There are a variety of techniques for lower eyelid surgery, or lower blepharoplasty, and each has its advantages and disadvantages. Dr. Jen Chow is well versed with the two most common approaches for lower eyelid surgery, which are the trans-conjunctival approach with or without skin pinch, and the transcutaneous approach.
He prefers the trans-conjunctival approach, in which the incision is made behind the eyelid, whenever possible because this safely allows removal of excess fat without causing injury to the eyelid muscle. If skin does not need to be removed, there is no visible scar. When excess skin is also present, a small amount of skin can be removed by direct excision, by chemical peel, or, on occasion, via laser.
Occasionally, when some of the eyelid muscle needs to be removed, or when planning to lift the cheek fat pad during lower eyelid surgery, Dr. Chow will perform the lower blepharoplasty through a direct transcutaneous approach. In this case, the incision is made through the skin just a couple millimeters below the eyelashes. Depending on the cosmetic goals of the procedure, any number of techniques may then be used.
During your initial consultation and on any subsequent visits, Dr. Chow will perform a complete history and physical examination of your face and eyes to ensure that lower eyelid surgery will be as safe and effective as possible. He will be happy to discuss any concerns or questions you may have regarding your cosmetic goals.
Before having any cosmetic surgery, you should always review the medications, supplements, vitamins, and foods that you consume. Many of these can cause problems during your procedure because they thin your blood, making you more likely to have heavier bruising or complicating the procedure with excessive bleeding. Others may overly enhance or otherwise interact with the numbing anesthetic used during your lower eyelid surgery.
Dr. Jen Chow should also know your medical history, especially any eye conditions you may have, such as glaucoma. Use of eyeglasses, contacts, and eye medications should be recorded. Any history of dry eye syndrome is very important and should be thoroughly evaluated, as this may be a reason to avoid eyelid surgery. If you have been seeing an ophthalmologist, or eye doctor, you will likely need to be declared safe for blepharoplasty by this physician prior to surgery. Previous surgeries, particularly previous eyelid surgeries, must also be known because they may affect your outcome.
Please be sure to avoid the use of make-up on the day of surgery. If you have previously had a permanent eyeliner tattooed below your eyelashes, be aware that some or all of this tattoo may be removed during surgery as a result of skin excision.
Before the procedure begins, Dr. Jen Chow will meet with you to discuss any last minute questions you may have. He may also make some markings while you are in the sitting position to aid in accurate fat removal during surgery.
Most lower blepharoplasty is performed with an anesthesiologist present at an outpatient surgical facility. An anesthesiologist is a doctor who is responsible for making you comfortable and safely sedated during your procedure. You should plan on having someone to take you to and from the facility and to stay with you overnight on the day of surgery.
Once you are comfortable, Dr. Chow will numb the eyelids. Using sterile techniques, he will then perform the removal or repositioning of fat through either a transconjunctival or transcutaneous approach. Excess skin or muscle will also be addressed. Once the procedure has been completed, your vision may be blurry due to antibiotic ointment or temporary swelling.
You will have a period of recovery afterwards while a nurse or team of nurses watches over you with physician supervision.