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Blepharoplasty Boston- How to avoid “Hound Dog Eyes”

Blepharoplasty or eyelid tuck, a plastic surgery operation that is done to rejuvenate the eyelid and remove eyelid bags and dark circles under the eyes is the third most common cosmetic plastic surgery operation performed in the United States. This operation is usually the first facial rejuvenation or skin rejuvenation surgery that most people consider, often in their 30’s or 40’s.
The results of blepharoplasty can be stunning and create a truly refreshed younger look to the entire face.

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Patients who seek blepharoplasty often complain of a tired look. The most common complaint I hear is that “people say I look tired when I am not”. The goal is to remove the tired look, the eyelid bags, the dark circles and tighten skin. Blepharoplasty alone does not remove wrinkles. Wrinkle removal requires resurfacing of the skin by one of many different new techniques.
The most common blepharoplasty technique done by most surgeons today involves making an incision on the outside of the lower eyelid with a scalpel in order to remove excess fat and skin.One very common problem following the scalpel blepharoplasty operation however is that the operation can change the shape of the eyelid. In some cases, after surgery the outer portion of the lower eyelid turns down revealing too much of the white portion of the eye. Technically this is called scleral show, and if it is extreme it is called ectropion and can damage the eye. Plastic surgeons refer to this complication as “hound dog eyes” or “sad eyed look”
Fortunately, the sad eyed look or hound dog eyes can be avoided by a newer blepharoplasty technique called the transconjunctival blepharoplasty.
The problem with the standard “old style” scalpel blepharoplasty technique is that when the surgeon cuts through the muscle which supports the lower eyelid the support for the eyelid is often lost. In addition, the scarring produced by the surgery tends to pull the eyelid down. If the patient has a lax lower eyelid to begin with, the situation is made much worse.
The transconjunctival blepharoplasty is done very differently from the scalpel blepharoplasty and avoids injury to the supporting eyelid muscle. The conjunctiva is the pink part of the eyelid on the inside. In transconjunctival blepharoplasty the small incision for a blepharoplasty is made with a laser through the conjunctiva on the inside of the lower eyelid and avoids damage to the supporting muscle. The fat is removed or repositioned from the inside and the lid tightened and an arcus marginalis release performed to correct dark circles. Laser blepharoplasty, that is using the laser to make the transconcunctival incision and tighten the skin and muscle, is becoming much more common today as blepharoplasty techniques continue to improve.
The benefit of the transconjunctival laser blepharoplasty is:


1. There is no visible scar on the outside of the lower eyelid
2. The eyelid shape is not changed
3. Healing time and recovery is usually quicker
4. Bruising is often less
5. The sad eyed look or hound dog eyes is avoided

If you have a lower eyelid that is lax or loose or if your outer lower eyelid turns down, there is a serious risk that you may have the sad eyed look or hound dog eyes or worse if you have an old style scalpel blepharoplasty with the incision on the outer eyelid. Very few plastic surgeons use the transconjunctival laser blepharoplasty technique. If you would like to read more about this technique and total eyelid rejuvenation visit saveyourface.com. Contact me for further questions about this article or read Save Your Face.

Dr Seckel

Boston, Massachusetts