I have been consulting with several plastic surgeons concerning a facelift.  All are pretty much in agreement with the exception as to how to handle the area below my eyes.  Some want to inject fat, others want to perform a lower eyelid lift, and one wants to do nothing to this area.  There is some disagreement as to whether the skin will wrinkle underneath the eye as a result of the facelift if a lower eyelid lift is not done.  I would appreciate other doctors experience and advice.

Lower eyelidplasty is commonly performed at the same time as a facelift surgery because patients who have the signs of aging such as jowls or ptosis of the cheeks usually also have baggy lower eyelids as well.

Better symmetry and facial harmony is achieved when you treat both problems in one safe and efficient operative setting.

At a consultation with a board certified plastic surgeon you will be evaluated and your treatment options will be discussed. 

It is very common to do both procedures at the same time.  As for technique, it really depends on what your problem is.  If it's protruding fat, reposition it; if you're deficient of volume, fat injections; if you have loose skin, pinch excision or lasering.  You will need to discuss your options with your doctor and hopefully you will arrive at a clear solution.  And if you're not sure, wait until you heal from your facelift and then proceed from there.

Lower lid blepharoplasty is not part of the face lift.  However a lower lid blepharoplasty can easily be done at the same time. Either a standard lower lid blepharoplasty or a transconjunctival blepharoplasty can be done.

Every situation is different and that is why facelift surgery is customized.  Sometimes this means that there will be different approaches.  Eyelid surgery is not a routine part of a facelift but can be done at the same time.  Whether it will be necessary depends in part on how much vertical elevation the cheek gets, since that would push up into the eyelid area.

As we age, several things happen.  We lose the fat in various places and the tissues sag. These changes occur at different speeds, so you may need only the fat injection, only a blepharoplasty, or more usually, both.  Surgeons used to remove the fat from around the eyes.  Now, we move the fat to fill the areas of loss.  As for the disagreement about whether a facelift will wrinkle the skin under the eyes, this depends on the technique of the facelift. The newer lifts that provide more upward lift (the direction from which the tissues came) also correct the mid-face better and usually also wrinkle the skin under the eyes.  My advice is to pick the surgeon with whom you could communicate the easiest and who showed you results that were pleasing to you.  Then, discuss any concerns you still have.

Whether an eyelid surgery should be performed at the same time as a facelift will depend on a variety of factors.  Some of these could include the amount of excess skin and fat volume in the eyelids, the age of the patient, and the comfort of the patient and plastic surgeon with proceeding with multiple procedures.  Only by having a consultation with a board certified plastic surgeon and having an examination of the areas in question can this be determined on an individual basis!

In my experience, the lower eyelid skin does not wrinkle more, as a result of a facelift.  For example, if a patient is perfectly happy with the appearance of their lower lids, and just needs a facelift, there is no bad effect on the lower lids seen postoperatively.  I usually explain to my patients that the facelift is really working from the level of the cheekbones on down.

As for how to best treat your lower lids, there are a number of options.  But that's a separate issue...

All the best,

The lower eyelids are consistently bedeviling to surgeons.  No great unifying solution exists to lower eyelids - and this is precisely why you are seeing so many different suggestions. 

Each of these has a role in lower eyelid rejuvenation.  Fat grafting can smooth the contour between the cheek junction (thick skin) and eyelids skin (one of the thinnest skin areas in the body).  Lower lid lift can be a very powerful way to improve excess skin as well.

Finally, doing nothing always leaves you the option of doing the lower eyelid lift later on (although another expense and recovery).

Best of Health,

Navin Singh