- Upper eyelids
- Lower eyelids
- Lower eyelids II
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Since no skin incision
is used for this operation, the incision to access and remove the fat is made on
the pink part of the lower eyelid, around the corner, inside of the
lashes. This person is pulling down her lower eyelid, showing us where the
incision will be made, along the blue line above right, most of the way from one
corner of the eye to the other.
That soft pink tissue on the inside of the lower eyelid is called conjunctiva (pronounced KAHN-junk-TIE-vuh). Since we make the incision in the conjunctiva, and since we go through the conjunctiva to get to the excess fat, this operation is called a transconjunctival lower eyelid blepharoplasty. Let's get started. |
| Click on any image in this tutorial to see a greatly-enlarged version |
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I like to mark the skin
where the fat resides. It's typically always in the same place, but
marking the fat helps to keep me oriented. When the patient is snoozing, lying back on
the operating table, gravity pulls the fat partially back into the eye socket, and
subsequently the fat bulges are a little harder to see with the patient supine
like this.
This patient is also going to have an upper eyelid blepharoplasty during the same trip to the operating room, so I've marked the skin to be excised on her upper lids as well. |
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The first thing to do
is to protect the patient's eye. I place a metal shield over the cornea of
the eye so that it can't be bumped with an instrument. The shield, shown
in close-up below, looks odd in place on the eye, like something out of a horror
movie.
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Above left we see the metal eye shields. The eye shield on the left is
turned so that we can see the surface that sits against the eye. That
shiny surface is highly polished so that it can sit directly on the eyeball and
not scratch or irritate it. If you look very closely into the shiny
surface, you can see me, upside-down, taking the photograph. The image
above right is me again, extracted from the image above left.
The patient is sedated, but even if she were wide awake, she wouldn't be able to feel the shield in her eye. I put anesthetic drops in the eye to numb the cornea, and then I inject the upper and lower eyelids with lidocaine to make sure the eyelids are completely numb for the operation. The smooth mirrored inner surface of the eye shield is reminiscent of the outer surface of a Slaver stasis box. Write me if you know what that is. |
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Clear all red checks in the Eyelid Surgery Tutorial |
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