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Modern Techniques

Modern advancements have been made to correct some of the problems associated with traditional lower eyelid surgery. New advancements include:

Fat Transposition/Fat Grafting

Newer techniques no longer remove the excess fat but reposition it, transposing it to the area that is depressed or concave. As stated in Traditional Technique, the main problem of the sagging lower eyelid was due to the weakened septum that could no longer tightly hold fat tissue. Thus, fat repositioning would not only remove excess fat but also enhances the area that is deprived of the fullness. This way, patients will not have to worry about a malnourished appearance.

There are a significant number of patients where they need more fat to transpose to the desired location (below lower eyelid bags). The area that is deficient is below the lower eyelid fat. In an attempt to fill the depressed region, the surgeon may take out too much fat from the lower eyelid which can lead to sunken eyes. Therefore, many patients will benefit from fat grafting. Fat grafting is transferring the fat from the abdominal region and injecting it into the areas that are deficient. By filling the depressed area and removing fat where it is bulging, the goal of a smooth vertical contour is achieved. Another advantage of fat grafting is that it has stem cells which give an overall youthful glow to the lower eyelid.

Muscle Release

The muscle that is attached to the bone of the lower eye rim is released to create space for placement of fat, therefore building more volume to the face.

Cheek Lift

Re-elevation of the soft tissue in the cheek is also performed in combination with the lower blepharoplasty. This will result in a smooth, flush surface from the lower eyelid, allowing the patient to appear younger.

Fascial Suspension

Fascial suspension is also performed by re-elevating the orbicularis oculi muscle fascia back to its original position. For many Asian patients, this creates the highly desired, youthful lower eyelid fullness (see Youthful Lower Eyelid Fullness). And unlike the traditional technique of canthopexy or canthoplasty, the advancements do not alter the eye’s anatomy, providing for the eye’s natural shape. Another important factor is that by suspending the fascia of the orbicularis oculi muscle, the muscle as a whole moves up. However, if the muscle is pulled up as commonly done, then over time the suture that is suspending the muscle will cheese-wire/cut through the muscle; therefore, leading to recurrence and lower eyelid skin/muscle sagging. In contrast, fascial tissue suspension can hold tension and simultaneously lift the entire lower eyelid muscle and skin to give a smooth contour that the patient desires.

Dark Circles

Depending on the cause of the dark circles underneath the eyes, modern blepharoplasty may drastically improve the discoloration.

Dark circles under the eyes can be caused by two factors. One cause can be due to blood flow blockage or vessel congestion (technically called venus congestion). Another cause of dark under eye circles is the over production of melanin, a substance in our skin that causes pigmentation.

If the dark circles are caused by venus congestion, releasing the vessels and increasing blood flow can drastically improve the discoloration. However, if caused by overproduction of melanin, surgery will not be effective. If both factors play a part in the dark circles, the ratio of the attributing cause will determine how effective the surgery will be in improving the dark circles.