Lower Eyelid Surgery

Learn about the techniques Dr. Schwartz uses for lower eyelid surgery.

In lower eyelid surgery, it is really important to respect the functional role of the lower eyelid and the aesthetic portion of the lower eyelid. The lower eyelid is much more susceptible to changes in tension and the lower eyelid elasticity decreases with ageing, so it is important to assess each patient beforehand and determine the elasticity of their lower lid and the lower lid position in relationship to the eyeball. Any increased or excessive tension on the lower lid can create too much the white portion of the eye showing, which is kind of a telltale sign of surgery. It is also a little bit of a scary look. It makes people look scary, so we would like to maintain the lower lid position. The way I do this most frequently is to do what is called a transconjunctival lower eyelid blepharoplasty where we inject the lower lid with numbing medicine that also prevents bleeding. We go inside the lower lid and make small incisions to remove or reposition the fat compartments, and if someone has excess skin or muscle of the lower lid, rather than making the older conventional skin muscle flap, which is fraught with more complications, I like to just take a little pinch of skin and possibly a little pinch of muscle or one or the other as indicated in the lower lid and this necessitates putting a few sutures under the lashes of the lower lid, though when closed carefully, this is absolutely undetectable, in fact, this incision cannot even be seen at one week when the stitches are removed.