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As we age, many of us will develop a “tired” or “baggy” appearance to the bottom eyelids. This may be described as dark circles, swollen bags, hanging skin, or drooping. Some of us may have puffiness of the lower lids starting at a very early age that can be attributed to allergies or inheritance of a family trait. Lower lid blepharoplasty surgery is designed to address each of these specific changes. There is no such thing as a “standard” approach to lower lid blepharoplasty as surgery must be specially customized to every individual.

Lower lid blepharoplasty surgery is primarily designed to address the puffiness caused by fat pads and/or the bagginess caused by excess skin. Three separate fat pads exist in the lower lid and for most of us these become more prominent with age. The goal of lower lid blepharoplasty is to sculpt the fat to create a smooth gentle concave contour from the cheek up to the eyelashes. When ideal contouring is achieved, undereye circles disappear. The fat pads can be approached through an incision placed in the skin just beneath the lashes (external approach) or through the inside of the lid (transconjunctival approach). The incisions beneath the lashes are well hidden and have the added benefit of allowing skin tightening to prevent aging changes over the years.


Prior to planning for surgery, eyelids must be assessed for the quality of tone or tautness. Many have looseness of the eyelids and those with “big eyes” tend to have pulling down of the lower lids from gravity. If looseness or pulling from gravity is noted, then an additional step in surgery is recommended to tighten the lid, and this is called a canthopexy. Dr. Heher’s training as an eyelid specialist allows her to tighten the lower lid while maintaining a natural appearance that does not look pulled or “slanted”. When a canthopexy is indicated, this maneuver assures that maximal results can be obtained while retaining the natural shape of the eye. Those who suffer from dry eye syndrome may also benefit from a canthopexy and can achieve considerable improvement in their symptoms. 

Some with only minimal prominence of the fat or slight excess skin can benefit from alternative procedures using fillers and/or botox injections. Surgery is only recommended when less invasive procedures will not lead to ideal results. Many that are good candidates for lower lid blepharoplasty can also benefit from upper lid surgery.

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