eyelid, and excessively hollowed eyes.
Improved results have been made possible with the development of modern eyelid surgery principles and techniques. It is now well known that only the skin and fat that is in true excess should be removed so that all required tissues are carefully preserved. Modern cosmetic eyelid surgery options now combine more calibrated removal of skin and fat with technical advances that enable lower eyelid tightening, fat pocket repositioning, micro-fat grafting to replace lost volume and upper lid tarsal fixation blepharoplasty. This concept is now known as “preservation blepharoplasty” and is similar in concept to my concept of restructuring versus skin tightening/removal in facelift surgery.
Surgical Options Available
Upper Blepharoplasty (Upper Lid Lift)
Several techniques are available for upper eyelid surgery. Dr. Greensmith will discuss with you the options that best address your concerns.
- Upper eyelid blepharoplasty also known as an upper eyelid lift, is performed via an incision placed within the upper eyelid crease. Only excessive skin and protruding fatty tissue are carefully excised. This is the usual technique used for most people with concerns related to ageing. Incisions in this area heal well, so the scar is usually fine and should not be as visible after three weeks.
Lower Blepharoplasty (Lower Lid Lift )
In all lower eyelid surgery, it is vital to avoid excessive excision of skin in a misguided attempt to smooth the eyelid by tightening the skin. Dr Greensmith offers a full range of lower eyelid blepharoplasty techniques, the most common of which are described below. Each of these can be performed as a standalone technique, and all or any can be combined as needed to address each person’s individual presenting concerns.
- Transconjunctival lower eyelid blepharoplasty – performed via an incision inside the lower eyelid which is not visible externally. This is a treatment for those who have concerns about excessively prominent lower eyelid bags. The surgery includes the removal and repositioning of excess lower eyelid fat. Often fat is not removed but rather preserved and repositioned, or the “hernia “ of fat is repaired. In more recent times emphasis is increasingly on fat and tissue preservation (excess removal of fat and skin can paradoxically age the eye ) and is known as Preservation Blepharoplasty.
- Transcutaneous lower blepharoplasty – also known as a lower eyelid lift, is performed via an incision just below the lower eyelashes (a sub-ciliary incision). Minimal skin is excised but redraped obliquely in a method known as “Pinch Blepharoplasty.”
- Canthopexy – a support technique to provide extra firming of the lower eyelids that also substantially reduces the risk of lower eyelid malposition when removal of significant degrees of excessive lower eyelid skin is performed at transcutaneous lower blepharoplasty. It involves the re-supporting of ligaments at the outer corner of the eyes that have become loosened due to the ageing process via a short incision under the eyelashes at the outer corner of the eye. In patients with particularly aged or lax lower eyelid ligaments, this may be needed.
Lower Eyelid Micro-fat or Nano Fat Grafting –precise injection of fat to address concerns due to loss of volume in the layer under the skin such as tear troughs, hollowing under the eyes, and mid-cheek grooves is often used by Dr Greensmith to further address the aesthetic concerns of his patients.
