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Lower Eyelid Correction (Blepharoplasty)

Lower eyelid blepharoplasty is used to remove or redistribute the fat deposits that may form on the lower eyelids with age as well as remove loose skin. Many factors, including heredity and sun damage, accelerate these changes.  Younger people also elect to have this procedure done to eliminate puffiness of the eyes from congenital excess fatty tissue.

This procedure is frequently done at the same time as other procedures, such as upper eyelid blepharoplasty, facelift or forehead lift, and can be combined with laser or chemical resurfacing to smooth skin wrinkles. When overhanging of the upper lids interferes with peripheral vision, and both upper and lower eyelids are done at the same time, the procedure may be covered by insurance. 

If you're considering lower eyelid blepharoplasty, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, please schedule a consultation with Dr. Kremer / Dr. Zettl.

 What are some of the most common benefits of this surgery?

Lower eyelid blepharoplasty can make a remarkable difference in the appearance of the face, alleviating the appearance of tiredness and old age by eliminating the excess, wrinkly skin beneath the eyes. The eyes appear fresher and more youthful, and the results may last for many years. The degree of improvement varies from patient to patient.

Important note: Lower eyelid blepharoplasty will not eliminate dark circles, fine lines or wrinkles around the eyes, or alter sagging eyebrows. To enhance the results of your eyelid procedure, Dr. Kremer / Dr. Zettl may also recommend: 1.) a brow lift to correct a drooping brow and smooth the forehead, 2.) a facelift for saggy jowls, and/or 3.) skin resurfacing to eliminate fine lines.

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 What will happen at the initial consultation?

During the consultation, you and Dr. Kremer / Dr. Zettl will discuss the changes that you would like to make in your appearance. He will explain the different options available to you, the procedure itself, and its risks and limitations. He will also explain the kind of anesthesia required and the surgical facility.

Dr. Kremer / Dr. Zettl will begin with a medical history and examine the skin and fat around your eyes. He will also examine your eyesight, peripheral vision, and tear duct. You should tell him about any related symptoms you may have, including any dryness of the eyes, changes in vision or eye pain. You should also tell Dr. Kremer / Dr. Zettl if you have 1.) thyroid problems such as hypothyroidism, 2.) elevated blood pressure or other circulatory disorders, 3.) cardiovascular disease, 4.) diabetes, or 5.) any other serious medical condition(s).

Be sure to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

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 How is lower eyelid blepharoplasty performed?

For traditional lower lid blepharoplasty:

1.       An incision is made along the lash line and smile creases

2.       Excess fat, muscle and skin are removed

3.       Fine interrupted sutures are used to close the incision

4.       Permanent stitches will be removed 3-5 days after the procedure

Fat may sometimes not be removed yet redistributed in patients that present with a hollowness around their eyes. In more complex cases, a dermal fat graft may be used to augment the soft tissue deficiency and hollowness, also called the "tear trough" deformity, a deformity known to be not easily correctable.

If you have a pocket of fat beneath your lower eyelids, but do not need to have any loose skin removed, Dr. Kremer / Dr. Zettl may recommend a so called transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with fatty lower eyelids. Transconjunctival blepharoplasty, however, does not tighten the skin.

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 How long does the surgery take?

A lower eyelid blepharoplasty generally takes about one to three hours to complete, depending on the technique used and the extent of the repair. 

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 Will I need to stay in a hospital?

Lower eyelid blepharoplasty can be performed on an out patient basis, in the office or in an ambulatory surgicenter, under either local or general anesthesia. The more extensive the procedure is anticipated (see above), the more likely Dr. Kremer / Dr. Zettl will recommend general anesthesia.

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 How much pain is there?

Initially, you may feel a tight sensation around the eyes, with minor discomfort that lasts for a day or two. A mild pain reliever can be taken as needed. People who have had the procedure are often surprised at how painless eyelid surgery can be. Many times, isolated eyelid surgery can be performed under local anesthesia with a total recovery time as short as 7 to 10 days. The recovery time varies from person to person.

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 What can I expect after surgery?

After surgery, Dr. Kremer / Dr. Zettl will lubricate your eyes with ointment to reduce dryness in this area. Your vision may be blurred temporarily from the ointment.

The first evening after surgery, you should rest quietly with your head elevated. It will help to apply cold compresses to your eyelids.  Although you can be up almost immediately, you should limit your activities.

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 What is the recovery period like?

At first the incisions will probably be red and somewhat bumpy. Eventually, the resulting scar should become flat and inconspicuous. Skin sutures will be removed sometime within the first week. The swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel better each day. Swelling and bruising varies considerably from person to person. Bruising typically disappears within seven to ten days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration.

