Lower Eyelid Surgery

You may not think of your lower eyelid very often, but it’s an integral part of maintaining a youthful appearance. Lower eyelid rejuvenation can have a notable impact on your overall sense of facial harmony, whether performed on its own or as part of a more comprehensive Vertical Restore procedure.

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.

A new era in facial rejuvenation

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Our Eye Rejuvenation Procedures

Lower Eyelid Skin Pinch

The lower eyelid skin pinch is a unique and versatile procedure that removes excess skin from the lower eyelid without removing any muscle or fat. In this procedure, an incision is made just below the eyelashes (along the inferior tarsal crease) and the excess skin is “pinched” and excised, then sutured.

This precise and direct procedure is extremely versatile and is used during eye rejuvenation and often with our Short Incision Facelift procedure. The removal of the skin allows the underlying muscle to move upward during closure, which improves the contour, firmness, and transition between the eyelid and cheek and tightens the lower eyelid skin.

Lower Eyelid Blepharoplasty

The transconjunctival lower eyelid blepharoplasty technique is used when patients have fat pockets (or “bags”) under their eyes. This can be done with or without a Lower Eyelid Skin Pinch, depending on whether the patient has both loose skin and lower eyelid bags.

The incision for this is made on the inside of the lower eyelid, where the fat pad is directly accessed and the fat is removed without cutting the muscle. Leaving the muscle alone is a key safety feature to prevent the lower eyelid from pulling downward. The removal of the excess fat allows the eyelid to have a smooth contour, transitioning seamlessly to the cheek.

Fat Transfer

Fat transfer is a highly effective method by which Dr. Karam can replace the fat that has been lost over time along the orbital rim and upper cheeks. This is an essential part of most of our lower eyelid procedures, and can also be an important aspect of the Vertical Restore operation. Without restoring this lost volume, a truly refreshed and youthful lower eyelid cannot be reestablished; fat transfer is essential for treating the hollows, concavity, and long eyelid cheek junctions that create the tired and drawn look we’re working to eliminate.

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.

Post-Procedure Care

Following surgery, ointment will be applied to the incisions and you’ll return to the comfort of your home or hotel room. A cool compress will be used to reduce swelling for the first two days after your procedure, while lubricating drops will be used during the day and ointment will be used at night to help keep the eyes moist and protected from drying.

Antibiotic ointment will be applied to the incisions for one week, at which point your sutures will be removed in the office. This is the point at which your swelling will start to resolve rapidly. Follow-up appointments are made at one month, three months, six months, and one year to monitor healing and make sure all of your questions are answered.

Your Recovery

Recovery is primarily related to swelling, as bruising is not commonly seen in our patients (although it is a possibility). The typical recovery takes between seven and 14 days, depending on the combination of procedures you’ve undergone. We recommend planning to take two weeks away from work or social engagements to allow sufficient time to heal. Although healing is not completed in only two weeks, most patients are sufficiently healed and can return to work and other social occasions. Minor swelling will continue to improve steadily for up to one year following the procedure. Exercise can be resumed between two to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.

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

Carmel Valley Plastic Surgery - Dr. Karam Office media

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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.

Planning Your Consultation

During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after a careful examination and discussion of your goals. The basic criteria for the timing of this procedure are dependent on two factors: first, whether there is enough sagging and deflation to justify the procedure, and the patient’s readiness to move forward. The average patient defines the changes seen in their 40s as a point where comprehensive eye rejuvenation would make a positive difference. In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and more subtle, and the results last longer. More and more patients are utilizing these procedures as a way to maintain their appearance and prevent aging. Lower eyelid surgery is just one of the ways Dr. Karam can help you enjoy a refreshed and youthful look, effectively turning back the clock and restoring your outer glow so you can look on the outside as vibrant as you feel on the inside. Lower eyelid surgery can be performed on its own, or as part of the Vertical Restore procedure, a highly customizable surgery that will be tailored to your specific goals and issues. To learn more, reach out and set up your consultation today.

Lower Eyelid Surgery

Our Unique Approach to Lower Eyelid Surgery

Is Rejuvenation of the Lower Eyelid Region Right for Me?

Aging of the Lower Eyelid

A new era in facial rejuvenation

Our Eye Rejuvenation Procedures

Lower Eyelid Skin Pinch

Lower Eyelid Blepharoplasty

Fat Transfer

Advantages of Lower Eyelid Rejuvenation with Dr. Karam

Complementary Combinations, for Comprehensive Rejuvenation

Fat Transfer

Skin Resurfacing

Procedures and Anesthesia

Post-Procedure Care

Your Recovery

What to Expect from Your Results

Slide One

Slide Two

Slide Three

Why Choose Dr. Karam for Your Lower Eyelid Rejuvenation?

A Published Author and Respected Lecturer

Planning Your Consultation

Schedule a Consultation