Eyelid Surgery Declines II

In a previous post the decline in eyelid surgery was discussed, focusing on upper eyelid surgery. However, it is likely that the decline in lower eyelid surgery has been much greater than the decline in upper eyelid surgery. The aging changes of the lower lid have, until recently, been poorly understood and have been the subject of a considerable amount of misdirected surgery.

Patient complaints related to the lower lid center around wrinkles and bags. Wrinkles have never been amenable to surgery, because one of the relatively frequent complications of lower lid surgery has been an unnatural downward pull on the lower lid. Attempting to pull the lower lid tight enough to eliminate the wrinkles, greatly increases the risk of this complication, round eye.
Most previous surgery has been directed at removing the bags beneath the lower lid skin, based on incorrect idea that people grow more eyelid fat as they get older (wrong), or that the fat that is normally present around the eye protrudes more as people age.
This last idea is partially correct, but instead of it being the major cause of eyelid bags, it is a relatively minor factor.
We now understand that people loose facial fat, bone and connective tissue as they age. For the most part it is the loss of facial deep tissue that exposes tissue that is normally around the eye and reveals what appears to be bags. While many cosmetic surgeons understand this, many others do not. Perhaps because there is no marketing machine behind this procedure, and there is no catchy name, the general public is even further behind in their understanding of this. We call replacement of the lost tissue with filler, facial sculpting. It produces a much more natural and youthful look than the surgery that had been popular in the past. Unfortunately it is a very technique dependent process and it is a step back from the current approach to try to make everything so simple that any technician or nurse can perform it. Here, especially, skill and artistic judgment is critical. We have seen some bad results coming in for repair.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA