7. Lower Blepharoplasty

Hello.

I am Dr. Young-moon Yoo, a board-certified plastic surgeon.

Today, we will take a look at what is commonly known as ‘dark circles’, ‘under-eye sagging’, or ‘under-eye fat protrusion’, which is more accurately diagnosed medically as ‘tear trough deformity’.

Recently, I saw a video on YouTube by a clinic director claiming that dark circles are not something to be treated with surgery... Watching that video, I found myself disagreeing with almost everything from the causes to the treatment methods. ^^;;

It appeared they weren’t a plastic surgery specialist... and seemed to be someone who primarily performs simple procedures rather than surgery.

Of course, there are cases where improvement is possible through simple procedures, and that would be ideal, but in reality, a surgical approach is often necessary. This is especially true for older patients.

The content I have prepared today isn’t particularly ‘clickbaity’ or provocative (I don’t have that talent, unfortunately ㅠ), but I believe it will be helpful if you read through it calmly.

* Causes

So, why exactly do they occur?

There are very diverse causes, and they are often intricately intertwined to create dark circles. Therefore, an accurate diagnosis is essential to obtain appropriate treatment and satisfactory results.

1. Fat Protrusion

: More precisely, it is the ‘shadow effect’ created by the bulging fat.

: As we age, the wall or membrane surrounding the under-eye fat loosens for everyone. This causes the fat to protrude.

: This is actually the most common cause and the area where surgery can provide the greatest effect.

2. Skin Characteristics

: The skin on our face is not made of a single piece or block.

: The skin is connected in segments for each area (around the eyes, cheeks, mouth, forehead, etc.).

: And the skin of each segment differs in thickness, color, pore size, and texture.

: Since the dark circle area corresponds exactly to the boundary of these skin segments, the sense of heterogeneity arising from differences in skin texture and thickness is felt strongly here.

3. Location of Blood Vessels and Pigment

: If you touch the dark circle area, you can feel the bone right underneath, right?

: Because the skin is so thin, blood vessels and pigments inevitably pass through very shallowly.

: The resulting bluish appearance is also a cause. (This is also called the Tyndall effect.)

* Physical Examination

Let’s look at the diagnostic methods.

To identify the cause and determine the treatment method, the following items must be checked:

- Skin elasticity

- #Snapback test

- Degree of fat protrusion

- Presence of tear troughs

- Sagging and hollowness of the front cheeks

* Surgical Methods

The appropriate surgical method is selected based on the physical examination.

1. Transconjunctival Fat Removal

This method involves approaching through the conjunctiva (the red inner flesh of the eye) to remove the bulging fat under the eyes.

For wrinkled skin, additional laser or injection therapies (#PRP, #PN, etc.) can be performed.

#TransconjunctivalFatRemoval

2. Transconjunctival Fat Repositioning

This method involves incising the conjunctiva, spreading the protruding under-eye fat, and repositioning it beneath the tear trough.

In cases where the tear trough is deep, fat removal alone is insufficient; repositioning is necessary to achieve more satisfactory results.

#TransconjunctivalFatRepositioning

3. Lower Blepharoplasty

This method involves making an incision just below the eyelashes of the lower eyelid to reposition fat, excise sagging skin and soft tissue, and then firmly fix the area.

It is more useful than transconjunctival methods (1 and 2 above) when sagging is severe, and it has the advantage of addressing skin wrinkles and sagging simultaneously.

#LowerBlepharoplasty

4. Lower Blepharoplasty + Midface Lift

In the aging process, under-eye fat protrusion is often accompanied by sagging of the front cheeks.

In such cases, performing a midface lift together allows for the repositioning of not just the under-eye area but also the volume of the front cheeks, leading to more natural and youthful results.

* Potential Post-operative Complications and Treatments

1. Conjunctival Edema (Chemosis)

This is usually caused by poor lymphatic circulation due to damage to the lymphatic vessels.

Lymphatic vessels are not visible to the naked eye and are spread out like a spider web, so they are structures that inevitably get severed during surgery.

As you recover after surgery, the connections of the lymphatic vessels also regenerate.

However, if the dissection area is too wide, the extent of lymphatic damage can be severe, causing this conjunctival congestion to persist for a long time.

From the surgeon’s perspective, the only way is to minimize dissection during surgery. Since it tends to last a long time once it occurs, it is a complication that requires significant attention. However, in most cases, it recovers completely within 3-4 weeks, so you do not need to worry too much.

Treatment) Artificial tears, steroid eye drops, hyaluronidase injection therapy; for long-term persistence, oral steroids may be considered.

2. Ectropion

Just because there is a lot of sagging, one must never simply cut away a large amount of skin.

Firm suspension and fixation of the muscle and soft tissue must be performed to ensure it stays in place for a long time without sagging again and to avoid serious complications like ectropion.

Ectropion occurring after lower blepharoplasty (left) and after surgical correction (right).

Treatment) In the early stages, taping or eyelid suturing may be effective, but if it persists, surgical correction is required.

This concludes the post on under-eye plastic surgery.

Actually, there is so much content that it cannot all be contained in this single post, but I have summarized the parts I consider most important.

How was it? Was it helpful in understanding the under-eye area to some extent?

Happy New Year to everyone, and I hope this year is full of only good things for you all. ^^