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There are two reasons people come to see us for lower eyelid problems. First, many patients simply have too much
extra lower eyelid skin. Wrinkles on the lower lids can be improved in several ways. Extra skin can be excised
through a tiny incision hidden just underneath the lower eyelashes. Once healed, this incision is almost invisible.
A peel (laser or chemical) can also tighten the lower lid skin very effectively.
Secondly, people often feel they look tired or old because of the puffiness that appears underneath their eyes.
These “bags” occur for several reasons. First, there is a sheath of tissue that holds back the fat that lives around
the eyes. At some point this sheath becomes weak and the fat pushes outwards. Treatment for this involves making an
incision on the inner surface of the eyelid (no outside scar), and removing or repositioning the extra fat. Sometimes,
the puffiness has little to do with the eyelid itself. As part of the normal aging process, the tissue of the upper cheek
starts to fall. As it does a groove, or hollow develops underneath the eyelid fat, making it appear as if there is too
much lower eyelid fat, when in fact it is the groove, not the fat that is the problem. In this situation, filling the
groove is the answer. This can be done very simply with an injectable filler, it can be filled with your own fat
borrowed from another part of the body, or sometimes is corrected by lifting the upper cheek back to its original position.
The key to a great result in lower eyelid surgery is knowing which procedure, or combination of procedures will achieve
the desired result. While I have to be technically proficient in all of the procedures I may use, it is the art of
surgery, knowing which procedure to perform, that is most difficult. We spend a great deal of time in our preoperative
evaluation; talking, examining, imaging your photo on the computer, and looking at the results of similar patients.
This cannot be done quickly. It is also part of the reason why information given about a particular procedure over the phone without seeing the patient, is often a disservice.
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