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The results of blepharoplasty can be stunning and create a truly refreshed younger look to the entire face. Patients who seek blepharoplasty often complain of a tired look. The most common complaint I hear is that “people say I look tired when I am not”. The goal is to remove the tired look, the eyelid bags, the dark circles and tighten skin. Blepharoplasty alone does not remove wrinkles. Wrinkle removal requires resurfacing of the skin by one of many different new techniques.

One common problem following the blepharoplasty operation however is that the operation can change the shape of the eyelid. In some cases, after surgery the outer portion of the lower eyelid turns down revealing too much of the white portion of the eye. Technically this is called scleral show, and if it is extreme it is called ectropion and can damage the eye.

More commonly this complication is called the sad eyed look or hound dog eyes. It is very distressing to those patients who have this complication.

Fortunately, the sad eyed look or hound dog eyes can be avoided by a newer blepharoplasty technique called the transconjunctival blepharoplasty.

Traditional “old style” blepharoplasty is done through an incision on the outside skin of the lower eyelid placed just beneath the eyelashes. The surgeon cuts through the skin and the eyelid muscle to get to the fat that is removed to lessen the eyelid bags. Often skin and muscle is also removed to lessen the amount of excess skin on the eyelid.

The problem with the standard “old style” scalpel blepharoplasty technique is that when the surgeon cuts through the muscle which supports the lower eyelid the support for the eyelid is often lost. In addition, the scarring produced by the surgery tends to pull the eyelid down. If the patient has a lax lower eyelid to begin with, the situation is made much worse.

The modern blepharoplasty, called the transconjunctival blepharoplasty is done very differently and avoids injury to the supporting eyelid muscle. The conjunctiva is the pink part of the eyelid on the inside. In transconjunctival blepharoplasty the incision for a blepharoplasty is made through the conjunctiva on the inside of the lower eyelid and avoids damage to the supporting muscle. The fat is removed or repositioned from the inside and the lid tightened and an arcus marginalis release performed to correct dark circles. Laser blepharoplasty, that is using the laser to make the transconcunctival incision and tighten the skin and muscle, is becoming much more common today as blepharoplasty techniques continue to improve.

The benefit of the transconjunctival blepharoplasty is:

1. There is no visible scar on the outside of the lower eyelid
2. The eyelid shape is not changed
3. Healing time and recovery is usually quicker
4. Bruising is often less
5. The sad eyed look or hound dog eyes is avoided

If you have a lower eyelid that is lax or loose or if your outer lower eyelid turns down, there is a serious risk that you may have the sad eyed look or hound dog eyes or worse if you have an old style blepharoplasty with the incision on the outer eyelid. Not all plastic surgeons use the transconjunctival blepharoplasty technique. I think it is very important to ask your surgeon about it if you are considering blepharoplasty especially if your lower eyelid is loose or lax.

Contact me for further information or read about the transconjunctival blepharoplasty in Save Your Face.

Dr Seckel

Facelift-Contact Dr Seckel

While Plastic Surgery is truly a much more comprehensive field including reconstructive surgery following burns, cancer surgery, and birth defects, the image most often projected in the media is that of image or beauty enhancement and non-surgical and surgical facial rejuvenation of otherwise normal people by surgery.

Blepharoplasty-Contact Dr Seckel

Revolutionary technological advancements in the past decade have significantly impacted the field of Plastic Surgery creating a shift from traditional surgical procedures to new non-surgical methods for correcting aging changes and improving appearance.

Laser Resurfacing-Contact Dr Seckel

Today Botox® injections can remove crow’s feet, frown lines, worry lines, and help lift the sagging brow. Prior to Botox® major facial surgery such as a brow lift and blepharoplasty (eyelid lift) were performed to correct these aging changes.

Botox-Contact Dr Seckel

New fillers such as Restylane® and Radiesse® are injected into the nasal-labial fold, lips, and marionette lines, those deep lines running from the lips down around the mouth and chin. Previously, a face lift was performed to correct these lines.

Fillers-Contact Dr Seckel

Skin tightening technology such as aluma, ActiveFX, LuxIR, Titan® and Thermage® are becoming better and can improve facial sagging in 30% patients if used early before the sagging is severe. Many patients choose to have one of these techniques rather than a face-lift. Many other new exciting techniques for laser restoration of skin collagen (Laser Genesis®) and improvement in skin wrinkling, removal of pigment, and removal of red spots and blood vessels on the face are already in use today.

These dramatic advances coupled with increasing public awareness of the importance of sun protection, a healthy anti-inflammatory diet, exercise, stress reduction, and a healthy lifestyle undoubtedly will impact the Plastic Surgery practice of the future. The Plastic Surgeon of the future will still have to be a highly skilled, knowledgeable surgeon, but I predict he/she will need to be an expert in the newer laser, light, pharmacological, and lifestyle therapies as well.

