Facial Plastic Surgery Questions and Answers: Part 3

Question: What can I do to refresh my eyes and look more awake? 
Answer: A full set of facial and eyelid photographs are going to be required to make a determination about how best to proceed. Those photographs need to be when you’re not smiling. The primary goal for upper eyelid surgery is to remove extra skin and a little bit of fat, while the primary goal for lower eyelid surgery is to remove fat bags.

Question: Would I be a good candidate for upper and lower blepharoplasty? 
Answer: The pictures are rather limited, but it does appear that your possible candidate for a blepharoplasty on both your upper and lower lids. The primary goal for upper eyelid surgery is to get rid of the hooded and excess skin and a little bit of fat located in the upper eyelids. The incision is located directly in the upper eyelid crease. The primary goal for lower eyelid surgery is to remove the fat bags in the lower lids creating the puffy look. We remove that fat through an incision on the inside of the lower lid called a trans conjunctival approach. This procedure is performed under general anesthesia takes about one hour, and anticipate about two weeks of visible bruising and swelling.

Question: Eyelid/eyebrow droopiness – what procedure(s) would be helpful? 
Answer: You are not a candidate for upper eyelid surgery due to the fact that you have very low eyebrow position. Consider a brow lift procedure, which can accomplish lifting your eyebrows to a more natural position.

Question: What procedure would make the biggest difference in opening the upper part of my face, brow lift?
Answer: A brow lift procedure can accomplish lifting your brows and surgically softening the corrugator muscles that are also adding to the depressor function of your central forehead. A brow lift procedure can also improve some of the hooded appearance of your upper eyelids simply by raising the forehead.

Question: What is the likely cause of my eyelid asymmetry and how can it be balanced? 
Answer: Everyone has some degree of eyelid asymmetry due to the embryologic development of the face from both the left and right half. A conservative skin only upper blepharoplasty can accomplish improvement of the asymmetry. This can be performed under local anesthesia as an outpatient procedure.

Question: Am I a candidate for eyelid surgery? 
Answer: You have low eyebrows which are creating the hooded look on your upper lids. Consider a brow lift procedure to raise the eyebrows and lift your lower lids off your eyelashes.

Question: Blepharoplasty quandary. How does a surgeon determine the amount of filler to be used?
Answer: In our practice, we simply remove the herniated fat bags in the lower lids through a trans- conjunctival approach on the inside of the lower eyelids. Some patients over 50 years of age requires pinch of skin when there’s extra skin present which is located on the outside of the lower lid directly underneath the eyelash line. For long list of reasons, we do not recommend fat injections to the eyelids or fillers in that area.

Question: Would having upper and lower lid surgery help with bags/darkness under eyes? 
Answer: The photograph demonstrates herniated fat in the lower lids for which a lower eyelid surgery can certainly improve. The fat is removed through a trans conjunctival approach on the inside of the lower lids. If there’s excess skin at rest (not when smiling) then a pinch of extra skin at the eyelash line can be performed to tighten the lower lids. In our practice, this incision is closed with tissue glue. No stitches are required.

Question: How common is entropion after lower blepharoplasty done from outside the eyelid? 
Answer: In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there’s loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.

Question: Do I need upper and lower blepharoplasty, please?
Answer: From the one limited photograph, it appears that you have significant asymmetry between your left side and right side. Your left upper lid is more hooded than your right, so a conservative skin only left upper blepharoplasty can make left eyelid Look more like your right. You also have fat bags on your left lower lid, and a left-sided trans-conjunctival lower blepharoplasty can make your left eyelid Look more like you’re right lower lid.

    Contact Dr. William Portuese