Facial Plastic Surgery Questions and Answers: Part 5

Question: Ocularplastic surgeon versus general plastic surgeon for upper & lower blepharoplasty?
Answer: In our practice for over 30 years, we’ve never heard of a blepharoplasty causing decreased vision. If anything, a functional blepharoplasty increases a peripheral vision by removal of excess hooded skin. It’s very important to go to A surgeon who has lots of experience performing blepharoplasty. Study your perspective surgeon’s before and after eyelid photo gallery to make sure that it is extensive with Lots of results that you like and they look natural.

Question: I was told I need an eyelid surgery and blepharoplasty. Should I use an ocular surgeon? 
Answer: Much more information is needed, such as a full set of facial photographs from all angles looking straight into the camera( Not smiling) and why were told you needed eyelid surgery? Cosmetic or functional purposes?? Plastic surgeons, facial plastic surgeons and oculoplastic surgeons all perform eyelid surgery depending upon what you need. Regarding jowls, facial aging and considering a facelift, that should be performed by a facial plastic surgeon.

Question: Follow-up question: Regarding first consult for lower eye blepharoplasty. Thoughts? 
Answer: In our practice, we definitely do not perform fat injections to cheeks for a variety of reasons. If you are trying to augment the cheeks, use fillers placed in the office setting, or cheek implants for permanent augmentation. A simple transconjunctival lower blepharoplasty can accomplish improvement to rejuvenate your lower eyelids.

Question: Am I a good candidate for a deep plane facelift? 
Answer: The goal of upper eyelid surgery is to remove mostly excess skin and a small amount of fat on the inner corners of the upper eyelids. The goal of lower eyelid surgery is to remove the fat bags through trans-conjunctival approach on the inside of the lower lids. In our practice we do not recommend a deep plane facelift due to higher risk of facial nerve damage. We perform a high-SMAS lower face and neck lift. This procedure accomplishes lifting the jowls, tightening loose facial and neck skin, tightening loose facial and neck muscles, and removing fat deposits in the neck which also includes a platysma plasty. It is very important to look natural after all of these procedures.

Question: 1.73cm, 80kg, male, 28 years old, brown skin – I want to know if have ptosis or not? 
Answer: Your photographs are rather limited, but it does appear that you may have ptosis on your upper eyelids, which is a weakness of the eyelid muscle. Ptosis repair is usually performed by a ocular plastic surgeon. A cosmetic blepharoplasty procedure will not help with this issue.

Question: Eyelids naturally heavy & sty may have left with with ptosis – best minimal procedure? 
Answer: It’s difficult to tell from the photographs presented, but you do have a symmetrical creases on your upper lids. An – person examination is going to be required to make a determination about how best to proceed. The asymmetrical skin and creases can be improved with a cosmetic blepharoplasty, while ptosis repair requires tightening, one or both of the muscles that open the eyelids.

Question: Do I need eyelid surgery? 
Answer: A very conservative upper eyelid lateral skin only blepharoplasty can accomplish your goals in the outer 1/3 of your upper lid. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: Can lower eyelid fat repositioning damage the tear trough area? 
Answer: In our practice, we only do fat repositioning for upper eyelid surgery when needed. We perform a transconjunctival conservative fat removal through the inside of the lower lids to rejuvenate them.

Question: Upper, lower blepharoplasty, brow-lift? Which combination do I need? 
Answer: The 1 Limited photograph demonstrates adequate brow position even though your raising them to lift upper eyelid skin skin. Performing a brow lift will make you look very surprised, since your eyebrow position is higher than normal. A brow lift is only performed for patients who have low set eyebrows. An upper blepharoplasty procedure can accomplish removal of the hooded skin touching your eyelashes, while a trans-conjunctival approach lower eyelid surgery can accomplish removal of the fat pad bags creating the puffy look. The incision is located completely on the inside of the lower lids. After you have performed the eyelid surgery, then consider Botox in your forehead for the horizontal lines.

Question: Do I need brow lift or upper blepharoplasty to reduce the outer crows feet? 
Answer: Crows feet are best treated with Botox, not surgery. The height of your eyebrows is acceptable, and a browlift is totally unnecessary. There is not enough extra skin on your upper eyelids, therefore, eyelid surgery is not necessary.

    Contact Dr. William Portuese