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    Lower Eyelid Surgery (Lower Blepharoplasty)

    Lower Eyelid Surgery (Lower Blepharoplasty)

    Lower Eyelid Surgery

    More than one hundred thousand people undergo lower eyelid surgery each year in order to improve their appearance and look more rested. The surgery is intended to help people that have “puffy” lower eyelid bags and/or “dark circles” underneath their eyes which can lead to a “tired” appearance.  You may have had the experience of a friend or colleague asking you if you are “tired” when you are truly well-rested. When people keep hearing this question even though they are not tired it is usually due to the presence of droopy lower eyelids, dark circles underneath their eyes and/or bothersome under-eyelid bags. These signs of aging can make you appear older than you are and look more tired than you feel. Believe it or not, these effects of aging can often be seen as early as in the mid-thirties in some patients! Cosmetic lower eyelid surgery, known technically as a lower blepharoplasty, involves removal of the lower eyelids “bags” along with tightening of excess loose skin in order to restore a refreshed and more youthful appearance to the lower eyes.

    Aging of the lower eyes can lead to the development of lower eyelids “bags” and a “tired” appearance. During your consultation, Dr Motykie will evaluate your eyes, forehead, eyelid muscles and skin in order to customize your surgery to your particular needs and concerns. Topics that will be discussed will include whether or not both your upper and lower eyes need to be treated, whether lower eyelid bags need to be corrected, whether loose skin needs to be removed and whether or not an additional procedure will help you to achieve your goal such as laser skin resurfacing or brow surgery. This initial evaluation is critical because, unlike some other centers that only perform one type of lower eyelid rejuvenation, Dr Motykie utilizes a variety of modern, time proven techniques that our custom tailored to your own unique anatomy and individual goals.


    During your consultation it will be determined which type of lower blepharoplasty technique will best meet your needs and desires from surgery. If it is determined that lower eyelid bags and loose skin are both a problem, Dr Motykie will most likely suggest a transcutaneous approach to your surgery which will allows for removal of the excess lower eyelid skin in addition to correction of the lower eyelid bags. In this approach, Dr Motykie is meticulous about hiding your incisions within the natural creases of the eyes in order to maximally conceal them. This means the incisions will typically fall just below the lashes of the lower eyelids. In some cases, the incisions may extend into the natural laugh lines at the corners of the eyes or into the crow’s feet. If during your consultation it is determined that your only problem is “bags” beneath the lower eyelids (without any loose skin), a transconjuctival blepharoplasty can most likely be performed which does not involve the removal of any skin below the eyelid. In this approach, an incision is made inside the lower eyelid which avoids any visible scarring on the outside of the lower eyelid. If there is fine wrinkling of the lower eyelid skin, a chemical peel or laser resurfacing often offers a safer solution than surgical excision of skin which can lead to lower eyelid retraction and a visible scar on the outside of the lower eyelid. Lastly, sometimes, the problem is not actually bulging fat pockets, but rather hollowing and loss of fat volume below the eyelids. In this case, adding some of your own fat to this area through facial fat grafting can do wonders in creating a more youthful and rested lower eyelid appearance. In fact, Dr Motykie will include facial fat grafting in the majority of his lower eyelid surgeries in order to enhance the final long-term results and youthful appearance of the lower eyelids.

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    Since, there are many options for rejuvenation of your lower eyes Dr Motykie will take time to discuss which of these separate or combined rejuvenation techniques will best accomplish your unique goals from lower eyelid surgery. During your consultation, photographs of your face will most likely be taken so that Dr Motykie can further study your eyes and utilizing state of the art computer imaging systems to show you what can be achieved form lower eyelid surgery in your individual case. You will be asked to provide your medical history, and will focus on conditions you have that may affect your surgery including thyroid problems, dry eyes, lack of sufficient tears, high blood pressure or other circulatory disorders, diabetes, cardiovascular disease or glaucoma. Dr Motykie will also give you an opportunity to ask him any question you may have about your surgery as well as its possible benefits in your particular case. When going into your consultation, it is wise to come with questions written down and have a general understanding of the overall procedure so you can be prepared to learn as much as possible during your visit with Dr Motykie. You should leave your consultation with a preliminary game plan for your surgery. Cost is always a consideration in elective surgery. At the conclusion of your consultation you will have the opportunity to meet with Dr Motykie’s surgical consultant who will be able to explain to you the possible cost and timing of your lower eyelid surgery. Cost may include surgeon’s fee, surgical facility costs, anesthesia fees, prescription medications, post-surgery garments, and medical screening tests. Dr Motykie’s consultant will also be able to explain to you all of your possible financing options.

