Lower eyelid surgery (lower blepharoplasty)

The lower eyelid, in particular, is highly sensitive to changes in the balance between volume, tension and bony support.
A prominent eyeball, a negative vector or insufficient bony support, for example, can have a significant impact on stability and the healing process.
This is why Dr Richter never considers the lower eyelid in isolation.
In his view, it is always part of a complex periorbital system.

For Dr Richter, successful lower eyelid surgery always begins with a detailed assessment.
As part of this, he examines, amongst other things:

• Eyelid tension and stability
• the position of the eye within the bony eye socket
• Skin quality and muscle structure
• Fat distribution and loss of volume
• the junction between the eyelid and the cheek
• Possible Malar bags
• previous filler treatments
• as well as patients’ individual expectations.

The key question here is:
Is it primarily a problem of volume, a structural problem – or a combination of both?
For this is precisely where one of the greatest challenges of modern lower eyelid surgery lies.
Not every lower eyelid requires the same treatment.
And not every visible problem is caused by excess tissue.
Very often, the actual cause lies instead in volume loss, mid-face sagging or a lack of structural stability.

In most cases, Dr Richter prefers the transconjunctival approach.
This involves performing the operation from the inside, via the conjunctival side of the lower eyelid.
For him, the key advantage lies not merely in the absence of a visible scar.
Far more important is the protection of sensitive structures.
The internal approach allows:

• Gentle on the skin and muscles
• spare one’s feelings
• and the functional integrity of the lower eyelid is better preserved.

Dr Richter works directly where the actual problem arises – on the fat and the deeper structures of the lower eyelid.
However, it is precisely this technique that requires a great deal of experience.
The incisions are small, and the anatomy is extremely dense and delicate.
Here, Dr Richter benefits particularly from his decades of experience in orbital surgery and the treatment of endocrine orbitopathy.

A key change in modern lower eyelid surgery concerns the management of fat.
In the past, fat was often removed as a matter of routine.
Today, Dr Richter places greater emphasis on preserving and strategically redistributing volume.
This is because excessive fat removal is one of the most common causes of lower eyelids that look unnatural.
The consequences can include:

• sunken eyes
• abrupt transitions
• reinforced tear ducts
• and a tired or post-operative expression.

That is why Dr Richter aims to preserve volume as harmoniously as possible or to redistribute it in a targeted manner.
The aim is to achieve a smooth, natural transition between the lower eyelid and the cheek.
He very often combines lower eyelid surgery with autologous fat grafting.
This is because the actual problem is often not too much volume, but too little.

Another crucial aspect of modern lower eyelid surgery is the structural stability of the lower eyelid.
Many patients already exhibit a degree of eyelid laxity prior to surgery.
This instability is often underestimated.
This is precisely why Dr Richter performs a canthopexy – that is, a procedure to stabilise the lateral canthus – as part of a large proportion of his lower eyelid corrections.
This serves to:

• to maintain eyelid tone in the long term
• to reduce the risk of post-operative malalignment
• and to preserve the natural shape of the lower eyelid.

For Dr Richter, however, cantopexy is not a standardised procedure.
It is always tailored to the individual patient’s anatomy, eyelid shape and stability.
The real challenge lies in

• to ensure sufficient stability
• without altering the natural shape of the eye.

In his view, a successful canthopexy should not be visible – but should simply serve a functional purpose.

Dr Richter never treats the lower eyelid in isolation.
For him, the following are always included:

• Upper eyelid
• Midface
• Volume structure
• eyelid-cheek junction
• and the overall periorbital balance as part of the treatment plan.

It is often the case that a natural look is not achieved through a single procedure, but through the harmonious combination of small, precisely coordinated measures.
That is why he often combines lower eyelid surgery with:

• Midface stabilisation
• Autologous fat transfer
• renewable processes
• or additional eyelid and eyebrow surgery.

It is not radical change that creates harmony.
Harmony arises from balance.

In Dr Richter’s view, a successful outcome is evident from:

• a smooth lower eyelid contour
• Stable lip position
• smooth transition to the cheek
• complete and secure closure of the eyelids
• and a natural balance between the lower eyelid, the eye and the midface.

However, like any surgical procedure, lower eyelid surgery also carries risks.
These include:

• Swelling
• Bruises
• Irregularities in the outline
• as well as, in rare cases, functional abnormalities such as ectropion or retraction.

This is precisely why careful planning, anatomical expertise and, where necessary, additional stabilisation of the lower eyelid are crucial.

In Dr Richter’s view, lower eyelid surgery is one of the most complex procedures in aesthetic surgery.
It requires:

• fundierte Kenntnisse der Anatomie
• surgical precision
• practical experience
• and a keen sense of balance.

Precisely because the changes often appear subtle, the complexity of this procedure is frequently underestimated.
Yet it is often a matter of millimetres that makes all the difference:

• naturalness
• printout
• Function
• and long-term stability.

Choosing a specialist surgeon for the initial procedure significantly reduces the risk of subsequent corrective surgery – even though risks can never be completely ruled out.

Dr Richter does not view modern lower eyelid surgery as a race to achieve the most dramatic change.
His aim is:

• Gentle care rather than unnecessary trauma
• Volume preservation rather than aggressive resection
• Stability where it is needed
• and a lower eyelid that looks calm, natural and structurally stable.

He does not wish to alter the lower eyelid.
He wishes to restore it to a natural, harmonious balance.
It is precisely in this that he sees the true art of modern lower eyelid surgery.