Lower Blepharoplasty

Q: Dr. Eppley, I do however still have some questions with regards to the lower blepharoplasty procedure.  My surgery is tomorrow and I’m flying out late tonight.  I hope I get to address these with you.  I really appreciate it.

After searching the limited info online about Alloderm, I read that alloderm is not permanent?  (If true, I don’t see the benefit of going with alloderm and assuming the risk of rejection and higher risk of infection).   Therefore, in the OR can we correct my hollowness by trans-positioning my fat pad and if I don’t have abundant fat pads what are other options (but not fat injections cause I dont want lumping)   Is there any permanent solution for the hollowing that would look natural?  Would that be a tear trough implant?

Another question is that my lower eye skin is crepey like ,very thin and  not tight.  Can I expect the lower blepharoplasty to address this? or Can CO2 laser be an alternative to the lower blepharoplasty?  I read online that worse crepy appearance can occur after the swelling of the lower blepharo procedure goes down. (is that true?) Is it important for you to assess the quality of my under eye skin to determine which is best for me?

Also with regards to the cheek lift  I found this picture on your website with the following description of a 47 year old female that had a cheeklift done through lower eyelid incision.  The cheek tissues were lifted up and sutured high up onto the cheekbones to a reabsorbable screw.  Would this be the technique you would use for me for my cheek lift?

A: Let me address/answer your lower blepharoplasty quesrions:

1) I have never seen Allodem resorb in the lower eyelids.

2) You probably do not have enough lower eyelid fat for transposition without running the potential risk of increasing lower eyelid hollowness. But that determination can not be made except during the procedure.

3) A tear trough implant is not appropriate for a thin-skinned hollowed lower eyelid as it will not look natural. The role of Alloderm is to serve as a method to address the lower eyelid hollowness that will not have the same risk of that of an implant.

3) While the lower blepharoplasty will improve some of the lower eyelid loose skin/wrinkles, it is not going to get rid of of all of them. My concern for you is that I don’t think you may have a realistic expectation for your lower eyelids. You can’t improve all of the aging concerns without the risk of other complications. (lower eyelid retraction, irregularities) While one can be aggressive on the upper eyelid, you must be more conservative on the lower eyelid to avoid problems. And being more conservative means you have ti settle for subtotal improvement.

4) The type of midface lift you have highlighted is as direct midface lift with fixation to the orbital rim. I just don’t use a resorbable srcrew anymore because it is very palpable for months.

Dr. Barry Eppley

Indianapolis, Indiana