Blepharoplasty | Browlift | Eyelift | Eyelid Surgery
It is often said that the eyes are the gateway to the soul. As we rely primarily on eye contact during interpersonal communications, the eyes and the condition of the associated soft tissues significantly contribute to our countenance and, thus, the way we are perceived by others in our environment. Over time, the natural forces of gravity cause the position of the eyebrows to descend. Our forehead muscles attempt to compensate, leading to increased prominence of horizontal forehead wrinkles and crease lines. Excess skin accumulates across the upper eyelids, giving the impression of chronic fatigue. In severe cases, excessive upper eyelid skin accumulation can even obstruct the field of vision.
Excess skin also accumulates across the lower eyelids over time. Additionally, pockets of fat normally confined beneath the skin may herniated or protrude to a more superficial level, conspiring to produce the appearance of "bags" and a deep crease dividing the lower eyelid from the upper cheek. The support mechanisms of the lower eyelid may weaken, resulting in a loose, lax eyelid with a rounded contour. In extreme cases, tearing may even result.
Treatments like chemical peels and botulinum toxin injections, BoTox, can slow the progression of some of these normal aging changes. However, these treatments represent just two components of a comprehensive periorbital (eyelid, eyebrow, forehead complex) rejuvenation strategy. Patients asking for these procedures often say:
- "I always look tired, even after a good night's sleep"
- "My vision is cut off whenever I look up"
- "People ask me why I'm angry even when I feel happy"
- "I can't apply my eye liner / eye shadow properly"
- "I'm developing the same bags under my eyes that my mother had"
Goals of Surgery
Form and function are inextricably linked during surgery, for the esthetically pleasing nose must also breathe well. Areas of concern that are successfully and commonly improved with rhinoplasty include:
Fortunately, a number of surgical techniques exist to create a more youthful periorbital complex.
Browlift procedures restore the droopy eyebrows to their normal anatomical position at, or just slightly above, the top of the bony eye sockets. When the eyebrow position is adequately resuspended, the amount of excess upper eyelid skin remaining oftentimes diminishes. For this reason, upper eyelid blepharoplasty surgery is often combined with a browlift procedure.
Browlift surgery is usually performed endoscopically, with several incisions hidden entirely within the hair-bearing skin near the front of the scalp.
Upper eyelid blepharoplasty surgery removes excess upper eyelid skin, while preserving sufficient skin to permit complete eye closure. The procedure is performed with an incision placed directly within the natural upper eyelid crease. A small amount of underlying fat is removed in those instances where it has protruded to the extent that it is visible through the overlying skin. This is performed conservatively so as to create the full, healthy appearance associated with the youthful upper eyelid.
Lower eyelid blepharoplasty surgery removes excess lower eyelid skin. It also removes or repositions protruding pockets of fat that form the "bags" and deep creases / wrinkles at the junction of the lower eyelid and the upper cheek. In cases where the lower eyelid support mechanisms have weakened over time, the lower eyelid is concurrently resuspended with a canthoplasty / canthopexy procedure.
Younger patients with lower eyelid puffiness produced primarily from protruding fat may undergo a transconjunctival lower eyelid blepharoplasty. This procedure, performed with an incision camouflaged entirely inside the lower eyelid, redistributes the fat across the crease separating the lower eyelid and upper cheek (referred to as the nasojugal fold).
Other patients with both excess lower eyelid skin and fat protrusion undergo a subciliary lower eyelid blepharoplasty with a skin incision hidden just beneath the lower eyelash line. Excess skin is conservatively removed, and the herniated fat is conservatively reduced and / or repositioned.
During the pre-surgical consultation, a detailed examination of the forehead, upper eyelids, and lower eyelids is performed. These areas are considered individually and then as a complex of associated structures. Digital photographs of each patient are carefully analyzed with advanced computer imaging technology.
A comprehensive rejuvenation plan is then formed to best achieve each patient's goals. This plan may include a combination of the above surgical techniques. A variety of on-surgical therapies may also be offered, ranging from chemical peels to laser treatments to injection of botulinum toxin.
Surgery is performed on an out-patient basis under either conscious sedation anesthesia or general anesthesia. One week off from work is advised. Browlift staples and blepharoplasty sutures (stitches) are removed one week after surgery. Bruising usually resolves by two weeks post-operative. Post-surgical swelling peaks two to three days after surgery and gradually declines thereafter. As recovery proceeds, a more youthful, well-rested, and refreshed look results.