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Smoothing Contours for a Youthful Appearance
By Dr. Kenneth Dickie
Jul 22, 2008 - 10:10:35 PM

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Traditional lower eyelid surgery is performed by opening up the pocket of fat under the eye and removing some. The problem that some surgeons, including plastic surgeons have discovered was there was no real guide on how much to remove. They weren’t convinced this was the best way to remedy hollows under the eye and make people look younger.

It is often said that, if there is one thing that makes us look younger, it is the absence of facial shadow. When we are children there is very little difference in high and low contours on our face. There are no hollows under the eyes; our cheeks are still high, our skin still firm and elastic. As aging occurs our cheeks fall, our skin sags, we get wrinkles, folds and crow’s feet. Some of this can be fixed with a facelift. But this only applies to areas like the jaw line and neck. The facelift does not fix the triangle of the face surgeons refer to as the ‘mid-face’ – from the corner of the eye to the corner of the mouth and alongside the nose to the inside of the eye. This area suffers from the same problem as the rest of the face – high and low contours occur with age. An example of this is puffiness directly under eyes and then a hollow.

As the cheek falls a ‘hill and valley’ effect is created between the eye and cheek. Taking away the pocket of fat under the eye, as done in traditional blepharoplasty, will not help get rid of the valley. It will get rid of the puffiness under the eye but it won’t anatomically fix the problem – the creation of dark circles under the eyes. These will in fact get worse when the fat is removed. Also, skin under the eye will become looser, so wrinkles in the lower eyelids get worse, which is why many blepharoplasties are performed in conjunction with laser treatment.

To create a smooth one-level contour in the face, fat under the eye can be released and slid down into the hollow. This is called an arcus marginalis release. It results in puffiness under the eye going down and the ‘valley’ being filled. In the absence of a lot of fat under the eye, a cheek lift can be performed.

Once the hollow has been removed under the eye, and a smooth contour created, the cheek will fall again with age. As the cheek and fat under the eye are now together, they will move down together – so there is not much of a chance it will create a deformity as the patient ages. Average surgery time is approximately 2 ½ hours. Recovery time can be between 3-8 weeks.

There is longer healing time than for regular blepharoplasty. It is a much more complicated operation and recovery. And it takes a significant amount of patient education before it should be done, and side effects include bruising. Sunglasses and camouflage makeup may need to be worn. Contact lenses shouldn’t be worn for a few weeks. In some people the cornea will temporarily be swollen and visual correction may need to be changed for a short time. Some people may find they need to change the prescription of their glasses for a month or two.


Have a plastic surgery question for Dr. Dickie?   If so, e-mail us at info@BahamasInstituteOfPlasticSurgery.com.   Dr. Kenneth Dickie is certified by the Royal College of Physicians and Surgeons of Canada in Plastic Surgery.   He specializes in Cosmetic Plastic Surgery as well as Plastic, Reconstructive, and Hand Surgery.   Dr. Dickie has been in clinical practice since 1984, and is currently a member of the Canadian and American Societies of Plastic Surgery, and the Canadian and American Societies of Aesthetic Plastic Surgery.   For a consultation, please contact the Bahamas Institute of Plastic Surgery at (242) 351-1234 or toll-free 1(242)300-1235.



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