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How is a lower blepharoplasty done ?

Procedure done under local anesthesia and in day-care.

1.A line drawing is made on the lower eyelid, just under the eyelashes.
2.Injection of local anesthesia. This solution is buffered to markedly reduce the pain of injection.
3.Incision of both the skin and underlying muscle.
4.Wide dissection of this muscle/skin flap in order to identify the underlying fat
5.Incision of the flimsy and bulging septum.the fat is visible underneath this structure
6.Excision of fat in three compartiments : inner, medial and lateral fat.
7.Coagulation of bleeding vessels before closing
8.In rare cases, removal of some skin, very conservatively.
9.Closure of the skin with separate suture of a fine resorbable thread.No need to remove these sutures . The skin heals with a very fine scar, unnoticeable after a few weeks.

 

Canthoplasty

In cases where the eyelid is very inelastic, a lateral suspension ligament (lateral canthal ligament ) can be tightened in the same session

 

SOOF procedure

The fat can be resected, but it can also be repositioned over the bony orbital rim in cases where there is a deficient volume at that level. This procedure is done in patients which have bags but also a depression under the bags. The technique is called a SOOF procedure (Sub-Orbicularis Oculi Fat repositioning)

SOOF procedure
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In a soof procedure ,the-bag fat is rewrapped over the arcus marginalis or orbital bony rim to obliterate the crease and create a smoother transition.