Our Unique Approach to Lower Eyelid Surgery

Much like other areas of the face, a combination of treatments is required to comprehensively restore the youthful features of the lower eyelid and create a truly refreshed and natural look. The secret to our success is our focus on the restoration of youthful anatomy; we never change the fundamental anatomy or “look” of a patient.

Our patients appreciate this attention to detail, especially when it comes to their eyes. As a result of this paradigm, it is rare to perform one procedure alone.

In line with our rejuvenation philosophy, we evaluate changes to the skin, volume, and sagging and apply a treatment plan accordingly, often resulting in the employment of Vertical Restore, our highly customizable facial rejuvenation procedure. When you’re ready to learn more, reach out and set up your consultation with a member of Dr. Karam’s team today.

Is Rejuvenation of the Lower Eyelid Region Right for Me?

Starting in the late 30s and early 40s, the lower eyelid region is one of the first parts of the face to show the signs of aging. The development of loose skin (dermatochalasis), bulging fat pads or “bags” (pseudo-herniation of fat), skeletonization of the lower orbital rim, and elongation of the eyelid cheek junction are the changes that result in the tired, hollowed, and aged lower eyelid.

Rejuvenation of the Lower Eyelid Region could be your best option if you’re looking to:

  • Eliminate bags under the eyes
  • Eradicate sagging around the eyes
  • Restore a youthful and natural-looking appearance
  • Revive fullness and volume around the eyes
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Aging of the Lower Eyelid

The youthful lower eyelid is described as having smooth and firm skin, a smooth contour as it transitions to the cheek, a lack of shadows or hollows, and a short distance between the eyelash (or the top of the lower eyelid) to the top of the cheek. This is called the eyelid-cheek junction, which is characteristically short in younger eyes. Fat pads lay over the lower orbital rim, which creates a soft fullness under the eyelid as it transitions to the cheeks. The upper cheeks are characteristically full and convex, supporting the lower eyelid position.

All of these characteristics define a youthful, refreshed-looking lower eyelid. We can’t talk about the lower eyelid’s aging process and subsequent rejuvenation without mentioning the importance and ubiquitous loss of the fat surrounding the lower eyelid. The malar fat pad and SOOF (subobicularis oculi fat pad) begin to diminish with age, leading to the outline of the bony lower orbital rim and tear trough deformity. The loss of the fat pads in the upper cheek causes a deflated, sallow look that leaves the eyes looking tired, less healthy, and drawn.

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Advantages of Lower Eyelid Rejuvenation with Dr. Karam

  • Natural-looking results
  • A truly refreshed appearance
  • No change to the shape of the eye
  • Consistency and reliability
  • Low complication rate
  • Long-lasting results (10+ years)
  • Performed under local anesthesia with IV sedation; no need for general anesthesia
  • Two-week downtime
  • Ideal balance between excellent and natural results, low risk, and brief recovery

Complementary Combinations, for Comprehensive Rejuvenation

The goal of any lower eyelid procedure is to create a refreshed and youthful appearance. In nearly every case where there is excess skin or bulging fat affecting the lower eyelid, there is also volume loss below the eyelid. The malar fat pads and cheek fat pads begin to diminish, causing the outline of the lower orbital rim to become prominent and skeletonized. The hollowing in the upper and middle cheek further gives the eyes a deflated and tired look exacerbating the aged appearance of the lower eyelid. In nearly every case, replacement of the lost volume is essential to lower eyelid rejuvenation.


Fat Transfer

This is a treatment that complements our surgical procedures and is done with essentially every rejuvenation case (approximately 350 cases per year), for long-lasting and natural volume restoration. Adding volume is the most effective and important way of rejuvenating the eyes. Without it, the skin and sagging may look better, but the eyes will never have that refreshed and youthful look.

Skin Resurfacing

The skin can often look crepey, thin, and wrinkled. In these cases, a chemical peel using Jessner’s 35% TCA formula or erbium: YAG laser resurfacing can eliminate these surface changes and create a smooth appearance of the lower eyelid.

Procedures and Anesthesia

One of the biggest advantages, from a safety standpoint, is that these procedures can be performed under local anesthesia with IV sedation. With this technique, patients are comfortable and moderately sedated. Most patients choose this method to avoid any of the risks associated with general anesthesia. For those patients who do prefer general anesthesia, our facility is fully equipped.

Procedures are performed in our accredited and certified (JCAHO and Medicare) Carmel Valley Surgical Center, located within the suite and offering the highest level of safety and state regulations for outpatient surgery. Highly-trained and experienced surgical techs, medical assistants, nurses, and a Board Certified Anesthesiologist (for general anesthesia cases) all work together to create the safest and most comfortable experience possible. 

Carmel Valley Surgical Center hosts two state-of-the-art surgical suites and a recovery center. Each room is equipped with next-generation equipment and instruments, and the center also has a separate entrance and exit from the main office, allowing our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures, and we’ll make sure that you enjoy peace of mind at every step of the way.

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What to Expect from Your Results

There are a variety of positive results you can expect from your Lower Eyelid Rejuvenation, including:

  • Restored youthful, bright-eyed appearance
  • Natural-looking fullness and volume around the eyes
  • Elimination of bags and dark circles under the eyes
  • Eradication of excess skin around the eyes
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Why Choose Dr. Karam for Your Lower Eyelid Rejuvenation?

An average Board Certified Plastic Surgeon performs approximately 20 eyelid procedures annually. Dr. Karam, on the other hand, performs over 350 every year. Extensive experience translates to more natural results, more consistency, and less variability, plus a distinct knowledge of different ethnicities and facial types, and how to adjust the surgical techniques to best suit a particular facial structure. Dr. Karam’s careful and intentional approach ensures that no one changes their identity but simply looks refreshed and youthful. Dr. Karam’s comprehensive technique, which involves combining these procedures with others, results in synergistic effects. The entire face looks naturally and vibrantly youthful, rather than hosting a single, unnatural element. In his textbook, Rejuvenation of the Aging Face, Dr. Karam describes his approach to facial rejuvenation and eye rejuvenation in order to teach his ingenious techniques to other surgeons and colleagues. 

A Published Author and Respected Lecturer

Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including upper and lower eyelid blepharoplasty, fat transfer, and rejuvenation of ethnic-specific (for example, Asian) groups.

And perhaps most importantly, Dr. Karam’s caring demeanor, good patient communication skills, and responsive and knowledgeable staff ensure you’re always comfortable and informed. It’s these particular attributes that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families.

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