Lower eyelid reconstruction and lower eyelid blepharoplasty: Advanced Plastic Surgery

The lower eyelid is a complex structure composed of skin, muscle and fat. The function is to protect the eye and keep the tear film on the globe. It does not have as much mobility as the upper eyelid which does have the most movement during the blink phase, though with squinting and when something is projected towards the eye (ball, fist, tree branch) the lower eyelid and cheek do provide a significant amount of protection. The lower eyelid is likened to a clothesline with a sheet of skin and muscle draped over it. The clothesline is the lash line which is the site of lower eyelash follicles, a stiff strip of collagen called the tarsal plate and moisture glands; this is all suspended by inner and outer eyelid tendons which anchor the lower eyelid to the orbital bone.
The lower eyelid can be reconstructed for congenital defects such as clefts or colobomas, for tumors such as skin cancer, or for scar after a traumatic accident. All layers and structures of the lower eyelid should be repaired individually to maintain function and position of the lower eyelid. If the lower eyelid is maligned or there is scar formation which pulls the eyelid down or away from the globe, dryness and irritation can occur. This is referred to a lower eyelid ectropion. Ectropion can be prevented with proper positioning and support with the first operation, with stretching and scar massage after and proper positioning of the lower eyelid during the reconstruction. Supportive type procedures are called canthopexy, which is the tightening of the outer eyelid tendon, or a canthoplasty which is the tightening and reconstruction of the tendon. A canthoplasty may involve detaching it from the bone and repositioning it to a new position through a drill hole suture. These same principles are applied to the rejuvenation of the lower eyelid which should involve tightening the lower eyelid and repositioning of the lower eyelid and cheek fat (cheek lift or mid face lift), and removal of skin. This will smooth and reshape the lower eyelid giving it a younger, more youthful look. Lower eyelid surgery does have a significant amount of recovery, with at least a two to three week downtime until the eyelid swelling and bruising resolve. With any invasive lower eyelid procedure the muscle of the lower eyelid can become lax and lose muscle tone which resolves over a short period of time. Every patient desires a short recovery but for youthful correction of the lower eyelid an individual approach to each structure is necessary and each patient, cosmetic or reconstructive should have a individual operative plan derived during your eyelid consultation with Dr. Trussler.