Blepharoplasty with fat transfer is a modern approach in eyelid surgery that ensures natural and youthful results. It diverges from the antiquated technique in which the main focus is to remove the excess skin and fat with little regard to age-related volume loss.
The antiquated technique may cause skeletonized eye socket appearance especially along the lower eyelid. This is particularly true when the fat is entirely removed, leaving no “carpeting” beneath the skin to promote smooth results.
To prevent creating or aggravating the hollowed lower eyelid, Dr. Tarick Smiley of the California Surgical Institute says he often incorporates blepharoplasty with fat transfer. The idea is to create a smooth transition between the lid and cheek, which is one of the key elements of a youthful face.
In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had upper and lower blepharoplasty with fat transfer.
The patient’s upper blepharoplasty was performed to eliminate the hooding of the lid; this was done with incisions made precisely at the existing skin fold to hide the resulting scar. Only a very small amount of skin was removed to preserve the function or “normal blink” and to allow for proper wound closure, which is the key to optimal hidden scars.
While some doctors extend the incision into the crow’s feet, Dr. Smiley keeps it within the natural skin fold of the upper lid to ensure that the scar will remain hidden.
The patient’s lower blepharoplasty surgery, on the other hand, was performed with an incision placed very close to the lower lash line so her eyelashes can hide the resulting scar. The area has a markedly thin skin, which allows the scar to fade better into the background.
Meanwhile, the antiquated technique removes the entire fat in an attempt to remove the under eye-bags; however, this causes hollowness right after surgery or years down the road, as soft tissue volume decreases with aging.
There are several ways to prevent the appearance of hollowed lower eyelid, with fat transfer being the most popular option, says Dr. Smiley.
Other patients can benefit from the repositioning of their superficial fat (fat beneath the skin; this is different from the deeper “bulging” fat that often requires removal), specifically laying it over the upper cheekbone to maintain a smooth lid-cheek junction. Fat grafting or injecting can further fine-tune the results.
Blepharoplasty recovery tips primarily aim to control the amount of swelling and bruising, and ultimately promote shorter “social downtime,” as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Blepharoplasty, or more commonly referred to as eyelid surgery or eyelid lift, removes the crepe-like skin above and/or below the eye. If needed, the procedure also eliminates the herniated fat that causes the “puffiness” or “shadowing.”
While the bruising and swelling are generally mild, “prudent” patients must give themselves a month or so of healing. This is particularly critical if they are going to attend a social function—e.g., wedding, graduation, and reunion.
However, it is safe to surmise that a good number of patients would look presentable in public (very minimal or barely detectable swelling and bruising) after two weeks. At this time, “camouflage” eye makeup can be used to further conceal the residual bruises.
In the first 7-10 days, most patients can expect mild discomfort that can be easily alleviated by over-the-counter painkillers. During this time when there is an increased risk of bleeding and poor healing, any medication categorized as blood thinners, such as non-steroidal anti-inflammatory drugs, aspirin, and aspirin-like products, are best avoided.
Extreme pain is very rare after blepharoplasty, and should it occur it is almost always a sign of healing problems, infection, or some type of complication that must be addressed immediately.
Controlling the amount of postop swelling and bruising is the key to enjoy quick “social recovery.” Head elevation, even when sleeping, for a few days after surgery can help the symptoms resolve quicker; this can be achieved by using large pillows or inclined foam wedge.
Furthermore, cold compress in the first 48 hours could help control swelling, although using it longer at a time (20 minutes longer) may lead to frostbite. To prevent this, a thin cloth should be placed between the ice pack and the skin, and apply this only 10-15 minutes at a time.
Some surgeons, meanwhile, advocate the use homeopathic remedies such as bromelain and arnica montana, although there is little scientific data proving their “purported” benefits.
Because blepharoplasty recovery tips may differ from surgeon to surgeon, a prudent patient should only stick to her doctor’s specific recommendations.
Male facelift techniques are designed to provide natural-looking and gender-appropriate results. In no way they should lead to a wind-tunnel effect or any reminder of the surgery, says Dr. Tarick Smiley who has recently posted a Snapchat video showing one case study.
In the Snapchat video post, the leading Beverly Hills plastic surgeon was seen performing simultaneous neck lift, facelift, and eyelid lift in one male patient.
Dr. Smiley created an incision starting from the temple area concealed by the hairline, which was extended into the ear’s front (very close to it in order to hide the scar) and behind the earlobe before it reached the nape, still hidden by the patient’s natural hairline for optimal scar concealment.
To avoid the wind-tunnel effect in male facelift techniques, Dr. Smiley said the right amount and angle of pull was of critical importance. The skin adjacent to the temple and upper ear was gently pulled downward, while the skin near the neck area was tightened in a more upward manner, he explained during the surgery.
After pulling the skin in the ideal direction, Dr. Smiley then removed a small amount of loose skin mostly in front of the ear. The scar was positioned very close to the ear-face junction so there is no detectable reminder of plastic surgery.
