Lower eyelid surgery has a special place among plastic surgeries in terms of the difficulty of the healing process and the susceptibility to complications. To an extent that can even discourage many surgeons from performing this surgery...

After this introduction, you should still know that lower eyelid surgery is the gold standard treatment for under-eye aesthetic problems.

The key factor affecting the healing process in lower eyelid surgery is the scope of the surgery. We can list the lower eyelid surgeries from simple to extensive as follows:

• Transconjunctival lower lid blepharoplasty (entering from the inside of the eyelid to remove bags)

• Transconjunctival lower lid blepharoplasty + Fat injection

• Transconjunctival lower lid blepharoplasty + Fat transposition (Spreading the bags over the bone to cover the tear trough)

• Lateral access lower lid blepharoplasty (Limited incision to the lower eyelid at the eyelash base)

• Subciliary lower lid blepharoplasty (Eyelash base incision at the lower lid)

• Subciliary lower lid blepharoplasty + Midface lift

• Subciliary lower lid blepharoplasty + Midface lift + Implant

The details of the surgeries listed above are not important to you. You may not understand some or even most of them. What I want to tell you here is that lower eyelid surgery is not a single operation but is planned in different accesses and scopes depending on the needs of the patient. This scope affects recovery and return to social life.

Lower lid blepharoplasty alone is a minimally painful - almost painless - operation. It is extremely normal to have a burning/stinging sensation in the eye, particularly in the first 48 hours after open (subciliary) lower eyelid surgeries. This feeling improves as the lid loosens. Routine pain control with mild painkillers is indicated. In this process, you should not use any additional, blood-thinning painkillers not recommended by your doctor. Anyway, you will not need them. Swelling and bruising are usually quite minimal in surgeries performed through the inside of the eyelid (transconjunctival). However, capillary bleeding on one or both sides may sometimes cause significant bruising. In open (subciliary) surgeries where we make an incision on the eyelid skin, bruising and swelling will be slightly more. There will be no restriction on eating and drinking for the first 24 hours after the surgery. After the surgery, you will be able to get up and walk, go to the restroom, brush your teeth and clean your face. There may be a slightly bloody leak between the sutures or with tears, and it will be enough to wipe this leak with a clean gauze.

We do not do any dressing after lower eyelid surgeries. We'll apply eye ointment between the sutures. We usually prescribe antibiotic and steroid eye drops. Although hospitalization is not required after these procedures, I hospitalize my patients on the night of the surgery for general comfort, facial cleaning and help from the nurses while applying the drops. After the surgery, a slight nausea due to anesthesia as well as rare cases of vomiting may be observed. We will prescribe you additional antiemetic medications as needed. You cannot drive your car on your way home after the surgery. Make sure to arrange a co-driver or transfer vehicle before surgery.

In operations where we make an incision on the eyelid skin, there will be sutures that remain for 7-10 days and need to be removed later. These sutures catch attention when viewed from the outside. Beyond these, we suspend the outer edge of the eye to the bone with a solid suture in lower eyelid surgery in order to prevent the complication of the eyelid turning down/outwards (ectropion). This suspension procedure is called lateral canthopexy. It's a protective measure. Lateral canthopexy stretches the eyes and gives then a slanting look. This slanting may last up to 3-6 weeks depending on the technique and suturing material used. In some cases, muscle slings are used to support the external angle of the eye. These techniques may also create notches and temporary irregularities on the lateral edge of the eye. They resolve spontaneously within 2-3 weeks.

What you need to understand here is that we knowingly and voluntarily allow the early appearance to deteriorate temporarily in order to prevent complications after open lower eyelid surgery. Know that when you first come out of surgery, what you will see will be far from having an aesthetic appearance. This picture will gradually change over the following weeks.

In open (subciliary) lower eyelid surgery, a 3-week rest period would be a reasonable planning. Although earlier recovery is possible, it is useful to make your plans as if you will not return to social life/work before 3 weeks.

Following lower eyelid surgery, the very thin layer on the inside of the eye (conjunctiva) becomes edematous and a bubble may form there. It may be necessary to use eye drops and temporarily suspend the eyelid for the treatment of this bubble. The suspension can be done by taping the lower lid to the forehead skin with suspending sutures or by joining the lower lid and the side edges of the upper lid with a suture for 2-3 days.

Sometimes, despite the precautions taken, the lower eyelid might be displaced downwards. In such a case, we may need to take additional measures such as a special eyelid massage, scar removal injections or taping. In the first 3 months after surgery, the body constantly produces healing tissue. This process is the same in any part of the body, but the stiffness, pulling and tension created by the healing tissue in delicate tissues such as the eyelid may cause symptoms disturbing the patient. For instance, after the operation, the eye muscles may become lazy and mild strabismus may be observed for up to 6 weeks. Due to the close relationship between the muscles that move the eye and the fat bags, these muscles may be temporarily compressed by the healing tissue. In some patients, the eye numbers might change.

After lower eyelid surgery, tissue swelling will peak around the 48th hour. From the third day on, the swelling will gradually decrease and will completely disappear in month three. It is expected that the scars will be red and prominent in the early period. Scars can be easily camouflaged with a concealer in 3 weeks. In month three, even without make-up, they become too faint to attract attention.

Unfortunately, some patients recover later than others. I had patients with edema, stiffness and redness in the wound that lasted up to 3 months without any underlying cause, and this period of waiting was highly challenging for these patients. Late recovery occurs in about 2-3% of patients.

A significant asymmetry always emerges after the procedure, particularly in patients who have both lower and upper eyelids operated. Such asymmetry will usually regress to a reasonable size in normal individuals within 2-3 months. However, you should know that there may always be 1-2 mm asymmetries between the eyes and this is considered normal in facial aesthetics.

In the week after the surgery, I would like you to be close to me, in the same city as me, in order to be cautious and vigilant in terms of the development of complications and to intervene rapidly in such complications, if any. I will see you on the first and third days after surgery as a precaution. We're just going to have a short chat. On postop day 7-10, we'll remove your suture. It may be possible to return to social life with a light, water soluble make-up 10-14 days after the operation.

However, you should note that the desired level of improvement can only be achieved in 2-3 months, particularly in individuals who work in the media / stage and performing arts. You can continue doing exercises at full performance in week 6 after the surgery. I will see you for routine follow-up in months 1 and 3 as well as year 1.

Recovery and return to social life in cases where we perform a midface lift via lower eyelid surgery or place facial implants (prosthesis) are much different from what was described above. Swelling, bruising and pain are much more common in midface surgeries. Typically, patients stay in the hospital for 2 nights. Return to social life may take up to 6-12 weeks, and patients may have to wait 6-12 months for the final result.

Lower eyelid surgery, like all other facial aesthetic surgeries, is an operation that should be planned individually. The postoperative period may also vary according to these individual differences. Please feel free to contact us to learn how this process will unfold for you and to get detailed information.

Take good care...

... of yourself and your beauty.

OB