Upper Eyelid & Lower Eyelid Surgery in Vermont

The lower eyelid is actually more complex, both anatomically and in terms of options for surgery, than the upper. There are several things that seem to change in the lower eyelid with age. One is that bags form under the eyes. Bags in the lower eyelids, as in the upper eyelids, are usually the result of protruding fat that belongs further back in the eye socket. The fat bulges forward either because of weakness in the membrane that should retain the fat in position or, according to a recent study, has increased in volume. Treatment options include removal of the excess fat, or repositioning it. If fat removal alone will give the desired result, I can even take it out from the back side of the eyelid, so no skin incision and no scars.

Another undesirable change that happens in the lower eyelid area is deep circles forming under the eyes.More often than not, there will be a combination of fat bags bulging above and a dark circle underneath. So what we want to do to correct that appearance is to change the contour. In those cases, rather than removing the fat, I use the fat to fill in the circles. In other words, if there is bulging fat in the lower eyelids and a deep circle below the fat, rather than take the fat out and get rid of it, I move the fat down and sew it into place to fill in the circle while at the same time removing the bag. It is a very nice technique initially developed by a Brazilian plastic surgeon.

I’ve also observed that the circles under the eyes are often the result of the cheek tissue below the lower eyelids falling downward. That area is called the “middle-face”, a term that is usually shortened to “mid-face”. With a mid-face lift, I raise the soft tissues of the front part of the cheek which automatically fills in the circles under the eyes without actually operating on the eyelids themselves. This method helps the lower lid to look more youthful. The way that I perform that procedure is through an incision inside the mouth under the lip, in combination with the endoscopic forehead lift mentioned above, so there are no tell-tail scars on the face at all. Hence, we have a very natural and overall nice procedure.