Procedure Cosmetic concerns about the lower eyelid include excess skin, bags and festoons of the lower lids. A lower blepharoplasty can improve eyebags, tighten the muscle (=orbicularis oculi muscle) and remove some skin. If the lower eyelid is lax, a canthopexy can tighten it. Surgery involves a scar below the lower eyelashes (=transcutaneous subciliary incision). Occasionally, scars can be hidden on the inside of the eyelid (=transconjunctival incision) – additional laser or other modalities can then be used to tighten the skin.
The wounds are repaired with sutures under the skin which don’t require removal and dissolve within four months.
Scars Under lower eyelashes with short sidewards extension or inside eyelid
Operation time 2 hours
Anaesthesia General or Sedation & Local
Hospital Stay Day Surgery
Benefits Cosmetic, Psychological
Risks Bleeding, Infection, Scar problems (stretched, thick, abnormal pigmentation, red, retracted etc.), Skin discoloration, Skin cones, Wound separation, Slough, Necrosis, Pain, Irritation, Nerve injury (Numbness, weakness), Bruising, Swelling, Hollowness, Cysts, Overcorrection, Undercorrection, Asymmetry, Recurrent redundancy, Cosmetic imperfections, Eye injury / irritation / dryness, Cornea abrasion, Double / blurred vision, Sympathetic ophthalmia, Blindness, Contour irregularities, Need for further surgery (+/– skin grafts), Ectropion, Lagophthalmos (Inability to close eyes), Scleral show, Allergic reaction, Chest infection, Heart attack, Stroke, Blood clots in legs & lungs
N.B. Most complications are unlikely and serious risks are rare
Risk factors Smoking / contraception / flights within 6 weeks of surgery, overweight, high blood pressure, bleeding tendency, diabetes, pre-existing eye problems
Optimising factors Diet rich in Vitamin C and protein, plenty of fluids, fresh air, scar massage, sun protection
Discomfort 1 week
Bruising 2 – 3 weeks
Recovery Driving and light activities 1 week, Physical work / sports 4 weeks
Acceptable appearance 2 – 4 weeks for most patients (This is subjective)
Final result 6 – 18 months
Alternatives No Surgery, Make–up, Fillers, Fat transfer, Laser

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