    For your own personal and confidential consultation, contact Dr. Motykie’s office today. Dr Motykie will answer all of your questions and together you can determine which procedure best fits your desires and needs. Remember, it is impossible for a surgeon to tell you the best approach for you without first listening to your desires and concerns and then performing an examination of your eyes and surrounding tissue. Out of town patients may send photographs in order to have a online consultation performed by Dr Motykie.


    Dr. Motykie will meet with you during your pre-operative appointment and he will take the time to answer any questions you may have about your surgery as well as to discuss your personal surgical plan in detail. Several different photographic views of your face will be taken during this visit for inclusion in your medical record. These photographs will also be used for reference during your actual surgery as well as to show you the difference in your lower eyes before and after surgery.

    “Safety first” is Dr Motykie’s motto so you will be required to give a thorough medical history, undergo a complete physical examination and obtain certain laboratory tests in order to evaluate your general, overall health prior to any surgery. You will also receive all of your post-operative instructions and prescriptions for medications to be taken during your post-operative course. It is advised that you fill these prescriptions prior to your surgical date and bring them with you on the day of your surgery. In this way you will have all of the medications you need prior to your surgery and any questions and/or concerns you may have can be addressed prior to your actual procedure. You will be instructed to avoid taking drugs containing aspirin, ibuprofen, blood thinning medication, anti-inflammatory drugs and any herbal supplements that are associated with an increased risk of bleeding during surgery. A complete list of medications, vitamins and herbs to avoid prior to your surgery will be given to you at you pre-operative appointment and it can also be downloaded by following this link(Medications to Avoid List).Depending on your health, you may be asked to take certain medications or adjust your current medications. Be prepared to discuss your use of any current medications, vitamins, herbal supplements, alcohol, tobacco and/or drugs.

    If you smoke cigarettes, you absolutely must stop smoking well in advance of surgery. If you are a smoker, plan to quit at least two weeks prior to your surgery and not to resume smoking for at least two weeks after your surgery in order to avoid the increased risks of complications associated with smoking. It is absolutely imperative for smokers to follow these guidelines if they do not want to risk any healing complications after surgery. The nicotine in the cigarette smoke can causes the blood vessels necessary for proper healing to shrink which can lead to healing problems after surgery. It is also important to avoid sunlight exposure before and after your surgery because sunlight exposure can cause permanent darkening of post-operative bruising.

    Guidelines on eating and drinking the night prior to surgery as well as everything you need to prepare and/or bring with you the day of surgery will also be explained and given to you in your pre-operative packet (Link to Pre-operative packet). Do not go on a stringent diet before or after surgery, as this can inhibit your ability to heal. If you develop a cold or infection of any kind prior to surgery, let Dr Motykie’s office know as soon as possible because your surgery may need to be postponed for safety reasons. Lastly, the consumption of alcohol prior to surgery can lead to an increased risk of bleeding during your surgery and you are therefore advised to limit your alcohol intake for the week prior to surgery. In addition, alcohol can interfere with your post-operative medications and should therefore be avoided as long as you are taking prescription medications (usually the first week after surgery).

    During your recovery period, be sure to arrange for someone to drive you home after surgery and to take care of you for at least the first day or two after your surgery. (You may also need to have someone drive you back and forth for your first few follow-up visits). You will also be given several post-operative visit dates and specific times that you will need to follow-up with Dr Motykie during your recovery process.


    Pre-Operative Marking

    Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your lower eyes. Marking is always done in the sitting position and the patient is asked to gaze upward and downward to assess the amount of budging of the orbital fat pads (bags) and the laxity for the lower eyelids. Accurate determination of the amount of skin to be trimmed is critical to a successful result from the surgery. Excess skin resection or aggressive lower eyelid tightening needs to be avoided in order to prevent the creation of strange, Asian, or unnatural looking shape of the lower eyelids with possible exposure of the white part of the lower eyeball (scleral show). These preoperative markings are essential to the surgery and are critical to perform accurately even in experienced hands in order to avoid the feared and hazardous “scleral show.” Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

    Anesthesia and Operating Facility

    You can have lower eyelid surgery under local (awake) or general anesthesia (you are asleep). However, for your own personal comfort, safety and surgical ease it is Dr Motykie’s opinion that the safest and most effective way to perform lower eyelid surgery is under general anesthesia. Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately 45 minutes to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance.   Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.


