Your plastic surgeon will assess you entire face, with a special focus on the function of your eyelids and brows. It is important that you volunteer any history of vision change, dry eye, eye irritation, seasonal allergy, eyelid or eye surgery, muscular or neurological disorders, thyroid disease and diabetes. If necessary, your plastic surgeon will ask you to be also evaluated by an ophthalmologist to address specific issues regarding your vision or eye health. It is crucial to know of any asymmetries to achieve the optimal result after surgery. Your surgeon will locate your natural eyelid crease by lifting your eyebrow, asking you to look downward, then slightly upward, then downward again. Together, you will determine your goals, and discuss what you can realistically expect from Blepharoplasty. Your plastic surgeon might also suggest that you consider correcting the position of your eyebrows if their sagging affects your upper eyelids.
How Will I Know Whether I am a candidate for Upper or Lower Eyelid Surgery?
This is something that you will discuss with your cosmetic surgeon. Depending upon the degree of fat and skin in the upper lid, and the puffiness below, your surgeon may recommend that you have surgery on all four eyelids, or just two. He or she will also discuss with you whether you have excess skin that needs removal, or only fat to remove.
If you are having all four eyelids corrected, the surgeon will generally work first on the upper eyelids.
What If I Have Fat Beneath My Lower Lids, But No Excess Skin?
In this case, your cosmetic surgeon may perform a Trasnconjunctival Blepharoplasty. This goal of this procedure is to remove bulging fat, with a secondary goal of transferring the fat to hollowed areas. This is generally performed on younger patients who have more elasticity in their skin, and involves an incision on the lower eyelid that leaves no visible scarring.
During this procedure the lower eyelid is moved away from the eyeball, which is then protected with a plastic plate. Through electrocautery, the cosmetic surgeon sweeps across the back layer and most of the length of the eyelid. The fat in three pockets is "teased out" of their capsules, clamped, excised and cauterized from each pocket. Sometimes, the surgeon closes the wound with dissolving sutures, although possibly no sutures will be required. The cosmetic surgeon will remove only fat and not any skin.
Advantages of Trasnconjunctival Blepharoplasty over traditional lower eyelid surgery include that it leaves no external scar, is less invasive, results in less bruising and swelling and has a more rapid recovery.
Will Insurance Cover An Upper Eyelid Lift?
The surgery may be covered only in few cases when excess skin and fat hangs over the eye, blocking your peripheral vision, and thus hinder your driving capacity. Obtaining coverage requires special testing by your ophthalmologist and pre-approval by your insurance company. Even so, any aspect of the Blepharoplasty that is "cosmetic" will not be covered.
What Is Canthopexy?
Extreme Blepharoptosis or the sagging of the lower eyelids is termed Ectropion. More specifically, Ectropion refers to abnormal laxity of the lower eyelids to a point that too much of the white of the eyes show. The loss of lower eyelid integrity can damper the normal flow of tears causing them to spill over onto the cheeks and resulting in the dryness and irritation of the eyes.
Canthopexy refers to a variety of procedures designed to re-establish the support mechanism of the lower eyelid skin so it no longer sags. Depending on the degree and cause of the Ectropion, the type of Canthopexy surgery varies. In those with minimal laxity, or a pre-disposition to developing Ectropion after lower Blepharoplasty, the outer edge of the lower eyelid is tightened against the rim of the eye socket or orbit. This procedure is called Lateral Canthopexy. In cases when Ectropion is caused by extreme horizontal redundancy of the lower eyelid skin, a wedge section of the lower eyelid is excised, thus shortening the horizontal length of the lower eyelid. This procedure is called a Lateral Tarsal Strip Re-suspension. In some cases, Ectropion results from a deficiency of lower eyelid skin, caused by scarring or previous eyelid surgery. In this circumstance, the deficiency of the lower eyelid skin is addressed via skin graft, flaps, or superior cheek advancements.
Your plastic surgeon must be alert of the risks of developing Ectropion, and should have the knowledge and skills to be able to surgically address it at the time of Blepharoplasty.
Are There Medical Conditions that Would Affect My Ability to Have Eyelid Surgery?
