In regards to the lower blepharoplasty procedure, the first question I would ask is if the procedure was performed with a subciliary (incision right under the lashes) or a transconjunctival (incision placed inside of the lid ) approach. If it was performed already with a subciliary or external approach, then your Plastic Surgeon most likely already removed some skin, and further skin removal may be difficult to the scarring and risk of ectropion (scar tissue pulling down the lower lid).

If the approach was done transconjunctival, then a simple office procedure of performing a “pinch blepharoplasty” is an option to remove excess skin in the lower lid area (granted that the fat in the lower lid has been properly removed). The biggest risk in lower lid surgery is ectropion, and so most of us surgeons would rather be safe and conservative when removing skin in the lower lid to avoid this complication.

If the skin in the lower lid is not too loose, then I agree with performing a laser or chemical peel under the eyes to tighten the skin. Commonly, I will perform a transconjunctival removal of fat in the lower lids combined with a laser or peel to tighten the skin.  Remember that in rejuvenating any part of the body you have to treat the skin AND the fat (and sometimes the foundational layer underneath, e.g. muscle).

Edward Park, M.D.
Board Certified by the American Board of Plastic Surgery