Excess and bulging skin in the lower eyelids is common with age. While over-full upper eyelids cause functional problems, reduction of the lower lids is strictly a cosmetic procedure (but can cause functional problems if not carefully done!)
An incision is made just beneath the lashes and carried laterally beyond the corner of the eye for 1 – 1.5 cm. The skin of the eyelid is lifted. At this stage fatty bulges can be removed or fat can be added if you have a hollow (“tear trough depression”.) Excess skin is trimmed off and the lid margin is tightened (lateral canthopexy). I do both of these steps conservatively. If the canthopexy is tight the eyelid skin reduction can be greater but this alters the shape of the eyelid opening and this, in my view, is undesirable. It’s important to note that removal of excess lower skin does not get rid of fine lines.
I can do this operation under local anaesthetic at my clinic though it’s a little less pleasant than upper eyelid surgery: you have to keep your eyes open as otherwise your upper lashes get in the way. My preference is to do this under general anaesthetic.
Since the nipple always has to be re-sited higher up, all breast reductions methods result in a scar right around the areola and a scar vertically down from there to the inframammary fold (groove beneath the breast). Usually there is also a curved transverse scar running the length of the inframammary fold. There are “vertical scar” techniques which seek to avoid this transverse scar and this is sometimes appropriate.
Loss of nipple sensation is not uncommon. Numbness of some skin beneath the nipple is usual.
You may not be able to breastfeed should you have a pregnancy after breast reduction.
The nipple has to move up and retain its blood supply. it is possible for this blood supply to be inadequate and to lose part or all of a nipple but this is an exceedingly rare complication.
Symmetry should be very good but may not be perfect.
out of town?
Ideally a consultation should be face to face but is certainly possible to arrange a telephone consultation. If you can email the photos first so much the better. If it is clear what procedure is required then the in-person consultation can be the day before or the morning of the surgery.