Lower Eyelid Surgery

 

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Lower Eyelid Surgery in New Jersey

Lower Eyelid Surgery (Blepharoplasty) Before & After Photo. Surgery by Dr. Baljeet K. Purewal (Oculoplastic Surgeon) in New Jersey.

Lower Eyelid Surgery (Blepharoplasty) Before & After Photo. Surgery by Dr. Baljeet K. Purewal (Oculoplastic Surgeon) in New Jersey.

 



 


FAQ: Lower Eyelid Surgery


What are the causes of my lower lid dark circles?

There are several underlying causes for dark circles. Dark circles may be secondary to hyperpigmentation of the lower lid skin from allergies or excess rubbing of the lids. It may be due to vascular pooling in the lower lids which can lead to a bluish discoloration. Tear trough deformity or hollows can give a dark shadow. And finally, as you age, the tissue structures and muscles of the lower lid weaken and allows for fat which normally sits within the eye socket, to protrude forward and give the appearance of bags.

What can I do to improve my puffy lower lids?

Lower lid blepharoplasty surgery can improve puffiness of lower lids. There are several options depending on your anatomy and laxity of your lower lid and skin. A transconjunctival blepharoplasty can be performed to remove excess fat. There are no stitches or external incision unless you have significant skin or eyelid laxity. In the case of excess lower lid skin, an external incision is created directly under the lash line to remove excess skin and tighten the eyelid. An absorbable stitch is used to close the incision and dissolves after one week.

What are the causes of my lower lid dark circles?

There are several underlying causes for dark circles. Dark circles may be secondary to hyperpigmentation of the lower lid skin from allergies or excess rubbing of the lids. It may be due to vascular pooling in the lower lids which can lead to a bluish discoloration. Tear trough deformity or hollows can give a dark shadow. And finally, as you age, the tissue structures and muscles of the lower lid weaken and allows for fat which normally sits within the eye socket, to protrude forward and give the appearance of bags.

How do I know if I am a candidate for lower lid blepharoplasty surgery?

If you have puffiness of your lower lids that continues to bother you, you may be an excellent candidate for upper eyelid lift.

Where is the surgery performed?

Surgery is performed in a surgical center with IV sedation or general anesthesia.

How long does the surgery take to perform?

Lower eyelid blepharoplasty surgery takes from 1-2 hours to perform.

What is the recovery time?

We do our best to minimize swelling and bruising by preparing our patients ahead of time with supplements and with careful intraoperative techniques and local medications. In the case of a transconjunctival blepharoplasty with no external incision, most patients feel comfortable to return to work or their usual activities after 4-7 days. In these cases, make up can be applied soon after surgery to cover up any bruising or swelling. For a more extensive lower lid blepharoplasty surgery with an external incision for skin tightening, the recovery time is 1-2 weeks.

What are my non-surgical options?

If you’re not quite ready for surgery, or your only concern is restoring lost volume and not excess skin, fillers may be just what you need to rejuvenate the eye area. For improvement of skin quality, we also offer lasers, peels, microneedling and creams to rejuvenate this area.

When can I apply make-up after surgery?

In the case of a transconjunctival blepharoplasty with no external incision, make up can be applied the very next day if desired. If there is an external incision for skin tightening, patients should avoid make up directly over the incision for 2 weeks.

Is the recovery from surgery painful?

The first evening of the surgery, swelling and bruising sets in and pain medicine is prescribed, but many patients feel that Tylenol is sufficient. For the next few days, ice compresses help with the mild discomfort that patients may experience.

How will the scars look once I am fully recovered?

Depending on the approach, there may be no external incision with no stitches. Make up can be applied soon after surgery to cover up any bruising or swelling. If there is loose skin to be addressed, an incision is placed under the lash line and is mostly hidden by the lashes. This incision line heals very well and often is barely visible. It fades after several months.

Will eye creams improve my dark circles?

It depends on the actual cause of the dark circles. The appropriate eye cream works best if the darkness is secondary to hyperpigmentation in the skin. Our Eye Brightener cream is works excellent to address this pigmentation and improve it.