Before undergoing any surgery your medical conditions such as hypertension, diabetes, or asthma should be optimized by your internist. If you are suffering from Graves’s disease, glaucoma, detached retina, or other diseases that directly affect the eyes; these issues should be properly addressed by an ophthalmologist beforehand. Excessive dryness of the eyes or "Dry Eye" can potentially hamper your eyelid surgery results if it is not addressed appropriately.
Can Eyelid Surgery Be Performed with Other Procedures?
In order to rejuvenate your entire face, or sections of it, it is very common for people to simultaneously undergo other adjunct procedures such a Facelift, Mid-Face Lift, Brow Lift, Rhinoplasty (nose surgery), Cheek or Chin implant placement, Lip Augmentation, or even non-invasive procedures such as BOTOX® or Laser Resurfacing.
Can Eyelid Surgery Affect My Vision or Eyeglass Prescription?
While upper eyelid Blepharoplasty can remove excessive skin that overhangs the eyes and hinders peripheral vision, the surgery itself can result in some inflammation and swelling of the eyes that can temporarily alter your Eyeglass Prescription. If this persists, medications or eye drops can be prescribed to help facilitate your recovery.
What About My "Crow's Feet"?
Eyelid Surgery does not eliminate "crow’s feet," which are the tiny wrinkles around the eyes that are also known as "laugh lines." These wrinkles are caused by excessive and persistent tightening or spasm of the eyelid muscles that can be weakened with paralytic agents such as BOTOX®.
Frown Lines are wrinkles in the forehead and between the brows that are caused by persistent tightening or spasm of some of the forehead muscles (Corrugator & Procerus) as well as parts of the eyelid muscles (Orbicularis Occuli Muscle). While BOTOX® injections can temporarily paralyze and weaken these muscles, a Trans-Palpebral excision of the Corrugator and Procerus muscles through an upper eyelid incision can almost permanently eliminate this problem.
Can Eyelid Fat Be Removed By Liposuction?
No. Liposuction is not an appropriate procedure for Eyelid Surgery because the tissues of the eyes are so delicate.
Does Blepharoplasty Affect My Permanent Eyeliner?
No, Neither lower eyelid or upper eyelid Blepharoplasty incision is going to remove or alter your permanent eyeliner tattoo.
How soon after eyelid surgery can I have Permanent Eyeliner?
In general, I suggest that you wait until all the swelling and inflammation of the eyelids have subsided, which takes approximately 6-10 weeks. Otherwise, your eyeliner can run or smudge.
Are there Alternative to Eyelid Surgery or Blepharoplasty to treat Aging Eyes?
There are many non-surgical modalities that are offered to help lessen the effects of aging but none offer as dramatic and lasting result as Blepharoplasty.
There are a variety of soft injectable fillers such as fat, collagen, dermis, hyaluronic acid, Restylane, Perlane, Radiance, Cosmoplast, Sculptra that are used to either fill in the wrinkles around the eyes or to fill the hollowing of the eye socket resulting from aging. Unfortunately, none can remove or smoothen excess eyelid skin or treat Blepharochalasia.
Paralytic Agents: BOTOX® is the most well know agent that temporarily paralyzes the orbital muscles, thus reducing the appearance of lines. Contrary to popular belief about the safety of Botox, it can not be used directly in the lower eyelid muscle because its paralysis can induce the drooping and sagging of the lower eyelid or can even cause Ectropion.
Laser & Thermage:
When laser resurfacing was popularized in 1997 it had promised to smoothen out the eyelid wrinkles and shrink the redundant eyelid skin, thus eliminating the need for eyelid surgery. As one of the original scientist who investigated the effect of laser on collagen and skin shrinkage, I know first hand that neither Laser, nor Radio frequency Energy (Thermage) can induce significant lasting shrinkage of the skin. At best, CO2 Laser can lessen the fine wrinkles of the eyelids and cause approximately a 15% temporary shrinkage of skin. Unfortunately, the recuperation of Laser resurfacing is weeks longer than Blepharoplasty.
During your consultation Dr. Younai with examine you and will answer you're your questions in detail. He will also review with you your treatment options for Eyelid Rejuvenation Surgery or Blepharoplasty, including pros and cons of each procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. At that time he will also recommend if you might need additional procedures to correct Ectropion, eyelid Ptosis or other eyelid dysfunctions. There are also many before-and-after pictures and high resolution images of Facial Plastic Surgery and Eyelid Surgery available in our photo gallery.
Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.