Blepharoplasty, Chapter 9 What Plastic Surgery Can Do For You, In Save Your Face, By Brooke R. Seckel, M.D.,FACS
Eyelid Rejuvenataion – Blepharoplasty
The eyes are truly the “windows of the soul” and of all our facial features, considered to be the most important. Studies have been done on infants who were shown only portions of their mother’s face, chin, mouth, nose, forehead, and eyes. The one part of the face they most frequently and easily recognized was their mother’s eyes.
Unfortunately, as I mentioned in Chapter 2, we age first in our eyes, most commonly in the 30s, and some of us in our late 20s. Eyelid rejuvenation is by far the most common and early plastic surgery operation I perform. The results are usually dramatic, pleasing and successful.
Blepharoplasty is intended to correct or partially correct the following aging changes:
· Hooding or hanging skin of the upper eyelid
· Puffiness (fat herniation of both upper and lower eyelids)
· Laxity or looseness of the lower eyelid
· Tear trough deformity (that line under the lower eyelid often called dark circles under the eyes).
A blepharoplasty alone cannot correct:
· Brow sagging
· Eyelid wrinkles
· Aging damage to eyelid skin
· Crow’s feet
Personally, I use the laser for my eyelid rejuvenation procedures. There is less bruising and quicker recovery. Also, I don’t make an incision on the outside of the lower eyelid. I use the laser to make an incision on the inside of the lower eyelid, the pink part (transconjunctival blepharoplasty.) From the inside of the lower eyelid, I remove or reposition the fat to remove the bulge and partially correct the tear trough deformity. I also use the laser on the inside to shrink or tighten the underlying muscle. Following these maneuvers, I frequently do what is called a canthopexy. The canthopexy is a procedure done through the upper eyelid incision to tighten the tendon of the lower eyelid, re-creating the nice curved, upward slanting lower eyelid appearance of our youth.
I then do laser resurfacing on the skin of the lower eyelid to rejuvenate the appearance of the skin and remove crow’s feet. What’s the point of tightening the lower eyelids and removing the bags, if the patient still has sun damaged aged skin on the eyelid? Patients must go through a period of healing during which the lower eyelid is red, but when the eyelid has healed and the patient sees brand-new smooth skin on the eyelid, they are very happy. (Figure 9-5).
igure 9-5. Before (left) and after (right) laser blepharoplasty.
Eyelid wrinkles and crow’s feet are also caused by the pulling of the muscle underneath the skin. Therefore, in my practice, I use Botox® to quiet the muscle after surgery and encourage the patient to continue to have Botox® treatment of the “crow’s feet”.
The laser is a marvelous, technologically- advanced tool that can create optimal results in eyelid rejuvenation. Not all surgeons are comfortable with or competent in the use of the laser. You should find a doctor experienced in and comfortable with the use of the laser.
Complications are rare, but you must be informed: Bleeding, infection, scarring, dry-eye syndrome (very serious), and ectropion, a sad-eyed or “hound dog appearance” more common with the external scalpel incision on the lower eyelid. (Just walk down Rodeo Drive or Fifth Avenue and you will see it!) Other complications include loss of eyelashes, damage to the eye or even blindness (1 in 800,000 operations.) These complications are rare, but serious. Your surgeon needs to discuss them with you.
The above procedures are the most common and effective plastic surgical operations to correct facial aging. In the next chapter I will try to help you to make a very important decision if you are considering having plastic surgery. Contact me by email for further information or read Save Your Face.
1. Seckel, B. R. Aesthetic Laser Surgery, 1st Ed.