What are Non-Surgical alternatives to LOWER Blepharoplasty Surgery and when are they effective?

Author: London Advanced Facial Cosmetic & Plastic Surgery

Hallo, welcome to my frequently asked questions. Today I’m answering a commonly asked question about lower eyelids. When can I have an alternative to lower eyelid surgery or lower blepharoplasty? In other words when can I use a non-surgical treatment to benefit my lower eyelid appearance? In answering this question we’ll talk about well, when is a non-surgical technique indicated in the lower eyelid, what are the alternative options for treatment. When are surgical options or techniques most indicated for the lower eyelid, and how can I choose the best technique and the best surgeon for me? My name is Dr. Julian De Silva, I’m a London based facial cosmetics and plastic surgeon and eyelid surgery is the commonest treatment I complete for my patients on a daily basis. And the information that we’re discussing today is information that I discuss with my patients regularly.

So, in terms of the indications for lower eyelid techniques that favour non-surgical treatments. Well, first of all we need to look at the common changes that you see in the lower eyelid that are associated with either aging or genetics. And all changes in the lower lid are really a combination of these features. So, in terms of common changes, well, the three common changes that we see are bags in the lower eyelids and these correspond to, a cushion of fat, called orbital fat that's coming forward to the lower eyelid creating that bulge Secondly we see a tear trough depression beneath the eyelid.

And this commonly is seen as a shadow, a dark circle, or sometimes it’s seen, as a semi-circular depression beneath the lower eyelid. And this corresponds to some loss of volume, the attachment of the ligament beneath the lower eyelid. Thirdly is loose skin,so, all all changes, in the lower eyelid tend to favour a combination of these three elements.

Some swelling of fat coming forward to the lower eyelid, some degree of tear trough or depression and thirdly some laxity in the skin. And if these changes are relatively mild, then non-surgical treatment can be effectively used to rejuvenate the lower eyelid. And commonly this uses a filler, and that filler is used to fill the depression, the tear trough area in the lower eyelid to lift that depression and smoothen out the contour between the eyelid and your cheek. And so, most nonsurgical treatments with the lower eyelid are using a volume effect to fill that depression.

What are Non-Surgical alternatives to LOWER Blepharoplasty Surgery and when are they effective?

There are different types of fillers available and the choice of different fillers is relatively important. Because treating the lower eyelid we want to give a natural result without lumpy bumpy changes without swelling. What important when considering this, is the type of filler, the way in which the filler is inserted into the lower eyelid, and the technique used. And these are all very important in having a good result and avoiding unnecessary risks. So, if we look at fillers, well, what are the different types of fillers? Well, the only fillers that really are, are currently advised to have in the lower eyelid are hyaluronic acid fillers. And hyaluronic Acid is a substance that exist naturally in your body, it exist in the skin, it exist in joint and a clever pharmaceutical company is devised a way of manufacturing this gel. Meaning that we can use it to fill areas in the body and smoothen out depressions.

The advantage of hyaluronic acid gel is that it’s very well accepted. Things like allergies are extremely rare. So, it’s very well accepted by us as people. But in addition to that, it has an antidote. So, there is an antidote that can be used to literally dissolve that hyaluronic acid gel in a matter of hours. And so, that makes this filler relatively unique because other types of fillers that are made of other substances well, generally they’re not dissolvable with an antidote.

So, in terms of the lower eyelid, well,this is a delicate area of the body where millimetres make a difference. Hyaluronic acid fillers are a safe product to be used, which can be used which can be dissolved if necessary. The other consideration is the technique in which it is used to administer the hyaluronic acid gel. And the older way of doing this is with a needle, and this by definition needle has a sharp pointed and that sharp point can give you more bruising more swelling. And very rarely if a little bit of that filler is injected into a blood vessel around the eye potentially it could have quite serious consequences. And this is a subject that I have taught both nationally and internationally in advising other clinicians, fellow colleagues, how to avoid issues such as complications around the eyes using techniques that avoid this.

And one of the ways is using a cannula as supposed to a needle around the eyelids. And what a cannula is, well it is an instrument that has a blunt end to it. And so, it cannot damage blood vessels in the same way that a needle can and instead of being traumatic, it will slide naturally in the soft tissues and by doing that it will avoids some of the most serious risks associated with fillers such as the blockage of the blood vessels and potentially damage the vision. So, a cannula technique is very important when it’s considering using fillers around the eye. When is surgery best suited for the lower eyelid? Well, this really goes back to the three changes that we were talking about that are commonly seen in the lower eyelid. Firstly fat coming forward as a bulge in the lower eyelid.

That orbital fat, once it reaches a certain point, only surgery is going to really treat that effectively. Secondly, if there is more of a mugged depression from the tear trough, well alternatives to using filler which needs to be replaced at least every year would be fat transfer. Fat transfer combined with the use of growth factors such as Platelets Rich Plasma can have a much longer lasting effect. And doesn’t need the same kind of top ups that fillers need. So, a deeper tear trough depression maybe treated more affectively with a surgical technique such as fat transfer and finally, skin laxity. And if there is excess lose skin in the lower eyelid, Well, only lower blepharoplasty is truly going to treat that effectively. So, in terms of the indications for a more surgical lower eyelids, surgical blepharoplasty would be increased prolapse of fat and swelling in the lower eyelid, a deeper depression dark circle in the lower eyelid an increased loose skin in the lower eyelid.

All these indications will give you a more favourable result with the lower blepharoplasty. There are different techniques within lower blepharoplasty that need to be looked at for each individual patient. And that’s a little bit outside the scope of this particular video. So,in terms of the lower eyelid, well, we’ve talked about when are non-surgical treatments particularly effective in the lower eyelid.

We’ve talked about the options and the way filler can be used. The different types of fillers and the techniques that can be used in the lower eyelid. Finally we’ve talked about more indications for a surgical lower blepharoplasty.

In terms of making the best decision for you, whether to have a non-surgical treatment, or a surgical lower blepharoplasty. Well,it does mean that you need to do a set amount of research to make sure you are making the best decision for you. And you really need to see a clinician or a surgeon who is able to advice you on the different techniques. Emphasize your personal circumstances evaluate your eyelids and give you a specific advice that is based on the changes that you have. And for some patients that maybe a more non-surgical treatment for other patients they may be more likely to benefit from a surgical lower blepharoplasty. And it does mean doing a sufficient amount of research and finding out about your potential surgeons.

What are the techniques they use, what are their before and after photographs are like and ultimately attending your consultation to discuss your specific indications for surgery, your concerns and what is the best treatment for you. I hope this information has been useful for you. Thank you for watching.

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