What is the cause of my puffy lower lids?

As you age, the muscles beneath your skin grow weak, allowing fat to protrude through and cause bags. A lower blepharoplasty, also known as lower eyelids surgery, corrects this prodtruding fat, and removes any loose skin. The goal is to create a smooth contour from your lower lash line down to the midface. Dark circles go hand in hand with under-eye bags. Fat that has fallen forward can be removed or repositioned right below where the tissue has fallen to reduce dark shadows that are cast on the eye.

Will eye creams help with my dark circles?

There are multiple causes of dark circles under the eyes. These include lower eyelid fat prolapse, genetics, allergens, sun exposure and loose skin. Understanding the underlying cause is the most important and effective way to treat them. During the initial consultation Dr. Purewal will identify the cause and will come up with the needed treatment. If a specific eye cream may be helpful, she will recommend it for you.

I am young and not ready for surgery. Are there non-surgical options for me?

Yes. If you’re not quite ready for surgery, or your only concern is restoring lost volume and not excess skin, fillers may be just what you need to rejuvenate the eye area. We also offer lasers, peels, microneedling and creams to rejuvenate this area.

What are the surgical options for lower lid blepharoplasty?

A procedure that’s performed under IV sedation or general anesthesia, a lower blepharoplasty uses small incisions that I make in the lower eyelids or just beneath the lower lash line to remove excess skin and remove the fat and in a way that gives a youthful and balanced look. If you’re bothered just by bulging fat not loose skin, I can make an incision inside the lower lid to remove only the fat.

How long do the results last?

10-15 years

How long does the procedure take?

The procedure typically takes between 1-2 hours. No patient is ever rushed so that the best results may be achieved.

What is the recovery time for the procedure?

There will be some swelling and bruising around the eyelids for one week. Most patients can return to work after 5 to 7 days. There is minimal eye discomfort after the procedure. Ice packs are recommended for the first few days to decrease swelling. We offer Arnika Forte to help reduce swelling and bruising.

How will my scars look once I am fully healed?

Depending on the approach, there may be no external incision with no stitches. Make up can be applied soon after surgery to cover up any bruising or swelling. If there is loose skin to be addressed, an incision is placed under the lash line and is mostly hidden by the lashes. This incision line heals very well and often is barely visible. It fades after several months.

As you age, the muscles beneath your skin grow weak, allowing fat to protrude through and cause bags. A lower blepharoplasty, also known as lower eyelids surgery, corrects this prodtruding fat, and removes any loose skin.  The goal is to create a smooth contour from your lower lash line down to the midface. Dark circles go hand in hand with under-eye bags. Fat that has fallen forward can be removed or repositioned right below where the tissue has fallen to reduce dark shadows that are cast on the eye.

Lower Eyelid Surgery (Lower Blepharoplasty) in New Jersey

The eyes are considered one of the most prominent facial features and, unfortunately, they are typically one of the first areas affected by the natural aging process. It is the delicate tissues and skin surrounding the eyes that make them so susceptible to the process of aging. A lower blepharoplasty, which is also referred to as lower eyelid surgery, consists of a group of surgical techniques that are designed to improve the way an individual’s lower eyelids look. During a lower blepharoplasty, excess fat and skin beneath the eyes may be removed to provide the patient with a youthful, more refreshed appearance. At Fresh Face & Eye in Chatham, New Jersey, Dr. Baljeet K. Purewal performs lower eyelid surgeries using the most modern techniques available.

Lower Eyelid Surgery is Available in New Jersey

Traditionally, a lower blepharoplasty involved the removal of fat and/or skin so as to reduce the fat bulges, excess skin and wrinkles affecting the lower eyelid and the surrounding area. Today, the excision of skin and/or fat remains a part of the lower eyelid surgery procedure however, when a modern lower blepharoplasty is performed, tissue-preservation through the repositioning of sub-orbicularis and orbital fat is preferred over excision. In addition, fat transfer techniques can be used to restore facial volume that has been lost due to the natural aging process.

