If not enough skin has been removed, it is possible to excise a little more. Be aware that skin excision will not eliminate wrinkles, while overzealous removal of lower eyelid skin can cause substantial functional problems.
Insufficient removal of fat may leave behind a bulge Most such irregularities can be addressed by revision.
Excessive removal of lower eyelid fat creates a hollowness within the socket. The best results seem to be obtained with orbital pearl fat grafting.
Functional Complications
Orbital hemorrhage, vision loss (see upper lid complications).
The most common functional complication of lower blepharoplasty is alteration of the lower eyelid contour ("malposition") due to:
• lower eyelid retraction, or
• cicatricial ectropion
While related, these conditions require different treatments.
Lower eyelid retraction is a pulling down of the lid thus exposing the white of the eye. This complication is most closely associated with blepharoplasty performed via the more invasive transcutaneous (skin) approach. Retraction is related to scarring in the middle layers of the lid.
Surgical revision is challenging and may incorporate removal of scar tissue, tightening procedures at the eyelid corner, grafting, and/or a midface lift.
Cicatrical ectropion is the pulling away of the lid from the eye. Ectropion is caused by removal of too much eyelid skin, and, again, is seen only after transcutaneous lower blepharoplasty.
Surgical correction presents a challenge and may entail grafting of donor skin and/or reinforcement of the eyelid at the lateral canthus.
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Introduction to Blepharoplasty Eyelid Plastic Surgery
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