Blepharoplasty is one of the most popular operations in the world of plastic surgery. However, it also leads in the number of dissatisfied and harmed patients. The eyes are not only the mirror of the soul, they are also the area that reveals age. The external beauty of the eyes is the first thing we see in the mirror and what the person opposite notices. Removing skin and “bags” seems simple, so what is the catch? The catch is that this area can be greatly spoiled aesthetically while trying to improve it.
It is important to remember:
The entire area around the eye must be considered as a single whole, not as separate elements. One must think about the result for years ahead, not only about what will be seen right after rehabilitation Mayo clinic.
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Why choose fat-preserving blepharoplasty?
Because women who once had their hernias removed do not know how to restore volume under the eyes, but only how to get rid of excess skin. The task of plastic surgery is to provide more information and to show before-and-after results of fat-preserving techniques.
Let’s analyze in detail the issue of removing the fat pads of the lower eyelids (hernias)
Fat pads of the periorbital area are the patient’s native (natural) anatomical structures. Their protrusion is the result of weakness of the orbital muscle, renal or heart failure, or genetic features of the phenotype. The task of surgery is to return the patient’s orbit to an aesthetically acceptable condition corresponding to a younger age. Fat pads are an irreplaceable plastic material (compared to fillers and/or lipofilling) for the correction of age-related changes. For this reason, it is better not to remove the hernia “bags.”
In 90% of cases, during the operation, fat pads are transposed into areas of tissue deficiency, most often into the tear trough. Moving the fat pads makes it possible to rejuvenate the look without lipofilling or fillers.
In some cases, part of the hernias may be slightly resected (removed), for example, in patients with exophthalmos (protrusion of the eyeball from the bony orbit due to thyroid disease). But such cases are extremely rare.
Removing fat hernias can lead to exposure of the lower orbital rim, which gives an extremely unattractive result that does not provide a true rejuvenating effect. After all, we all remember that the lower eyelids in children and young girls usually do not have hollows.
What does “extended” mean in this context?
Classical techniques of blepharoplasty always involved, in the practice of some doctors, removal (resection) of skin, muscle, and fat in the periorbital area. This, in turn, leads to insufficient aesthetic results that do not fully satisfy patients.
After a few months, once swelling has completely subsided, patients begin to notice that they have not received significant rejuvenation and that their gaze looks tired. In short, removing hernias eliminates a cosmetic defect but does not give the effect of a youthful face.
Extended blepharoplasty techniques involve modification of fat pads, tightening and refixation of canthal ligaments, levator tendon adjustments, myopexy (tightening of the orbicularis oculi muscle), and transposition of lacrimal glands in the upper eyelids.
Classical techniques involve separating the skin from the periorbital muscle, which after healing gives the effect of rigidity (immobility) of the lower eyelid skin, excess scarring, and an unnatural look. Extended techniques involve working in deeper layers, under the muscle, leaving the skin intact (untouched).
Extended techniques require more time and effort from the surgeon, but they provide the most aesthetic and rejuvenating result.
Who is transconjunctival blepharoplasty indicated for?
Transconjunctival blepharoplasty is indicated for a narrow group of patients (as a rule, under 35 years old) with pronounced lower eyelid hernias and no excess skin. Simply put, when there is nothing to remove except the hernias.
To determine the presence of skin excess, there is a simple “pinch” test. Extended lower blepharoplasty techniques make it possible to mobilize (make available for removal) skin excesses that most doctors do not see or underestimate.
Performing myopexy (a technique for working with the orbicularis muscle) and working with the orbital ligament makes it possible to release a considerable amount of skin.
What is the most unpleasant consequence after blepharoplasty?
The most dangerous complication of blepharoplasty is considered worldwide to be retrobulbar hematoma (the formation of a blood cavity located behind the eyeball). However, in ophthalmic surgery this is encountered quite often and is not considered rare.
What is a true surgical error and what is a temporary complication during rehabilitation?
Everything that can resolve within 60 days without surgical intervention but with conservative therapy is considered acceptable during rehabilitation after blepharoplasty.
Errors include iatrogenic trauma — surgical manipulation that unintentionally harms the patient, such as burns from electrosurgical instruments or injury to the eyeball with surgical tools.
Other mistakes include:
- Significant asymmetry beyond aesthetic limits.
- Reckless resection of fat pads of both the upper and lower eyelids (yes, not all upper eyelid hernias require full removal; sometimes they must also be redistributed), which results in a “bald” eye (as patients say) and/or orbital skeletonization in the case of the lower eyelids.
- Low placement of the incision on the lower eyelid relative to the lash line.
- Failure to address the medial (inner) corner of the upper eyelid, where many leave skin excess resembling a pouch.
- Excessively long lateral extension of the incision toward the temple. Some extend the cut up to 20 mm, whereas aesthetically it is acceptable only up to 5–7 mm.
- Excessive resection of lower eyelid skin (“over-cut eyelids”), leading to permanent inability to close the eyes, i.e., lagophthalmos, observed after 60 days or more post-surgery.
Why can vision be lost during blepharoplasty?
Partial or complete loss of vision after surgery is the most severe complication, which, fortunately, has become extremely rare in recent years worldwide in plastic surgery.
This can occur either due to the previously mentioned retrobulbar hematoma or corneal trauma if protective shields are not used during surgery.
Removal of hernias + lipofilling
Fat pads are the most valuable plastic material, which should be resected carefully and reasonably, with their transposition into areas of deficiency. In this case, there is no need for subsequent lipofilling.
Indications for lipofilling of the lower and upper eyelids include patients with skeletonization of the periorbital area due to phenotype or previous surgeries.
Author: Emily Carter
Senior Health Editor & Market Analyst Emily specializes in plastic surgery trends and implant technology. Her work focuses on analyzing FDA reports and patient satisfaction data to help readers understand the technical side of breast and body contouring procedures.