Adding Volume Beneath the Lower Eyelid with Autologous Fat

Patients who are interested in using their own fat to add volume will have the fat removed from an area on the body via liposuction. Many patients choose to have Dr. Purewal harvest the fat from their abdominal area. Once the fat is harvested, it is purified before it is injected into targeted areas to achieve the desired effect.

Additional Treatments Frequently Performed with a Lower Blepharoplasty

Besides using the patient’s own harvested and purified fat, hyaluronic acid-based dermal fillers can be used to add volume to the lower eyelid as well as to the infra-orbital area. Furthermore, light-based and laser energy treatments are a non-surgical lower blepharoplasty option that can be performed alone or in conjunction with an incisional lower blepharoplasty procedure.

What Causes the Changes that Occur Beneath the Eyes?

As a natural part of the aging process, the body’s production of collagen decreases, which leads to a loss of skin elasticity. This lack of elasticity causes the skin to become lax. Once the skin is lax, sagging and wrinkles start to develop in the lower eyelid area. In addition, the fat pads beneath the eyes may begin protruding, causing a swollen or puffy-looking under-eye area. This characteristic usually makes people look older and appear more tired than they actually are.

Although droopiness and under-eye bags are frequently a part of the natural-aging process, these characteristics can also occur due to genetics. It is common for individuals who inherit this trait to notice under-eye changes during their twenties.

Types of Lower Eyelid Surgery Available in New Jersey

There are three methods that can be used while performing lower eyelid surgery. The method Dr. Purewal chooses to use is based on each patient’s particular needs.

The three lower eyelid surgery techniques available at Fresh Face & Eye:

1. The transcutaneous lower lid blepharoplasty

– This is the technique Dr. Purewal uses when the patient needs both skin and fat removed.

2. The transconjunctival lower lid blepharoplasty

– This is the method that Dr. Purewal uses when a patient does not need to have any excess skin removed.

3. The transconjunctival arcus marginalis release

– This is the technique Dr. Purewal uses when the fat within the lids is being relocated to add volume to specific areas of soft tissue. The goal of the transconjunctival arcus marginalis release is to prevent the orbital bone from becoming overly pronounced.

When Transconjunctival Lower Eyelid Surgery is Necessary

This lower eyelid surgery approach is typically used when a patient has developed puffy-looking bags under the eyes (i.e., steatoblepharon)in conjunction with moderate or minimal lower lid laxity. When necessary, Dr. Purewal can also address a noticeable deformity of the tear trough by repositioning the fat during a transconjunctival lower eyelid surgery.

Although the principles used today emphasize preservation of the orbital fat via fat augmentation or repositioning, some patients are suitable for resection when they have steatoblepharon without a tear trough deformity.

Other reasons Dr. Purewal may perform a transconjunctival lower eyelid blepharoplasty include a:

  • History of blepharoplasty.
  • Pre-existing pseudoproptosis.
  • History of hypertrophic scarring.

Who Should Consider Having Lower Eyelid Surgery in New Jersey?

Lower eyelid surgery is ideal for healthy men and women who are interested in restoring the area beneath their eyes to attain a more youthful and well-rested appearance.

Individuals with the following aesthetic concerns should consider having lower eyelid surgery with Dr. Purewal in New Jersey:

  • Excess tissue beneath the eye causing the individual to continuously look as if he or she is sad, tired or angry.
  • A constant look of puffiness or swelling (i.e., bags) beneath the lower eyelids.
  • Excess skin that causes the lower eyelids to wrinkle.
  • Deep grooves beneath the eyes.
  • Lower eyelids that look as if they are uneven.

Whether changes beneath the eyes are the result of aging, negative lifestyle choices (e.g., smoking) or genetics, a lower blepharoplasty can address these issues to effectively eliminate the unwanted characteristics that have developed beneath the patient’s eyes.

A Lower Blepharoplasty with Dr. Purewal in New Jersey: Sedation

This is an outpatient procedure performed using either general anesthesia or light sedation. It is the complexity of the surgery and the number of procedures being performed that determines which form of sedation Dr. Purewal recommends.

