Eyelid Procedures
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.
This patient with absolutely gorgeous blue eyes is seen 3 months after in office blepharoplasty of her upper eyelids. Success in this procedure results in a more awake appearance without changes in the natural contours of the eye. Interestingly, the more awake you look, the more awake you actually feel! Procedures to tighten lower eyelids or improve skin coloration and frown lines are easily added at a later date.
This patient has a more relaxed forehead after minimal in office upper eyelid shaping. This photo is 5 months post operative.
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.
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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 skin can create a more open and 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 it sounds complicated, it is! You really need a good thorough examination during which time any prior eyelid surgery or medical issues will be reviewed.
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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 4-5 days.
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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.
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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. It’s possible I will recommend botox to make sure your measurements are taken with complete forehead relaxation. Again, please do not underestimate the importance of careful planning when it comes to making a good choice about your surgery.
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Botox (a neurotoxin that relaxes muscles) and fillers (fat or 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 med-spa. The forehead and the cheek areas are a major factor to the aesthetics of 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 fractional CO2 laser or medical grade skin care should also be considered as part of a complete treatment plan.