He also removed the excess fat in the neck with tumescent liposuction, a technique known to minimize bleeding. Then, he carefully lifted off the skin to access the platysma muscle in the neck to tighten it in the midline, ultimately creating an improved angle between the chin and neck.
To avoid injuring or cutting the skin, Dr. Smiley said he used blunt scissors while separating this layer to the muscle. To further gauge the skin’s thickness, he lifted it at a certain angle so the surgical lamp could illuminate it properly.
In addition to neck lift and face lift, the patient also requested for upper and lower eyelid surgeries.
For upper eyelid lift, Dr. Smiley removed the excess skin and a small amount of muscle and fat using incisions placed inside the natural lid for optimal scar concealment.
And for lower eyelid lift, he removed the excess skin with the use of incisions adjacent to the lash line so the scar would blend well with the eyelashes. But instead of removing the excess fat entirely, he “rearranged” it to create a smoother lower lid-cheek junction.
He also performed fat transfer to the tear trough and nasolabial folds, or more commonly referred to as “laugh lines.”
Blepharoplasty procedure, or eyelid surgery, is not just about removing the redundant skin and under eye-bags caused by the excess fat around the eyes. A more important goal, according to Los Angeles plastic surgery expert Dr. Tarick Smaili, is to create a more rejuvenated appearance that looks natural.
Some patients require the surgery to improve their upper eyelid, lower eyelid, or both. Regardless of the surgical area, it is imperative to hide the resulting scar within the upper eye crease, close to the lower lash margin, and/or inside the lower lid.
Because of varying anatomies and cosmetic goals, blepharoplasty procedure always entails a comprehensive evaluation of skin, fat, eye shape, and other pertinent factors.
In upper blepharoplasty, the scar should always lie within the natural fold of skin to hide the telltale sign of the surgery. Through the use of incisions, doctors are able to remove the hooding skin that can sometimes impede with the patient’s vision, and possibly some excess fats.
However, removing the fats entirely rarely provides a natural-looking outcome due to the resulting hollowness or skeletonized appearance of the eye socket. A good rule of thumb is to preserve the youthful plumpness of the skin around the eyes.
Sometimes upper blepharoplasty requires the use of internal strands to tighten the levator muscle, which is responsible for raising the lids. On some occasions, the technique prevents the patients to close their eyes completely, although it will most likely resolve as the tissue relaxes over time.
When there is a need to remove some excess skin in the lower eyelid, a fine incision close to the lower lash line is used. But if the under eye-bag is only caused by the excess fat, doctors use a technique called trans-conjunctival in which a small incision is made literally inside the lower eyelid.
Instead of removing the excess fat entirely, most doctors excise just a little amount and/or redistribute it to make the lower lid and upper cheek of the same level.
Meanwhile, some patients can “escape” having an actual surgery although they may have to adjust their expectations. Possible alternatives to blepharoplasty include dermal fillers and laser skin resurfacing, which are only suitable for patients with no or very little excess skin around their eyes.
While dermal filler injections are commonly used to correct the hollowed or skeletonized eye socket, they are also helpful in concealing under eye-bags by creating a smooth transition between the lower eyelid and upper cheek.
There are different blepharoplasty lower lid techniques because of varying anatomies and cosmetic goals, as suggested by experts at the reputable California Surgical Institute.
A lower blepharoplasty, or more commonly referred to as lower eyelid surgery, is not just about removing the excess skin and fat beneath the eyes that contribute to their aged appearance. An equally important goal is to preserve the normal function and look of the eyelid.
Lower blepharoplasty before-and-after photos
The list below shows the different techniques used in blepharoplasty surgery and their adjunct procedures as well.
* Standard technique. It uses an incision placed directly below the lash line, allowing the surgeons to remove the excess skin and fat. However, the most important element is how much skin and fat can be [safely] removed without causing unnatural appearance and complications.
Lid retraction—or pulling down of the eyelid—is one of the most difficult complications, as it generally requires an extensive reconstructive surgery. For this reason, experienced plastic surgeons will always avoid over-aggressive methods, which can also lead to poor scarring and dry eye syndrome.
* Transconjunctival approach. It uses a hidden incision on the inside of the lower eyelid, so the risk of visible scar is eliminated entirely. But the technique is only suitable for patients with no or very little excess skin and whose main problem is the fat deposit under their eyes.
But instead of removing the fat altogether, most doctors prefer removing just a little and/or redistributing the fatty tissue to create a smooth transition between the lower lid and the upper cheek.
* Dermal fillers injections. While they are commonly used to correct soft tissue atrophy (shrinkage) that leads to the skeletonized eye socket, they are also helpful in smoothing out the under eye bags.
Dermal fillers can be injected right below the under eye bags so the cheeks and the lower lids will be at the same level.
* Laser skin resurfacing. It works by minimizing the appearance of fine lines and wrinkles. While it promotes skin tightness to some degree, it has no or very little effect on the redundant or loose skin.
The results of blepharoplasty lower lid are near permanent—i.e., the vast majority of patients will not need a touch-up for at least 10 years. However, it is a highly technical procedure that carries more potential risks such as lid retraction, making it important to achieve good results the first time around.