Since the patient is having surgery on the eyes and does receive sedation, he or she will not be able to drive home following the procedure, therefore, the patient needs to bring a driver to the surgery center on the day of the lower blepharoplasty.

Lower Eyelid Surgery in New Jersey: Procedure Steps

A lower eyelid surgery can last up to an hour, however, if the patient is having a combination of procedures during the same surgical session, the procedure time will increase.

1. Pre-op

Dr. Purewal may visit the patient while he or she is in the pre-op area. At this time, patients should ask any last-minute questions they have about the lower blepharoplasty and/or any other procedures they are having performed during their surgical session.

2. Anesthesia is Administered

Once the patient is asleep, the lower blepharoplasty begins.

3. Creating the incisions

  • The incisions for a transcutaneous lower lid blepharoplasty are created just beneath the lash line.
  • The incisions for a transconjunctival lower lid blepharoplasty are created inside the lower eyelid.
  • The incisions for a transconjunctival arcus marginalis release are also created inside the lower eyelid.
  1. Removing and/or Repositioning the Fat

    Dr. Purewal will gently reposition and/or remove the fat beneath the patient’s eyes, creating a smooth, natural contour underneath his or her lower eyelids.

    5. Excess Skin May be Removed

    If necessary, Dr. Purewal will remove any excess skin that is causing wrinkles to form on the lower eyelid.

    6. Tightening the Muscle of the Lower Eyelid

    If the patient’s lower eyelid muscle is lax, it will be tightened. Tightening this muscle provides patients with long-lasting, completely natural-looking results.

    7. Closing the Incisions and the Applying Ointment

    Once the procedure is complete, sutures are used to close the incisions and Dr. Purewal applies a thin layer of ointment to the patient’s eye area. This ointment helps promote the healing process.

    For the majority of Dr. Purewal’s patients, after closure, the incisions are virtually undetectable.

    8. The Patient Spends Time in the Recovery Area

    The patient is moved to the recovery area, which is where he or she remains for several hours before being released to the driver. Upon releasing the patient, he or she receives detailed instructions to make sure that recovery is as uneventful as possible.

    Recovering from Lower Eyelid Surgery in New Jersey

    Patients should expect to experience inflammation, dry eyes, bruising, blurred vision and discomfort. These post-surgical symptoms typically resolve within several days or a few weeks. To speed up the healing process, Dr. Purewal may recommend that the patient take extra vitamin C and use ice to bring the inflammation down. It is crucial that patients follow the proper icing technique, otherwise, they could damage the delicate skin surrounding their eyes as well as the eye itself. Furthermore, to keep the eyes from becoming irritated by UV rays and wind, patients should wear sunglasses while spending time outdoors, including while riding in a car.

    Returning to Work and/or School

    Most of Dr. Purewal’s patients return to work within a week of their lower blepharoplasty procedures. At this time, they can usually resume all of their daily activities as well. However, strenuous exercises and activities must be avoided until Dr. Purewal clears the patient to participate in these activities. Clearance is usually given within two to three weeks of the procedure.

    Although the incisions take a couple weeks to heal, any resulting scars are well-hidden within the skin’s natural folds. This ensures that the patient’s lower blepharoplasty result looks totally natural.

    Lower Eyelid Surgery in New Jersey: The Results

    Results become apparent once the inflammation and bruising subsides, which is typically within two to three weeks’ time. Nonetheless, it may take a few months for the eyes to heal completely.

    Once healing is complete, the area beneath the eyes will appear more youthful than it did before the lower eyelid surgery was performed. The excess skin and fat that caused the under-eye puffiness and wrinkles is gone, thus, it can no longer age the patient’s appearance.

    How Long Do the Results Attained with Lower Eyelid Surgery Last?

    Although the natural aging process cannot be prevented, patients who have lower eyelid surgery can expect their results to last for years. This is especially true for those who choose to live a healthy lifestyle and implement a daily skin care regimen.