    With age, the skin of the lower eyelid becomes thinner, the muscles become weaker, bags become more prominent and the supporting framework of the eyes begins to buckle. The shape of the lower eyes can begin to change shape along with drooping of the outer eyelid skin and supporting structures. This creates a dangerous set of conditions to perform surgery in inexperienced hands. Your surgeon must understand that support of the lower eyelid framework may need to be added along with the cosmetic portion of the surgery; otherwise complications can develop that include changing the shape of the lower eyelid and exposure of the white part of the eye.

    In addition, there are two possible approaches to take when rejuvenating the lower eyelid area: transcutaneous (through the skin on the outside of the eyes) or transconjuctival (though the inside of the lower eyelid). The transcutaneous approach to lower blepharoplasty entails the use of an incision along the lash line of the lower eyelid. There is a thin scar along the lower eyelid as a result of this surgery and it takes an experienced surgeon to create a natural result without any complications. This is one time the eyes should NOT give you away. If too little fat is removed it can lead to residual bags and if too much fat is removed it can lead to hollowing of the lower eyelid area. In addition, a poorly planned surgery can lead to droopy, misshapen or retracted eyelids with possible exposure of the white part of the lower eyeball. It does not seem to make much common sense to perform a lower blepharoplasty utilizing this older external method considering the lower eyelid by nature is not well supported. In addition, with advancing age, which is the group of patients typically seeking this type of surgery, the supporting structures (tendons) of the eyes weaken and stretch which magnifies the potential for lid scarring and retraction after surgery. Therefore, experienced surgeons know that in cases where skin must be removed, secondary support of the lower eyelid should be created with a “suspension” suture placed near the outer eyelid on both sides. However, the potential complications from transcutaneous blepharoplasty can be avoided all together by removing the lower eyelid bags from inside the lower eyelids (transconjuctival approach) and I therefore prefer to perform my lower eyelid surgeries using this more advanced technique. Because there is no external suture along the lash line, there are no resulting incisions/scars on the lower eyelids and the risk of potential complications is very small. The only drawback to this type of surgery is that it does not allow removal of any loose skin from the lower eyelids. With the advent of more effective skin treatments, however, lower eyelid wrinkles and loose skin can often be treated with chemical peels or laser skin resurfacing before, during or after the surgery. In extreme cases in which skin must be removed, new simpler methods of lower eyelid tightening can be performed by an experienced surgeon that gives added support to the lower eyelids and preserves their natural shape and symmetry. No dressings are applied to the eyes after the surgery and only antibiotic ointment needs to be applied to the incision twice a day.

    Recovery Room

    After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications. The most comfortable position to recover in after surgery is a reclining chair with your head elevated. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. Temporary bruising and swelling are also common the first night after surgery


    The next morning following your surgery, you will return to Dr Motykie’s office for your first post-operative visit. Upon arrival to the office you will be escorted to a private examination room where your lower eyes will be evaluated. After your examination, you will be allowed to return back to your home. All of your questions will be answered and you will be given instructions for the following week.

    • Diet: Mostly patients start with a liquid diet the night after surgery. Usually by the next day most patients are back to a normal diet.
    • Medications: Some swelling, bruising and discomfort are normal immediately following surgery and it is typically controlled with your prescription pain medication. Do not take any other pain medication including Tylenol, aspirin or ibuprofen in combination with your pain medications unless you are given permission by Dr Motykie. A combination of Arnica Montana and Bromelain are encouraged after surgery in order to promote your healing process.
    • Bathing: Showering and bathing are permitted the very next day after surgery.
    • Activity: Light activity is allowed and encouraged including moving about your house and going for walks outside in order to aid the circulation in your lower extremities. However, no heavy lifting or strenuous activity should be attempted during your first week of recovery. You can usually return to a desk-type job within 72 hours. Physical exercise generally can be resumed two weeks after surgery but aerobic and impact cardio exercise should be avoided for one to two weeks post-operatively. Weight lifting should be avoided for 2 weeks.


    The final results of your surgery will typically be obscured by swelling and bruising at one week after surgery. Your lower eyes will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with your prescribed medications but most patients say that lower eyelid surgery is almost “painless.” Some people can return to work after a few days and some after one week. Most patients can drive their vehicles within a few days after surgery, but plan on having someone drive you to your first few post-operative visits anyway. In regards to an exercise program, use common sense and use pain as your guide; if it hurts, simply don’t do it! The majority of patients are allowed to return to light, low impact cardiovascular exercise after the first week of recovery. Your progress will be closely followed during the first week or two, and you will be given a list of activities and environments that should be avoided in the weeks after surgery. The stitches are removed within three to five days, or self-absorbing stitches will dissolve on their own.

