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Previous lower eyelid blepharoplasty volume loss: the eventual need for Restylane filler: Part 1

This morning I had a patient come to see me who had had lower eyelid blepharoplasty done 18 years ago and then more recently ten years ago a small MACS facelift.
When lower eyelid blepharoplasty is done for fatty eye bags, a small amount of fat is removed either via a transconjunctival eyelid approach or through a skin incision. A small amount of loose baggy skin can also be trimmed. It is not uncommon for patients to return 10 to 15 years later with a hollow under eye area. They often find that they look a little hollow and tired underneath the eyelids because with ageing they have cheek descent.
Since they do not have the fat volume in the lower lids, the ageing cheek ptosis can make them look tired with hollowing of their tear troughs. This is particularly severe and noticeable if the patient has what is called a “negative vector” cheek to eyeball, where the eye itself is naturally protruding, and the under eye area looks more hollow, especially with natural cheek descent, or cheek ptosis, with age.
Ptosis means to fall down! We use the term more often for the upper eyelids when they droop, called upper eyelid ptosis. It can also be used to describe the sagging of the cheeks which occurs with age and loss of cheek volume and increased mid face laxity.
In this patient, I have recommended Hyaluronic acid gel filler into the tear troughs called TearFill, by cannula. The alternatives are to do further surgery to put fat on her lower lids and upper cheeks or to try and reposition some of her existing fat down into the tear troughs. Both of which are quite invasive surgical procedures with uncertain results.
I noted that she had a descent of the cheek with some triangular atrophy at the lid cheek junction, and with some tear trough hollowing with very little fat above. This was on top of a natural facial asymmetry which made one lower eyelid look much longer than the other: all of which can be largely corrected by a filler such as Restylane or Juvederm.

Lower eyelid blepharoplasty surgery can be very effective in getting rid of eye bags in young to middle-aged women and men aged 45 to 65 years. However, where the lower eyelids have had the fat pads reduced, there is a subsequent hollowing with age, which can become apparent, therefore require correction with hyaluronic acid gel.


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