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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Eyelid Surgery

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Img_EyesIt has been said that the eyes are the windows of the soul; they convey one’s deepest feelings and emotions.

The eyes are considered the most expressive features on the face. However, the eyes are often one of the first facial features to show signs of aging and therefore may be transmitting the wrong signal to the world.

Rejuvenation of the upper face has many forms. Blepharoplasty treats aging eyelids. Browlift treats low or sagging eyebrows. The eyebrows should arch above the corner of the eye. If this is not the case, you may require a browlift instead of or in addition to eyelid surgery. Botox is also very useful for aging brows that show furrows, lines and can even treat drooping brows.

What are we treating? Blepharoplasty treats a “tired look;” reducing excess eyelid skin and bags. Browlift treats an “angry or sad appearance.”

Why do eyelids sag so early?

We blink thousands of times per day. But the skin of the eyelids is much thinner than the rest of the face, with fewer internal moisture glands. As a result, eyelid skin is more prone to sagging and stretching. This is made worse by sun exposure, squinting and eye rubbing.

As we age, the fat surrounding the eye tends to bulge outward, sometimes at a prematurely early age due to heredity. Eyelid fat also retains water, so these bags often appear puffier in the morning, when over-tired and/or with allergies.

Ideal Eyelid

The ideal eyelid has a defining fold. This fold, along with smooth skin provides a canvas for eye shadow. A youthful upper eyelid should be full. Lower eyelids are ideally smooth without fatty pouches. A small roll of muscle right below the eyelashes is normal. This is the muscle supporting the lower eyelid and should not be confused with fatty bags.

Actual Patient of Dr Pearlman

The Eyelid Surgery Procedure

Lower Eyelid

Bags under the eyes can be removed by making completely hidden incisions within the eyelids, which is called a transconjunctival blepharoplasty. This is an excellent technique, especially for younger patients with good skin, as well as for men since there are no visible incisions. With the advent of hidden incisions, patients with inherited lower lid bags may be candidates for removal as early as their late 20s (in very select individuals).

In patients with wrinkles of the lower eyelid skin, the skin can be smoothed simultaneously by a laser or chemical peel. A “pinch” or skin-only technique removes excess lower eyelid skin. The combined approach of transconjunctival blepharoplasty with external lasers, peels, or skin removal preserves the integrity of the supporting muscle sling of the lower lid. This inside/outside procedure reduces chances of rounding of the lower eyelid after surgery.

For patients with more advanced skin wrinkling of the lower lid, an external incision is made right below the eyelashes. This incision usually heals very well and is barely detectable. The lower eyelid muscle is supported with suspension stitches to reduce rounding of the eyelid.

To fill dark circles under the eyes, the newest solution is the application of facial fillers. Dark circles are often the result of fat bulging in the lower eyelid that is exaggerated by a hollow area called the “tear trough.” By placing fillers such as Restylane into this tear-trough, there is less shadow and therefore improvement in dark circles, making you look more rested and smooth.

Upper Eyelids

Upper blepharoplasty should be contemplated when the skin of the upper lids hangs over the eyes. Sometimes the overhang is to the extent that it becomes difficult to put on eye shadow or the hooding of the lids interferes with vision. Visual obstruction is one of the only conditions that may be covered by medical insurance.

The incisions for rejuvenation of the upper eyelids are made along natural creases and are barely visible after healing. Eyelid incisions are closed with very fine sutures, which either dissolve or are removed in four to five days.

Post-operatively, patients can often return to work in a week or less after transconjunctival surgery and slightly longer after upper and lower lid surgery.

Sometimes what appears to be sagging of the upper eyelids is actually from drooping of the brow, and is better addressed by a browlift. Dr. Pearlman can help decide which treatment is best for you. You might even consider bringing in photos from your 20s to determine how best to rejuvenate your upper face.

Modern trends in blepharoplasty are designed to avoid creating hollow appearing eyelids. Removing too much skin or fat can make one look worse than not having surgery at all. It can also make male eyelids appear “feminized” and female eyelids more hollow. By using the latest techniques, Dr. Pearlman creates a more youthful, yet natural look.

Questions? Contact Dr. Pearlman about eyelid lift procedures


Answers to frequently asked questions about the procedure

Q: Can Plastic Surgery Help my Eyes Look Less Tired?

Eyelids can look "tired" from a number of reasons. The more common ones are bags under the lower eyelids, excess skin of the upper and/or lower eyelids and drooping of the eyebrows. You don't have any of these.

Your eyelids slant downward towards the sides; the corner where the upper and lower eyelids meet (called the canthus) is lower towards your ears than near your nose. There are a number of surgical techniques that can be used to raise the lateral canthus. Sometimes, there may be some hollowness of the bone of the eye socket as well. This is also treatable. Seek out a surgeon who is versed in this procedure for a more definitive discussion.

Q: How long does a rhinoplasty last and at what point will you need to do additional maintenance?

A: A rhinoplasty will last for the rest of your life. However, even a nose that has undergone a rhinoplasty ages like the rest of your face and body. As we age, the nose begins to droop. After a rhinoplasty they will age from where they were after the procedure. The procedures we do for an aging nose is often more subtler than a formal rhinoplasty.

Q: What is a "mini lift"?

A mini-facelift of today was the maxi-facelift of 2 decades ago. Mini or maxi, best to discuss with your doctor.  There are many definitions of what a mini-facelift is. For some it's a shorter incision, for other doctors its less work on the muscle called the SMAS. The technique depends more on the doctor's skill and your anatomy. For a patient in their early 40's, you often don't need the same deep plane facelift that someone in their 50's or above might need. Most of these procedures address your jowls.

Q: If I were to have a rhinoplasty and septoplasty, would I go to a facial plastic surgeon, ENT or Plastic surgeon?

A: Performing both a quality septoplasty and rhinoplasty is dependent on the individual's training and experience. Generally, facial plastic surgeons start with ENT training before they move on to facial plastic surgery. Although they are not formally trained, many plastic surgeons can also be experience and qualified to perform septoplasty procedures. The main focal point should be how much training they have received and how much experience do they have performing the procedures together and separately. There are subtle signs that could indicate if the proposed surgeon is right for you:

  • Did the surgeon look inside my nose? (As surprising as it sounds, in a number of my revision consults, patients often say that their original surgeon never looked inside their nose.)
  • Do they have specialized instruments to tackle the procedure? (A special headlight, nasal instruments, etc.)
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