A lower eyelid surgery for puffy eyes is a highly individualized procedure, which entails meticulous physical examination to determine the factors causing the problem. Excess deeper fat, loose skin, abrupt transition between the lower lid and cheek, cheek descent, or a combination of these might be the culprit.
It is important to note that factors such as lack of sleep, allergies, and fluid retention and other causes of intermittent swelling must be ruled out prior to surgery.
Simply put, eyelid surgery for puffy eyes only applies when there is a true excess skin and/or fat around the lower eyelid.
California Surgical Institute medical director Dr. Tarick Smiley says that some patients have lower lid puffiness caused by deep fat, with no or very little loose skin. For these individuals, a transconjunctival approach in which a small incision is made inside the lower lid, thus the risk of visible scar is almost zero.
The incision allows the surgeon to remove the deeper fat, which becomes herniated due to aging (i.e., tissue laxity/weakness). But for a more rejuvenating and natural result, Dr. Smiley says he almost always complements it with fat injection to create a smooth transition between the lower lid and upper cheek.
Unlike the deeper fat along the lower lid that becomes more prominent with aging, the superficial fat “shrinks,” a condition referred to as soft tissue atrophy, thus resulting in an abrupt transition between the lid and cheek. Further contributing to the problem is the cheek fat pad descent.
Dr. Smiley says fat injection or transfer involves collecting just a few teaspoons of unwanted fats in the tummy area, which are then processed before injected around the lower lid.
Most patients will only need small amounts of purified fat (less than 1 ½ cc) to correct the abrupt lid-cheek transition and eliminate the appearance of deep tear trough.
Meanwhile, some patients have puffy eyes that are not just caused by excess fat, but also by loose skin. In this scenario, a small linear incision is made very close to the lower lash margin to remove some excess skin and thus achieve a tighter, more youthful appearance.
The resulting scar from the external incision technique is expected to fade into the background, particularly when it is hidden by the patient’s lower eyelashes.