    Additional Lower Eyelid Procedures Frequently Performed in Conjunction with Lower Eyelid Surgery

    There are numerous procedures that Dr. Purewal can perform during a patient’s lower eyelid surgery session. Patients who are interested in learning more about these other procedures should feel free to ask about them during their initial consultation with Dr. Purewal at Fresh Face & Eye in Chatham, New Jersey.

    Below are some of the other lower eyelid procedures frequently performed with a lower blepharoplasty in New Jersey:

  • A canthoplasty can be performed to lift the external commissure of the patient’s eyelids to eliminate the eye characteristic that makes an individual appear as if he or she is constantly sad.
  • A lateral canthoplasty may be performed to reshape or reconstruct the outer corner of the eye. This procedure is used to address laxity in the eyelid.
  • Chemical peels, laser skin ablative or non-ablative resurfacing can be performed to improve the skin quality of the lower eyelid as well as to reduce dyschromia (i.e., a skin pigmentation disorder) and/or rhytidosis (i.e., wrinkling).
  • Fat grafting can be used to increase the volume in the lid-cheek junction as well as in the infraorbital hollows.
  • Sclerotherapy, ligation or laser treatment can help reduce or eliminate any unwanted veins that are present on the lower eyelid.
  • Injections of botulinum toxin can be administered to reduce the dynamic creases in the lower eyelids and the periorbital region.

Dr. Purewal wants her patients to decide which procedure(s) they would like to have, she and her staff would never attempt to coerce a patient into adding on procedures.

A Combination of Procedures Performed Together at Fresh Face & Eye in Chatham, New Jersey

As long as an individual is in good health and has no pre-existing eye conditions, he or she is likely a good candidate for lower eyelid surgery.

Dr. Purewal can combine a lower blepharoplasty with a variety of other procedures that are designed to address the signs of aging.

These procedures include:

  • A facelift.
  • A Brow lift.
  • Upper blepharoplasty.
  • The transfer of facial fat for comprehensive facial rejuvenation techniques.

Postoperative care:

  • For the initial 48 hours following surgery, patients can use cold compresses to reduce swelling.
  • For the first week after lower eyelid surgery, patients will apply ophthalmic antibiotic ointment or drops to their eyes. These products help promote healing.
  • Patients return for a follow-up visit within five to seven days of their lower eyelid surgery. At this time, if non-absorbable sutures were used, they are removed. Removing them in this time frame is crucial, otherwise suture tracks and/or excessive scarring could result, therefore, keeping this appointment is vital to a attaining a natural-looking result.

What to Expect During an Initial Consultation at Fresh Face & Eye in New Jersey

Before Dr. Baljeet K. Purewal performs an upper or a lower blepharoplasty procedure, she needs a thorough ophthalmic and medical history.

Pertinent patient information includes:

  • A full medical history.
  • A description of previous surgeries and procedures.
  • A list of the patient’s medications, herbal supplements and/or vitamins.
  • Allergies to medications and/or latex.
  • Current medical issues relating to the eye (e.g., dry eye, the need to wear contacts, etc.).
  • Ophthalmic medications and/or lubricants that are currently being used.
  • His or her social history (e.g., occupation, smoking, sun exposure, etc.).

After she reviews the patient’s information, Dr. Purewal will want to know what the patient would like to achieve with a lower blepharoplasty procedure.

A Physical Examination of the Eyes is Completed Before Scheduling a Lower Blepharoplasty in New Jersey

During the initial consultation, Dr. Purewal also physically examines the patient’s eyes.

As she performs this examination, Dr. Purewal is determining the patient’s:

  • Extraocular motility.
  • Visual acuity.
  • Blink rate.
  • Blinking strength.

Other aspects of this visual examination include:

  • A pupillary exam.
  • Determining whether there is a negative vector present.
  • Evaluating the tear film and ocular surface.
  • Establishing whether the patient has orbital dystopia.

An evaluation of the skin is performed to determine if the patient has:

  • Rhytidosis.
  • Fitzpatrick skin type.
  • Skin redundancy.
  • Dyschromia.
  • Lesions.

