There’s a disconnect when it comes to performing the traditional approach to lower eyelid surgery to rejuvenate the eyes. Blepharoplasty removes tissue — the bags — from the eyes, but accentuates the natural aging process, leaving behind a hollowing of the tear trough.
That's according to Andrew Jacono, M.D., who presented yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas. Dr. Jacono is a facial plastic surgeon in Manhattan and assistant clinical professor of facial plastic surgery at the New York Eye and Ear Infirmary and the Albert Einstein College of Medicine.
Dr. Jonaco says that his approaches build up, rather than take away, tissue around the lower eyelid.
“What we’ve come to realize is we don’t want to debulk or remove tissue from around the eyelids as much as we want to build it up, because that’s really what makes eyes look youthful,” Dr. Jacono says. “The point of the talk was to first address that issue and motivate surgeons to change the way they approach eyelid surgery. There are multiple techniques to do that.”
His favorite approach involves surgically using the orbital lower eyelid fat bag that is already there in many patients. When patients have enough of an orbital lower eyelid fat bag under the eye, he repositions it to replace the natural volume around the tear trough area.
“What’s really wonderful about that is when you use that fat, it’s attached to a blood supply. What we do is we leave it attached to the blood supply and move it down into the upper cheek. We then suture it into place, so it will live there forever,” Dr. Jacono says.
For those patients who don’t have enough fat around the eye or prefer injections to more extensive surgery, Dr. Jacono uses either temporary fillers or surgically injects fat from another area of the body around the eye. Nonsurgically, Dr. Jacono uses hyaluronic acid injections to rejuvenate the eyes.
“I usually use either Restylane or Belotero because they have less of a Tyndall effect…,” he says.
Fat grafting can be a little trickier, according to Dr. Jacono.
“The problem with fat grafting is there is a significant proportion of patients who have complete reabsorption of the fat injections after they’re done. And there’s a significant percentage of people who get a partial take,” he says.
When done correctly, these procedures can restore the youthful contour of the eyelid-cheek junction, rather than accentuate sunken or darkened lower lid areas.
Dr. Jacono reports no relevant disclosures.