REFRESH, BRIGHTEN, REJUVENATE: BLEPHAROPLASTY FOR CAPTIVATING EYES
Has anyone ever said, “you look tired” or “you must have been up all night” when in fact you feel great? Changes around the eyelids lead to an aged, tired appearance. Youthful eyes have no excess fat, smooth skin, no lid laxity, and an almond shape. Undesirable changes in the upper lids include excess skin and fat as well as droopy eyelids, which obscures your vision. Undesirable changes in the lower lids include excess fat and skin and ectropion (laxity) leading to a dry eye. Turn to blepharoplasty to help.
Surgical procedures to rejuvenate the eyelids involve removing excess skin and fat and tightening of lax eyelids. However, blepharoplasty will not correct crow’s feet. Additionally, the procedure doesn’t correct excess skin in the eyebrow area. Botox helps correct crow’s feet and a brow lift will correct brow droopiness. Most eyelid surgeries are performed in-office under local anesthesia with minimal discomfort and recovery. Check out a former patient’s review on RealSelf now. Below you’ll find common methods used on the eyelids.
BLEPHAROPLASTY
IN CINCINNATI
FREQUENTLY ASKED QUESTIONS
What kind of procedures can be done for blepharoplasty?
First, we measure the skin in the upper lid. Then, the area is marked after a thorough cleaning. Next, we inject local anesthesia to numb the area while limiting bleeding. Fourthly, we remove skin and a strip of the eyelid muscle. Though, for some patients, the muscle stays for a more natural look. Next, we dissect fat pockets and take away extra fat. If the eyelid droops, a repair happens at this time. After three days, we remove the sutures. After a few weeks, you can’t see scars. Complications are rare and can include over-tightening of the lid skin, bleeding, and incomplete removal of fat.
Lower blepharoplasty
A pre-operative evaluation includes the amount of skin and fat as well as evaluating the elasticity of the lower lid by performing a “snap back” test. For laxity of the lower lid, we may perform one or two procedures. Next, we clean the area with an antiseptic and inject anesthesia. Then we make a 2-3 mm incision from the lash line, developing a flap. This allows the surgeon to remove fat from multiple pockets. Sometimes fat is preserved and rolled under the nasojugal groove. After surgery, keep your head elevated. Also, ice the lower lids for the first day. After 2-3 days, your surgeon removes the sutures. You can expect a fast recovery.
Transpalpebral lower blepharoplasty
For patients with fatty lower eyelids and minimal skin, a lower eyelid lift with an incision inside the eyelid may be used. This has the advantage of no external scar but may require a peel of the lower lid skin.
“Droopiness” repair
Eye droopiness of the upper eyelid occurs when the eyelid drops down toward the pupil. This happens for many reasons, including age. The repair involves suturing the levator aponeurosis (a ligament) which elevates the lid to a more normal position. Additionally, insurance may cover the procedure.
TCA peel
Chemical peeling improves wrinkling eyelid skin. Chemical peeling requires 2-5 days of recovery and has minimal complications.
Orbicularis lift
Some patients need an orbicularis lift. If you have lax lower lids or festoons, this will help. Essentially, this involves pulling the muscle of the lower lid upward. From there, the lid sutures into place. Suspension of this muscle supports the lower lid leading to a more youthful look.
Canthopexy/Canthoplasty
These procedures tighten the lax lower lid by repositioning the corner of the eye or by shortening the lower lid. Laxity of the lower lid can lead to ectropion (outward bowing of the lower lid) which causes dry eyes. Bowing also leads to an aged appearance. A snap-back test helps determine lower lid elasticity. The eyelid is pulled down by the surgeon and the degree of “snap back” is measured. If your eye doesn’t return to its normal position, you may need one of these procedures. Ultimately, your surgeon decides which procedure you need to get a normal appearance.
When should I have one?
You should consider facelift surgery when you want improvement in your facial situation. You are never too young (well maybe) nor too old to have a facelift. The aging process of the face is determined by genetic factors as well as environmental factors. You have no control over genetics but you can control environmental factors (smoking, sun exposure, skin care regimen, etc.) Younger patients will usually require less invasive procedures for facial rejuvenation. Some evidence exists that having a facelift at a younger age will result in a longer-lasting facelift.
Am I too old?
As stated above, you are never too old for a facelift as long as you are healthy. Dr. Martin’s oldest patient is 85 years old.