Your vision may be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. You may receive eyedrops to help relieve any burning or itching.

For the first week, you’ll need to avoid activities that dry the eyes, including reading, watching television, wearing contacts, and using a computer. Also avoid excessive blinking, which leads to increased swelling. You may also wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation. The eyes may tire easily for several weeks; frequent naps are helpful.

For the first three or four weeks, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and sports. Dr. Kremer / Dr. Zettl will let you know when you are ready for exercise. Also avoid drinking alcohol, which can lead to fluid retention and delay recovery.

Read our Postoperative Care Form from the comfort of your home NOW! 

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 What is the long-term outcome like for most people?

The more alert, youthful look that this surgery provides is usually long lasting. Thin scars may remain slightly pink for six months or so, but can easily be concealed with makeup. They eventually fade to a thin, nearly invisible white line. The removal of fat is permanent, but the looseness of the skin and fine wrinkling of the eyelid area may return in the future.

Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time. If continued loss of skin tone in the forehead later causes sagging of the eyebrows, a forehead lift or second eyelid procedure may be performed.

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 Ideal candidate:

In general, the best candidates for lower eyelid blepharoplasty are people:

• 18 years of age or older
• In good physical health
• Psychologically stable
• Understanding the procedure's outcome
• Desiring correction of droopy, baggy eyelids
• With no known ophthalmic conditions such as glaucoma or detached retina
• With no known medical conditions such as high blood pressure, circulatory problems, hypothyroidism or other thyroid related conditions.
• Having realistic expectations for the outcome

The above is only a partial list of the criteria that Dr. Kremer / Dr. Zettl will consider in determining whether or not this procedure is appropriate for you. Be sure to ask Dr. Kremer / Dr. Zettl if he considers you an ideal candidate for lower eyelid blepharoplasty.

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 Alternatives:

Lower eyelid blepharoplasty is frequently combined with a upper eyelid blepharoplasty, a facelift, or a foreheadlift as part of an overall facial rejuvenation procedure. It can also be combined with laser resurfacing or chemical peeling to further enhance the results. Usually, resurfacing will be recommended as a separate procedure, although it can be combined in certain situations. Dr. Kremer / Dr. Zettl will discuss this with you if he thinks additional procedures would help your overall appearance.

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 Risks:

Significant complications from aesthetic eyelid surgery are infrequent. As with any surgical procedure, however, there is always a possibility of infection, or reaction to the anesthesia.

Other potential complications include:

• Retrobulbar hematoma (bleeding behind the eye). Rare, but can be serious. Symptoms include loss of vision
• temporary problems with excessive tearing
• decreased sensation in the eyelid
• dry eyes - dryness, burning, stinging, gritty sensation in your eye(s)
• prominence or firmness of the scars
• blurred vision
• asymmetry in healing or scarring
• milia or whiteheads where the sutures emanate from the skin.
• difficulty closing eyes completely; in rare cases, this condition may be permanent.
• ectropion, or a pulling down of the lower lids.

Further surgery is uncommon but often may be quite straightforward. You can help minimize certain risks by following the advice and instructions of Dr. Kremer / Dr. Zettl, both before and after your eyelid surgery. Pre-existing conditions can also put you at risk. They include thyroid problems such as hypothyroidism, insufficient tear production or dryness of the eye, elevated blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. Caution should be exercised if you have ophthalmic problems, or other serious medical condition(s). In this case, Dr. Kremer / Dr. Zettl may require a clearance from your general practitioner or other physician.

Read our Specific Surgical Risks Form from the comfort of your home NOW!

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 Be sure to:

• Tell Dr. Kremer / Dr. Zettl about any allergies you have (to foods, drugs, environmental elements)
• Tell Dr. Kremer / Dr. Zettl if you have a history of bad scarring, such as keloids.
• Tell Dr. Kremer / Dr. Zettl about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription)
• Carefully follow any instructions Dr. Kremer / Dr. Zettl gives you regarding eating and drinking and smoking.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
• Arrange for someone to drive you home after surgery or after discharge from the day surgery facility.
• Please inform Dr. Kremer / Dr. Zettl immediately in case you should experience fever or symptoms of an infection after surgery.
• Please use a cooling mask or ice packs to reduce swelling an discomfort after surgery.
• Refrain from strenuous physical activities during the first days after surgery.

Tell Dr. Kremer / Dr. Zettl if you have any of the following pre-existing conditions:

• thyroid problems such as hypothyroidism
• insufficient tear production or dryness of the eye
• elevated blood pressure or other circulatory disorders
• cardiovascular disease
• diabetes
• ophthalmic problems
• any other serious medical condition(s)

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. 

The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer / Dr. Zettl. He will be able to answer specific questions related to your situation.

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