The Butterfly Lower Blepharoplasty: A Mid-face Lift for Results in a Class of Their Own

 

The Butterfly Lower Blepharoplasty: A Mid-face Lift for Results in a Class of Their Own

In this post, I'll be introducing the signature procedure of Returning Plastic Surgery: the Butterfly Lower Blepharoplasty. Hello, this is Dr. Kim Yong-woo, Director of Returning Plastic Surgery.

Lower blepharoplasty is the most common and representative eye surgery for middle-aged patients. However, surgical techniques vary widely between clinics, and results can be unsatisfactory or lead to complications. To ensure a safe and highly satisfactory outcome, it's essential to accurately understand the reasons for aging in the lower eyelid area to formulate a better diagnosis and surgical strategy.

"Butterfly Lower Blepharoplasty" is officially in the process of being trademarked by our clinic!

The Aging of the Lower Eyelid (An Anatomical Understanding)

If we look at the anatomy of the lower eyelid, the skin, muscle (orbicularis oculi), and orbital septum form the outer "shell." Inside this shell lies the orbital fat, which acts as a cushion for the eyeball. As we age, the elasticity of this shell—the skin, muscle, and septum—decreases. This allows the orbital fat to push through the weakened barrier and bulge forward. This is also why eye bags appear more prominent in the evening or when you're tired, as facial swelling subsides compared to the morning.

Along the lower rim of the eye socket lies the tear trough ligament, which forms a strong adhesion between the bone and the skin. This area does not lose its tension with age. Therefore, as the orbital fat bulges out above it, the area of the ligament appears relatively sunken, creating a deep tear trough.

Therefore, a lower blepharoplasty works by reversing this process. First, the tear trough ligament is thoroughly released. Then, the protruding fat is repositioned into the area below the released ligament. Finally, to restore the tension of the outer shell, the orbicularis oculi muscle is lifted (suspended), and any excess skin is removed. While this surgery is very intuitive and logical, neglecting even one or two of these steps can lead to suboptimal results.

Key Points of Lower Blepharoplasty:

• Release of the Tear Trough Ligament
• Orbital Fat Repositioning
• Orbicularis Oculi Muscle Suspension & Excess Skin Removal

The Butterfly Lower Blepharoplasty

Improving the Tear Trough + Malar Grooves (Indian Bands) / Nasolabial Folds!

While a standard lower blepharoplasty is a surgery that improves under-eye fat bags and the tear trough, the Butterfly Lower Blepharoplasty goes further by incorporating a mid-face lift to improve malar grooves (Indian bands) and nasolabial folds as well. It is a method that lifts the "Butterfly Zone" at the same time as the lower blepharoplasty.

The aging of the lower eyelid is accompanied by the sagging of mid-face tissues. Therefore, for a more fundamental anti-aging solution, the sagging mid-face tissues must be lifted upwards through a mid-face lift.

The crucial question here is, "How do you lift and fixate the mid-face?" A mid-face lift has a higher chance of relapse than fat repositioning. Fat repositioning is stable because the fat is secured in a downward direction (with gravity). In contrast, a mid-face lift requires fixation in the opposite direction, against gravity, so there is a strong tendency for the tissues to droop again.

It's not just a problem of gravity. Excessive facial expressions—smiling, frowning, yawning—or straining the face also create a downward-pulling force. The most common methods for a mid-face lift involve either securing the tissue to the periosteum (bone lining) with surgical sutures or using a device called an Endotine.

Fixating with sutures often leads to a rapid relapse due to the "cheese-wiring" effect when strong facial expressions are made. In the case of Endotine, the hard implant can feel like a foreign body and may cause initial unnaturalness, such as dimpling. There is also a risk of nerve damage due to the wide range of dissection required.

The Butterfly Lower Blepharoplasty was designed to overcome these shortcomings. It is a surgery that distributes the fixation points of the mid-face lift instead of concentrating the force in one spot. This results in less initial swelling and a longer-lasting effect.

The most common feedback I receive from patients post-surgery is their surprise at how full and restored the volume of their front cheeks is. By incorporating a Butterfly Zone lift during a lower blepharoplasty, we can create highly satisfying results.

 [Actual surgery at Dr. Returning's clinic] The change in the position of the markings after lifting the same area during surgery.

Post-Operative Instructions (For 2 Months!!)

Dr. Returning is extremely emphatic about post-operative care.

For the first two months, the lift is maintained by the physical forces of the fixation. Only after two months does natural tissue adhesion occur. If any external downward force is applied during this critical period, the tissues can heal in a drooped position. Therefore, the cooperation of our patients during these two months is absolutely crucial.

For Two Months, You MUST AVOID:

• Excessive Facial Expressions
• No squeezing your eyes shut (scrunching).
• No opening your mouth wide.
• No laughing widely.
• Lifting Heavy Objects
• Strenuous Exercise
• Deep Tissue Facial Massages

Butterfly Lower Blepharoplasty Patient Reviews

I have prepared a variety of patient photos, from early to late post-operative stages. If you have read and understood this post in detail, you will be able to appreciate the difference in the fine details compared to a standard lower blepharoplasty.

Not all lower blepharoplasties are the same.

I hope everyone can achieve a successful surgery through the Returning Plastic Surgery's Butterfly Lower Blepharoplasty.

Thank you! This has been Dr. Kim Yong-woo, Board-Certified Plastic Surgeon.