It has been stated that the eyes are the windows to the soul. Unfortunately, your eyes are also one of the first areas of the face to reveal signs of aging. Regardless of how youthful and energetic you may feel, an aging eyelid gives the impression that you are tired and aging. Several surgical and non-surgical interventions to rejuvenate the eyelid are currently available and Blepharoplasty is one of the most popular procedures. During your consultation with Dr. Schoenfeld, he will discuss the areas of the eyelids that need attention, and explain to you in detail which technique will provide you with the best possible outcome. No single procedure is right for all patients and Dr. Schoenfeld practices the latest surgical and minimally invasive techniques so the treatment you receive is right for you.
Upper Lid Blepharoplasty
As we age, skin of the upper eyelid becomes stretched and lax. This process leads to loss of the natural contour of the upper lid. The process is not unique to men or women, but is often the result of a hereditary predisposition in combination with exposure to harsh environmental elements over a lifetime. One thing is certain, excess skin and aging of the upper eyelid eventually occurs in everyone. In addition to excess skin, the fatty tissue which is responsible for supporting the eyes begins to protrude from its normal position, which causes the eyes to appear puffy.
Before & After Blepharoplasty Patients:
Upper eyelid surgery can be performed under local anesthesia but is generally supplemented with I.V. sedation or general anesthesia when other procedures are also performed. An incision is made in the natural upper lid skin crease (about 1cm above the eyelashes) and the appropriate amount of skin, fat, and muscle will be removed. Dissolvable sutures are used to close the wound. Bruising is minimal and a light cover of makeup may be applied after the first week to help camouflage the incision during the early recovery period.
Lower Lid Blepharoplasty
No area of the face has been reevaluated more critically in recent years than the lower eyelid and cheek complex. Changes which occur to the lower eyelid and cheek are somewhat different than what we see in the upper eyelid. You may present to our office complaining of the “bags” under your eyes, and that you always appear poorly rested. This may be a hereditary predisposition or familial trait and can occur quite early in life. In most individuals, this is a normal aging process. In the past, the plastic surgeon would simply remove the bulging fat of the lower lid and if necessary, remove excess lower lid skin. As we age, we lose fat around the eyes as part of the normal aging process. Patients who had this fat removed surgically would eventually develop a hollow looking eye without any sign of the full lower lid and smooth cheek that is so attractive in youthful faces.
During your consultation with Dr. Schoenfeld he will discuss with you the various surgical and non-surgical approaches to rejuvenate your lower eyelid and cheek complex. He will discuss with you the concept of lower lid fat repositioning to correct the hollows of your lower eyelids, and concurrently reduce the bags that form in the lower eyelids. Dr. Schoenfeld will also determine the need for removal of excess skin and muscle of the lower eyelid, whether the eyelid needs to be tightened to prevent post operative drooping, and if laser resurfacing or chemical peel are necessary to help manage mildly lax skin and poor lower eyelid skin texture and elasticity.
I had eyelid surgery two and a half weeks ago on both my upper and lower eyelids. I was hoping that the bruising would be gone at this point but I’m still bruised. What can I do to help get rid of the bruising faster?
I encourage my eyelid and all cosmetic surgical patients to stop all natural remedies and vitamins prior to surgery as many of them, although healthy in normal circumstances, may lead to bleeding and increased bruising in the face of eyelid surgery. I start my patients on Arnica and encourage the use of ice immediately after eyelid surgery. I use epinephrine for hemostasis during surgical injections of the eyelid and face which decreases intra operative bleeding. In spite of all of these precautions, bruising still occurs and there is not a great deal to do for bruising other than perhaps a light laser treatment that will expedite the resolution of the bruising postoperatively.
Lower eyelid surgery can treat the hollowness that you appreciate in your lower eyelids. There are actually several ways to treat under eyelid hollowness. In the office I use fillers such as Restylane and Juvederm to fill in the hollowness of the lower eyelids. Surgery of the lower eyelids with fat removal and fat repositioning is another way to treat lower eyelid hollowness. The lower eyelid surgery results last considerably longer than filler injections to the lower eyelids and the results are much better. My least favorite selection to treat lower eyelid hollowness is fat injections to the lower eyelids. When fat injections to the lower eyelids are performed perfectly, there can still be flaws in the appearance of the lower eyelids. Fat injections to the lower eyelids are very unforgivable and even in experienced hands irregularities can occur.
I am a Caucasian male but I have eyelids that look more Asian. You don’t see my upper eyelids at all because the skin hangs down. It doesn’t look puffy or wrinkly, just hangs down. How is this fixed?
What you are describing does not sound entirely like the result of excess upper eyelid skin. It may be that you are also suffering from eyebrow ptosis or falling eyebrows. Upper eyelid skin excess can be treated with blepharoplasty surgery but, falling brows would have to be evaluated and treated with a browlift. A thorough physical examination of your eyelids would enable me to decide which surgery is most appropriate for you.
I’d like to get eyelid surgery. When I think of what the surgery actually does, I feel like the eyes will be more open after surgery and that you may then have trouble closing them. Does this ever happen?
The purpose of eyelid surgery is to rejuvenate your eyes so that they do appear to be more open and attentive. My goal in blepharoplasty is to give your eyes about 10-15 years of youth. I do not attempt to change the shape and overall appearance of your eyes and face with blepharoplasty. Upper eyelid surgery is performed by removing the excess skin of the upper eyelids. One of the potential complications of upper eyelid surgery is to remove too much skin which would lead to difficulty closing the eyes. It is imperative that the experienced blepharoplasty surgeon takes time to measure the proper amount of excess upper eyelid skin prior to removal to avoid this potential complication.
A friend of mine just had eyelid surgery and she looks amazing! She said it was transconjunctival blepharoplasty, which I’d never heard of before. What is this? Is it better than regular eyelid surgery?
If your friend had transconjunctival eyelid surgery, her eyelid problem was likely excessive bags of the lower eyelids and perhaps some mildly loose skin. In a transconjunctival lower lid blepharoplasty the incisions into the eye is actually made on the inside of the lower eyelid. The incision actually goes through the conjunctiva and directly into the fat compartments avoiding skin incisions. The transconjunctival lower eyelid surgical approach has a much lower incidence of post-operative eyelid malposition then a traditional eyelid surgery.
What’s the typical post-op period like after eyelid surgery? I can take only 2 weeks’ vacation from work, no more, and I would like to know if this is sufficient time. What can I expect to look like going back to work after that 2 week period?
If you are having all of your eyelids operated on, although physically you will feel well in less than a week, it could take two weeks before you are presentable at work. I am not so concerned with the appearance of your eyes after upper eyelid surgery, but, depending upon the amount of work that needs to be performed on your lower eyelids for rejuvenation, the swelling and bruising can be fairly marked and you will appreciate the two weeks you have taken.
I have sagging upper eyelids that I would like to have fixed. How do you tell whether you need an eyelid lift or a browlift? Is there some rule of thumb for when one is needed over the other?
A thorough physical exam by an experienced surgeon is a good way to determine whether an upper lid eyelid lift, a browlift, or both are needed to rejuvenate upper face. If you are in front of a mirror, you can try to lift your eyebrows with your fingers to the height that you would like to see your brows at. If your brow really does not need any lifting, then you are probably a candidate for an upper eyelid lift. If you lift your brow and you are satisfied with your appearance then you likely needed a browlift only. If when you lift your brow there is still an excessive amount of upper eyelid skin, then you need both upper lid blepharoplasty and browlift.
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