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Key Points
- Transconjunctival approach to blepharoplasty improves lower eyelid bags, puffiness, edema
- Many patients benefit more from filler treatment than from surgery, surgeon says
- Cutaneous blepharoplasty may be required in patients with significant lower eyelid skin laxity with overlapping skin
Recent advances have given rise to new blepharoplasty techniques, some of which can benefit patients without the need for surgery. Filler and other rejuvenation options can achieve comparable cosmetic outcomes without the risks inherent in more invasive procedures.
"Much of blepharoplasty success essentially revolves around choosing the right operation or procedure for the right patient. Patient selection is crucial here, as many blepharoplasty patients could do equally well, if not better, with a filler procedure, sparing them the risks of surgery," says Robert Alan Goldberg, M.D., chief of orbital and ophthalmic plastic surgery and co-director of the Aesthetic Reconstructive Surgery Service at the University of California, Los Angeles' Jules Stein Eye Institute.
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Dr. Goldberg
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FILLER FANCY One of the main options in lower blepharoplasty surgery remains the transconjunctival approach, with or without fat repositioning. This approach is considered effective in improving lower eyelid bags, puffiness and edema. Nevertheless, surgery is associated with complications, and therapeutic choices must be made with caution. According to Dr. Goldberg, a more conservative approach, such as the use of fillers, can often be sufficient to appropriately treat certain patients.
"When aesthetically treating the eye region, many surgeons today will quickly opt for a surgical approach. In my experience, however, many patients benefit more from filler treatments than they do from surgery, particularly in light of the potential complications that can and do occur, some of which can be severe in the unlucky patient," Dr. Goldberg says. He currently treats most of his patients noninvasively with fillers instead of blepharoplasty. "I often choose the hyaluronic acid (HA)-based fillers for this indication, such as Restylane (Medicis) or Juvéderm (Allergan), as the HAs are by far the safest fillers that we have available. The drawbacks with Restylane and perhaps more so with Juvéderm is the transient edema occasionally seen following the periorbital treatment. Nevertheless, the side effects are by far more acceptable than the complications that can result from a surgical approach," Dr. Goldberg says.
