3 Questions to Help You Choose a Good Gangnam Lower Blepharoplasty Clinic (Side Effects)

Hello.

I am Ban Ho-gyeong, a board-certified plastic surgeon whose specialty is eye surgery and whose strongest skill is revision eye surgery.

When children bring their parents in for a lower blepharoplasty consultation, I often see them unsure about what they should ask. Some people even come with a prepared list of questions, but they rarely ask the key questions that actually affect the surgical outcome. Or rather, they cannot ask them.

People in their 20s and 30s actively share surgical information through the internet and social media, but that is not the case for people in their 40s and older. The more you know, the more questions you naturally have.

That is why I first answer, one by one, the things the patient and their children are wondering about, and then objectively explain the options that fit the patient’s current eye condition. I also explain what surgery or procedure the patient needs, why it is appropriate, and the advantages and disadvantages of each surgery and procedure.

Anti-aging surgery varies greatly depending on the individual and the stage of aging, so the solution for the problem you are currently concerned about may not be lower blepharoplasty at all, but another surgery or another procedure. That is why especially people in their 40s and older tend to be very satisfied with the consultation.

That was a long introduction, but in surgical consultations, questions about recovery time and scar size are of course important. However, there are separate key questions that determine the quality of the surgery and whether revision surgery will be needed.

In particular, lower blepharoplasty is difficult to perform multiple times and can be done at most twice in a lifetime, so the first surgery must be done properly. So let’s get right to what you should focus on asking during a lower blepharoplasty consultation.

Lower blepharoplasty consultation

Must-ask question list

1. On what basis do you decide the amount of skin to excise?

I covered this in a column about a month ago. If I had to choose just one factor that determines the outcome of lower blepharoplasty, it would be the measurement of skin excision, so I will bring it up again.

The most important thing in lower blepharoplasty is how appropriately the sagging skin is removed. If this amount is not calculated accurately, the likelihood of problems after surgery increases.

What happens if too much skin is removed?

The skin under the eyes is connected to the muscle, and the lower eyelid must naturally fit snugly against the eye. But if too much skin is excised, the eyelid can be pulled downward (ectropion). In that case, the eye may not close properly, or the result may look unnatural, with the eye opening too round.

In addition, dry eye symptoms may worsen, or tearing may continue.

What if too little is removed?

Even after surgery, it is hard to achieve the youthful effect you expected because sagging remains. The problem is that there are quite a few clinics that decide it is better to be conservative and remove less rather than remove too much and leave side effects behind. In other words, the surgery ends without clearly improving the sagging, and even though the surgery was done, the result may feel vague, making you wonder, “Did anything really happen?”

Left: Before surgery

Right: After lower blepharoplasty and brow lift

Left: Before surgery

Right: After lower blepharoplasty and brow lift

What is the method for deciding the exact excision amount?

The amount to be excised should not be judged by rough intuition alone; it must be measured accurately according to each patient’s condition. To do this, the measurement is taken while the patient opens their eyes upward and opens their mouth wide. The point is to check how much skin remains when the skin is stretched tight.

So, during the consultation, ask this question first.

"On what basis do you decide the amount of skin to excise?"

If they cannot explain a clear measurement standard, or give an ambiguous answer, skip them.

The ability to measure the skin excision amount accurately so that sagging does not remain and the eye does not turn outward. That is the standard for skill in lower blepharoplasty.

2. What kind of anesthesia is used?

(Is there any pain during the surgery?)

Lower blepharoplasty is basically performed under sedation anesthesia. The problem is that the area under the eyes is not easy to anesthetize. In fact, when anesthesia is insufficient, patients may feel pain during surgery, move more, and create variables that ultimately make the operation difficult.

As more issues have to be managed, the difficulty increases and the surgery takes longer.

As a result, precise anesthesia is fundamental in lower blepharoplasty. Proper anesthesia allows the patient to undergo surgery comfortably and allows the doctor to perform a more precise operation without unnecessary variables. (For the record, I studied anesthesia separately. So I am good at it.) Now let’s go one step further.

What is the most important thing in lower blepharoplasty? Yes, accurate measurement of the amount of skin to be excised. And to measure that accurately? Yes, the amount must be measured while the patient has their mouth wide open and their eyes looking upward.

In other words, the patient needs to be conscious during the process of measuring the skin excision amount. If the anesthesia is too deep, the patient will not wake easily; on the other hand, if the anesthesia is too light, they may feel discomfort in the middle of the procedure.

Left: Before surgery

Right: After lower blepharoplasty and upper blepharoplasty

So, in my case, I perform the surgery under deep sedation until the skin excision amount is checked, and from the step where I confirm the skin sagging, I wake the patient from anesthesia and continue with the remaining steps. That way, the patient does not feel discomfort throughout the entire surgical process.