She will also be looking for the presence of:

  • Canthal tendon dehiscence and lower eyelid laxity.
  • Bell’s phenomenon.
  • Lagophthalmos.
  • Infraorbital hollowing.
  • Steatoblepharon (typically associated with dermatochalasis).
  • Atrophy of malar fat (i.e., cheek fat).
  • Tear trough malformation.

Dr. Purewal takes external photographs of the patient’s eyes. She uses these photos as she creates the patient’s personalized lower blepharoplasty treatment plan.

Potential Complications Following Lower Eyelid Surgery in New Jersey

Patients who experience any of the symptoms listed below need to contact Fresh Face & Eye at (973)635-4000 because these symptoms may indicate an infection or bleeding.

Chemosis

– Inflammation of the eye that causes swollen eyelids.

Retrobulbar hemorrhage

– This condition results when there is an accumulation of blood within the retrobulbar space. Although rare, if this complication occurs, it is a sight-threatening emergency. Symptoms of retrobulbar hemorrhage include a feeling of pressure, severe pain and loss of sight. Other common symptoms include nausea, vomiting and double vision.

Pyogenic granuloma

– A shiny red lump with a surface resembling a raspberry.

Lagophthalmos

– The inability to close the eyelids all the way.
Overcorrection or under correction of the steatoblepharon – The term steatoblepharon refers to the anterior prolapse of the eyelid’s fat pad, which results in puffiness beneath the eyes. This condition occurs when the orbital septum weakens.

Hypertrophic scar

– Incision area appears raised.

Epithelial inclusion cysts (aka suture cysts)

– This complication appears similar to a hypertrophic scar; however, suture cysts need to be excised. For this reason, patients who notice these cysts and those who think they may have a hypertrophic scar forming need to contact Fresh Face & Eye at (973)635-4000. Dr. Purewal will be able to determine if the patient is experiencing epithelial inclusion cysts or if a hypertrophic scar is forming.

Strabismus

– Injury to the inferior oblique muscle resulting in a cross eye.

Diplopia

– Double vision.

The Importance of Choosing an Experienced, Board-Certified, Ocuplastics and Reconstructive Surgeon

While complications are rare, one of the best ways patients can decrease the likelihood of experiencing any type of complication is by choosing an experienced, board-certified Ocuplastics and Reconstructive Surgeon like Dr. Baljeet K. Purewal to perform their lower eyelid surgery in New Jersey.

Complications that May Result Due to Surgeon Error

The complications listed below generally occur due to an error made by the surgeon. These errors are usually made by surgeons who lack experience with performing blepharoplasty procedures.

Ectropion

– When a surgeon neglects to correct a lax lower eyelid during a lower blepharoplasty procedure, ectropion may result. Ectropion refers to a condition in which the lower eyelid turns away or sags causing the surface of the inner eyelid to be visible. This condition also causes eye irritation.

Retraction of the lower eyelid

– This issue can occur following lower eyelid surgery; however, it seems to be more common when the septum is violated during an anterior approach to a blepharoplasty procedure. Retraction becomes visible due to scarring of the middle and/or posterior eyelid lamellae, resulting in a low-positioned eyelid. This scarring causes the eyelid to become attached to the orbital rim.

Anterior lamellar shortage

– This condition can occur when a surgeon removes too much skin, due to poor healing or because of an unfavorable contraction that occurs after resurfacing the skin on the eyelid.

How Much Does a Lower Blepharoplasty Cost?

Since each patient is unique, the only way that Dr. Purewal can determine how much a lower blepharoplasty will cost is with an examination.

With a patient-centered practice, innovative procedures and a caring staff, Dr. Baljeet K. Purewal helps her patients turn back the hands of time. She is a board-certified Ocuplastics and Reconstruction Surgeon who specializes in cosmetic eyelid surgery. Dr. Purewal has been serving the New Jersey area for 10 years. She is known for her artistic vision, attention to detail and natural-looking results.

If you would like to learn more about the facial rejuvenation procedures available at Fresh Face & Eye in Chatham, New Jersey, contact the office today at (973)635-4000 to schedule your initial consultation or, if you prefer, click here to fill out our online form. Fresh Face & Eye is located at 82 Main Street.