Will I look “pulled” or “windblown?
Absolutely not! Most people want to look like themselves only younger. Few people want a windblown look. A tight, pulled look is very unnatural. Some people believe the tighter the pull the longer the facelift will last. This is not true. A tight, pulled look results from over-tightening the skin without any pull on the underlying structures (SMAS). Pulling the skin in the wrong direction (abnormal vectoring) can also result in an abnormal appearance with lines going in the wrong direction. A secondary facelift can sometimes correct a pulled or vectored look.
How long will it last?
The results can last forever but you will continue to age and the skin on your face will continue to sag. Some patients with poor elasticity will require a secondary facelift (minor tightening) in as little as 6-12 months following the first one. A secondary facelift generally involves simply tightening the skin with minimal alteration to the SMAS.
Is a “mini facelift” effective?
Yes, a mini facelift can be effective but less so than a major one. The problem is agreement on what constitutes a mini facelift. Some consider a mini facelift to consist of skin excision only with short incisions. Others consider a mini facelift a secondary lift. One caveat to remember is that some non-certified doctors promote the mini lift because they don’t know how to perform a more invasive facelift.
Where will the incisions be made?
Standard incisions start just above the ear at the sideburn, continue down in front of the ear, and circle back under the earlobe and behind the ear. Dr. Martin usually makes the post auricular incision straight up the ear without crossing into the hairline. This allows for the incision to hide completely behind the ear and not be seen when one wears their hair short. Be sure to ask if your incision will show when wearing short hair. This is a very common complaint from patients.
Will the procedure remove wrinkles?
Yes and no. A facelift can stretch the skin allowing for the wrinkles to look less prominent. The only wrinkles that are actually removed are the wrinkles adjacent to the skin that is excised. Most facial wrinkles require soft tissue augmentation (Radiesse, Restylane, Fat, etc.) and or wrinkle reduction (chemical peels, laser, etc.)
Will it improve nasolabial folds or marionette lines?
Yes and no. Most standard procedures do not affect the nasolabial fold or marionette lines. Some special techniques and a particular type of facelift known as a mid-facelift can improve these areas. Usually, these areas respond best to soft tissue augmentation.
Most facelifts involve common principles of repositioning deeper structures, removing excess fat, and excising loose skin. Many can be performed under local anesthesia while the patient is awake. The face is infiltrated with an anesthetic solution that numbs the face and reduces bleeding allowing for more precise dissection. Incisions are made under the chin and around the ear followed by dissecting the skin away from the deeper structures. The area is then plicated (sutured up) to reposition the jowls and cheek tissue. The skin is then carefully removed and sutured back in place. Excess fat is removed from the neck, followed by tightening of the neck muscles. All sutures are removed in 5-7 days and recovery takes 1-2 weeks. Pain is minimal.
Complications include bleeding, infection, seroma, tissue loss, and nerve damage. Other tell-tale signs which should be avoided include pulling of the external auditory canal, a pixie ear, disappearing sideburn, abnormal vectoring, and abnormal scarring.
Anything else I should know?
It is very difficult, even for a plastic surgeon, to determine which techniques work the best without performing a large number of that specific procedure. Ask your surgeon how many facelifts he has performed using specific techniques.
If you smoke, you may be a poor candidate for a facelift. Even if you quit smoking, you are still at high risk for tissue breakdown and scarring.
Some patients develop recurrent laxity of the facial skin following a facelift. This may occur as early as 2-6 months following the procedure. It’s important to note that this laxity does not occur from the surgeon not pulling the skin tight enough! Recurrent laxity is more related to your genetic makeup, and there is very little you can do to improve the elasticity of your skin.
Never leave your sutures in more than 5-7 days. With time, sutures cut through the skin leaving small cuts that heal as “railroad track” scars. These can be very noticeable.
One serious complication is a hematoma which can lead to tissue necrosis and unacceptable scarring. The most common causes are aspirin, Advil, alcohol, and herbal products, all of which inhibit platelet function. Don’t take any of these products before or after your surgery. Ask your surgeon which other products to avoid.
Never place a heating pad on your face following your facelift. The skin lacks normal sensation and the heating pad can burn your skin.
Be sure to ask where your incisions will be located behind your ear. An incision that crosses into the hairline may leave scars which are easily seen if you wear your hair short. Ask about placing your incision totally behind your ear without crossing into the hairline.