(Doing it this way requires time for the patient to wake from anesthesia, so it can be inefficient from the perspective of a clinic that wants to increase operating room turnover. Because the most important thing is satisfaction throughout the entire preoperative and intraoperative process, I stick to this method. As satisfaction rises, referrals naturally increase.)

During the consultation, you can ask like this.

"I heard the area under the eyes is not easy to anesthetize. Is there any possibility that I could feel pain during the surgery?"

If you get vague answers like "We give additional anesthesia if there is pain during surgery" or "There may be some localized pain, but it is not significant," skip them.

Anesthesia is not only meant to reduce the patient’s discomfort and pain during surgery; it is also a factor that improves surgical precision. If there is pain or discomfort during surgery, the quality will naturally suffer.

3. What side effects are there?

(Skip places that answer with evasive wording.)

Lower blepharoplasty can only be performed a maximum of twice in a lifetime. Multiple surgeries are not possible. So, as I mentioned in the introduction, the first surgery must be done properly. One of the side effects people commonly worry about is the ectropion mentioned earlier, where the eyelid is pulled downward. Ectropion can occur for two major reasons.

The first is when too much skin is excised. In this case, an experienced doctor is less likely to remove too much skin, even if they end up removing a bit less than ideal, so this happens relatively rarely.

The second is due to scar contracture, and this is the more common cause. Scar contracture refers to the tightening that occurs when internal tissue gathers and pulls during the healing process after surgery. It is part of the normal process of scar healing.

People often think only of the scar on the skin surface at the incision site, but in reality, scars form in all damaged tissue within the surgical area. As healing progresses, these scars gradually become firmer and tighter, and the eyelid may become unable to rise back to its original position.

It is especially most severe one month after surgery, and then it usually gradually improves over more than six months. But if severe ectropion occurs? Yes. Because the eyelid cannot adequately cover the eye, it is not only unsightly but also quite uncomfortable because of the stinging sensation.

Left: Before surgery

Right: After lower blepharoplasty and brow lift

Then, how can scar contracture-related ectropion be prevented?

By accurately measuring the amount of skin excision, as mentioned in point 1.

Another important point is the side effect caused by bleeding.

Lower blepharoplasty proceeds by making an incision from above and then moving downward. If bleeding occurs, the blood does not drain outward; it pools inside. The problem is that the space inside the orbit, the bony structure surrounding the eye, is limited. So if the bleeding is severe, it can press on the eyeball and, in the worst case, lead to blindness.

So, do we do plastic surgery with blindness as the price???

Of course not. There are ways to prevent this.

If you have high blood pressure, check whether it is well controlled and whether you are taking any medications or supplements that thin the blood (aspirin, omega-3, vitamin E, etc.). Also, avoid environments where your blood pressure may rise sharply for a period after surgery, such as cold environments, strenuous exercise, and air travel. And sudden emotional changes can also be risky, so please let those around you know in advance. In other words, tell them to get along.

And if, against the very small odds, bleeding occurs after surgery, you must go to the nearest emergency room immediately. It can be managed with a fairly simple procedure to remove the pooled blood. The important thing is to respond quickly, so please remember that you should go to the nearest emergency room you can reach quickly, not necessarily the hospital where you had the surgery.

The reason I mention these things before surgery, even though there are ways to prevent side effects and the probability is extremely low, is because the possibility is not 0%.

Accidents happen when people brush them off lightly, thinking, “Surely that would never happen to me.”

So, in preparation for possible situations, we must thoroughly prepare what can be prevented in advance, and be ready to respond appropriately without panicking if something does happen.

So, if it is a good clinic, then when you ask about side effects, they should not say, "It’s fine. That kind of thing doesn’t happen often." They should clearly explain, "This possibility exists, but this is how we prevent it, and if it does happen, this is how we handle it."

Today’s conclusion

When consulting about lower blepharoplasty,

Be an interviewer who presses hard.

There are more patients needing revision eye surgery, including lower blepharoplasty, than you might think. All the patients who came to fix a failed surgery from another clinic naturally never expected something like that to happen to them.

This means you cannot guarantee that revision surgery will never be needed for you or your family.

That is why, during the consultation, you must ask the key questions that determine the surgical result. Ask actively, and if the answer is vague, ask again.

"Can I trust this clinic, this doctor, with my eyes or my parents’ eyes?"

Confirm it until you can convince yourself, because that is the wisest choice.

That is why you cannot help but like it — this was Ban Ho-gyeong. Thank you.

[Why there is no consultation fee at Banni in Gangnam

(+ Dr. Ban Ho-gyeong’s philosophy)]

https://blog.naver.com/rush_724/223776150003