    • Medications: Some continued swelling, bruising and discomfort are normal and they are typically controlled with your prescription pain medication. You should also be finishing your prescription antibiotics at this time. Arnica Montana and Bromelain may be continued for another week in order to promote your healing process.
    • Bathing: You may bath and shower freely during the second week after surgery.
    • Activity: Exercise of some sort is very important, even if it is just walking around your house. Having said this, rest is also important to the healing process and heavy lifting and strenuous activity are still restricted during the first month after surgery. You will be able to return to more strenuous exercise/heavy lifting at 3-4 weeks after surgery.


    Depending on the amount of physical exertion required to perform your expected duties, you should already be back into your normal rhythm at work. Exercise and workout routines should also be back to your normal level of activity. The majority of your swelling and bruising should be completely resolved at this time and you should be starting to enjoy the benefits of your surgery. Some dryness of the eyes may still be present but should be expected to resolve over the next several weeks.


    Lower eyelid surgery, can effectively rejuvenate puffy, sagging or tired-looking eyes by removing excess fat, skin and/or muscle from the lower eyelids. All patients vary in their ability and speed to recovery after surgery but most commonly you can expect the final result from surgery to be evident at six months after surgery. Long term after the surgery, you should look younger and “more-rested” not strange or “over-done.” As you heal further your friends, family and colleagues will most likely stop asking you if you are tired and begin to ask you what your secret is to looking so rested and “healthy.” The final result should look very natural and simply make you appear more rested and youthful.


    Although “bags” underneath the eyes and loose skin can be improved with a lower eyelid surgery, fine wrinkles under the eyes are very difficult to correct surgically. However, crêpe skin and wrinkles of the lower eyelid skin can be improved dramatically with chemical peels or laser treatments before, during or after the surgery. Injectable artificial fillers have also been touted to improve aging lower eyes without the need for surgery. In experienced hands, I think the artificial fillers offer a valid temporary solution for camouflaging hollowness underneath the lower eyes but these type of injections simply cannot correct lower eyelid bags or remove loose, wrinkled skin.


    If a lower eyelid surgery has been unsuccessful elsewhere due to retraction of the lower eyelid skin or hollowing underneath the eyes due to over aggressive removal of lower eyelid fat pockets, a revision lower eyelid surgery may be able to restore a normal appearance and a rested, natural look when performed by an experienced surgeon. A lower eyelid “sling” or reconstructive lower eyelid surgery can be performed by Dr Motykie to repair and improve the appearance of the lower eyelids if the eyelid shape has been altered unfavorably by prior surgery. If too much fat has been removed by a prior surgery elsewhere, Dr Motykie can most likely repair the resulting sunken look with facial fat grafting underneath the eyes.


    In the majority of patients undergoing lower eyelid surgery, there are other areas of the face and neck that may also benefit from rejuvenation surgery such as the upper eyes, brow, face and/or neck. It is very common to combine upper eyelid and lower eyelid surgery at the same time since both the upper and lower eyes typically age at a similar rate. Facial fat grafting is invaluable to perform in combination with lower blepharoplasty surgery because it can correct a “sunken” look underneath the eyes by replacing lost facial fat volume as well as enhance cheek bones and camouflage dark circles under the eyes. A lower Blepharoplasty can also be combined with a browlift or BOTOX® treatments to raise the eyebrows and reduce the appearance of wrinkles or crow’s feet above and around the eyes. Although wrinkles of the lower eyelid skin can be difficult to completely correct surgically, they can be dramatically improved with chemical peels and/or laser resurfacing. Lastly, a facelift can be performed with lower eyelid surgery in order to achieve balanced facial rejuvenation in patients that have developed jowls or loose skin in the neck in addition to aging of the lower eyelids.

    For your own personal and confidential consultation, contact Dr. Motykie’s office today. Dr Motykie will answer all of your questions and together you can determine which procedure best fits your desires and needs. Remember, it is impossible for a surgeon to tell you the best approach for you without first listening to your desires and concerns and then performing an examination of your eyes and surrounding tissue. Out of town patients may send photographs in order to have a online consultation performed by Dr Motykie.

    To find out more about eyelid surgery please contact us at 310-246-2355