In our San Diego plastic surgery practice we see a lot of patients who are interested in eyelid rejuvenation or blepharoplasty. Often, they are not sure what exactly they don’t like about their eyes- only that they look “tired” or “aged.”
It is the job of the facial plastic surgeon to make an accurate diagnosis and to also explain to the patient what they see as as the problem and what can be done to correct it.
In the past- plastic surgeons would address most lower eyelids the same way: removal of fat-as well as skin and occasionally muscle, to try to “smooth out” the lower lid area.
Unfortunately, not all eyelids respond well to “removal” of tissue, and in some cases this will create an artificial appearing “hollow” look around the eye.
In many cases, it is helpful to address the groove beneath the lower eyelids: this is called the nasojugal crease. It is formed due to thinning of the skin over the boney orbital rim, and leads to an aged appearance with a resulting shadow over the area.
The nasojugal crease can be addressed with fat grafting, fat repositioning, a midface lift, or with implants.
Fat repositioning can often be the most straightforward approach-as we are able to use tissue that is already there, avoiding liposuction or additional surgery. The fat that is herniated or bulging below the lower eyelashes is manipulated into a new position over the boney orbital rim, and often secured with sutures. The loose skin and muscle layers are then redraped over this, and excess skin and muscle may be removed.