Upper Eyelids

This patient has a more relaxed forehead after minimal in office upper eyelid shaping. This photo is 5 months post operative.

This patient had upper and lower eyelid surgery one month prior to this photo. She is shown without make up and the slight pink coloration around her eyelashes will fade over the following weeks to months.

Gorgeous eyes now more visible after in office upper eyelid procedure. Note relaxation of forehead in the after photo taken 13 months after surgery.

Gorgeous eyes are clearly the center of attention for this beautiful woman. She had upper and lower eyelid surgery performed in combination with a facelift procedure, which is sometimes the most natural looking way to improve the lower eyelid.

UPPER EYELID PROCEDURES INFORMATION

Eyelid surgery (blepharoplasty) is one of the most common procedures in my practice.  This is in part because the eyelid tissue is usually the first area of the face to reveal the signs of aging.  Saggy tissues around the eye create the appearance of tiredness, sadness, or even an angry stressed look.  There are both surgical and nonsurgical ways to improve the appearance of the eye area.  The needs of the upper eyelid are typically different than the lower eyelid and I will address those two areas separately.

Am I a candidate for upper eyelid surgery?

Upper eyelid surgery typically involves removing excess tissues.  When the muscle and skin of the upper eyelid start to drape across the eyelashes or create a hooding effect towards the lateral part of the eye, trimming the excess can create a more open awake appearance.  Eyelids which have heavy or excess tissue can create strain for the forehead as the eyebrows attempt to lift the tissues up and away from the eye.  Some people also have a heavy fat pocket which can be removed only with caution!  As we age, we typically lose fat around the eye, and removing too much fat can create an aged appearance.  It is very possible to have less loose skin, but look older as a result of overly aggressive resection.  This is not what anyone wants!  If if sounds complicated, it is!  You really need a good thorough examination during which time any prior eyelid surgery or medical issues will be reviewed.

WHERE ARE THE SCARS?

Scars in upper eyelid surgery need to be placed in the crease a few millimeters above the eyelashes.  This typically means the scar will be very hidden during your recovery.  Some people also have excess tissues on the lateral part of the eye area, which means the scar needs to extend towards the tail of the eyebrow for an optimal result.  Cover up and or silicone scar gel are used in the recovery period.  Stitches are removed after 5 days.

AM I A CANDIDATE FOR LOWER EYELID SURGERY?

Lower eyelids tend to have different problems from upper eyelids. Patients usually complain of bulges and dark circles in the lower eyelids skin as well as crepey loose skin.  Lower eyelids are supposed to be convex and your cheek area is also supposed to be convex.    Depending on the anatomy of your cheek bones, dark circles under the eye can occur at a very early age. When the connection between the eyelid and the cheek starts to widen or separate, a crevice starts to form and the appearance of a dark circle is exaggerated.  There have been many ways to manage the lower eyelid proposed over the years.  There is still no one technique for lower eyelids that all experts agree upon.  Most patients need some combination of tightening of the tissues and blending or augmentation of the crevice between the lid and the cheek.  For younger patients, this can sometimes be done with fillers alone, for patients who also have sagging cheek tissues, the best approach can be to lift the cheek tissues.  Some patients actually benefit from a small cheek implant.  If it sounds complicated it is.  One size does not fit all!

Where are the scars?

Scars in lower eyelid surgery need to be placed just below the eyelashes.  This typically means the scar will be very hidden during your recovery.  Some people also have excess tissues on the lateral part of the eye area, which means the scar needs to extend towards the tail of the eyebrow for an optimal result.  Cover up and or silicone scar gel are used in the recovery period.  Stitches are removed after 5 days.  Swelling of the lower eyelid can be prolonged so patience and careful massaging techniques may be required for an optimal result.

WHAT IS THE RECOVERY?

Eyelids are very thin and for this reason they show bruising very easily.  Bruising and swelling are the most important factors in the recovery process.  It is important to make sure your blood pressure is well-controlled and that you are off any medication or supplements which thin your blood.  There may be a period of dry or irritated sensation of the eye after surgery, but the pain is usually very self-limited with many patients requiring no narcotic medication.

WHAT ARE THE POSSIBLE COMPLICATIONS?

Eyelid surgery complications should be rare.  Especially for patients who have not had prior eyelid surgery.  However, as swelling affects the early and sometimes late surgical outcome and as swelling cannot be fully controlled, early asymmetries or need for small revisions might be required.  The most important complication of eyelid surgery is removal of too much eyelid skin.  If eyebrow position is not considered, or if too much volume of the soft tissue around the eye is removed a severe shortening can occur.  The relationship between the forehead and the upper eyelid needs to be discussed prior to surgery.  Again, please do not underestimate the importance of careful planning when it comes to making a good choice about your surgery.

WHAT ARE THE NON-SURGICAL OPTIONS?

Botox ( a muscle relaxer) and fillers (fat, and hyaluronic acid) are often used in my practice to improve the appearance of the eyes.  The results can be very natural and long lasting, but this is not a procedure to trust to your local medspa.  The forehead and the cheek areas are very connected to the eyes and these areas can be important to consider when making a plan for improving the appearance of the eyes.  Skin improvements with our matrix laser or medical grade skin care should also be considered as part of a complete treatment plan.


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