Plastic Surgery is becoming more non-surgical with every new technological advancement. The 6-step facial rejuvenation program encompases all the new non-surgical facial rejuvenation techniques. For questions read Save Your Face, or contact me.

Dr Seckel

The threads are placed beneath the skin using a needle attached to the “thread’. The needle is passed through the skin at a point low in the cheek, passed under the cheek skin up to a point higher on the face and then passed back out through the skin. The “thread” has small barbs sticking out which attach to the undersurface of the skin and pull up on the skin as the “thread” is tightened from above creating a face lift.

Although the Feather lift, Thread lift, and Russian lift are being marketed as a non-surgical face-lift, a no down time face-lift, a lunch time face-lift, and other such terms, you must understand that these are surgical procedures. In fact they are a surgical implant procedure, and complications can and do occur.

Before undertaking a Feather lift, Thread lift, or Russian lift you need to be aware of several potential problems:

1. bruising and down time
2. infection
3. extrusion – that is the thread pushes out onto the surface of the skin
4. Injury to the facial nerve – this can paralyze your face
5. “divits” or visible dents or depressions in your face
6. scarring
7. failure to lift the face
8. Excess skin bulge above the exit point of the needle and thread

Bruising and Down Time

Injecting a local anesthetic (required for these procedures) and passing a needle and thread beneath the skin for a facelift damages blood vessels and causes bleeding. Bleeding under the skin causes bruising. You will have bruising following this procedure. Some of you I know can go to work with bruises and swelling on your face, but most people don’t want to. If you have one of these procedures be prepared for swelling and bruises that can last up to 10 days, sometimes 2 weeks.

Infection

Anytime you enter the skin with a needle or other foreign object bacteria can be pushed into the skin and cause infection. Good surgical technique-scrubbing with an antiseptic solution and using sterile techniques- and antibiotics help, but infections happen in spite of these precautions.

Placing an implant, such as a thread, under the skin introduces a “foreign body” under the skin and greatly increases the chances of an infection.

Extrusion

Our bodies recognize and try to reject or push out foreign material. A splinter is a good example, notice how the splinter becomes infected and the pus eventually pushes the splinter out. When the body rejects or pushes an implanted material out it is called an extrusion

Although medical devices such as breast implants and the facelift “threads” can be implanted safely, the implanted material musty be inert-hard for the body to recognize-and must be perfectly sterile and placed with meticulous sterile surgical technique. In addition, the body tissue around the implant must be healthy, and generally the deeper the implant is placed in the body the better the chance that it will not be rejected.

Since the threads used in facelifting techniques like the feather lift, thread lift, and Russian lift are placed close to the surface of the skin the chances of infection, rejection, and extrusion are greater than implants placed deeper in the body.

Injury to the Facial Nerve

This is the most dreaded and debilitating of all complications of any facial surgery, including a face lift. Damage to a facial nerve branch is often permanent and causes paralysis or sagging of the face, inability to smile or raise your forehead, and can cause difficulty closing your eyelids.

Board certified plastic surgeons spend many years learning how not to injure these nerves during face lift surgery and understand and recognize the locations of these nerves so that they are avoided and not injured.

The feather lift, thread lift, and Russian lift are Blind Procedures, meaning that the needle and thread are passed beneath the skin without the surgeon being able to see the structures, under the skin, that the needle is passing through. If the needle is passed a little too deep or through an area where the facial nerve is close to the skin, the nerve can be injured and facial paralysis can result.

Divits or visible dents or depressions on your face

One problem that surgeons have had with the feather lift, thread lift, and Russian lift face lift techniques is that on occasion, the barbed thread catches hold of the underside of the skin tightly in one location on the face. When this happens, the upward pull on the cheek is entirely placed at that one spot. The cheek is “hooked” from underneath at that one spot and creates a dimple or depression on the skin of the cheek creating an unsightly deformity.

Scarring

When you break or enter the skin whether with a scalpel or a needle the skin always forms a scar. Of course a needle puncture creates a smaller scar than a scalpel. However if the needle, a large one in the case of the Feather lift, thread lift, and Russian lift, passes through the skin it will always leave a mark.

If the needle needs to be passed through the skin several times to get the right position, and at the exit point where the thread is tightened and tied, a scar is likely to be larger.

If the thread becomes infected or a divit or depression forms, the thread will need to be removed surgically, and a larger scar will result.

Failure to lift the face

Threads can fail and the face can drop.

Excess skin bulge above the exit point of the thread

Take your hands, place them on your cheeks and push your facial skin up to tighten the face to make it look younger. Do you notice the excess skin bulging above your hands high up on your face and around your ear?

This is what you will see if you have a face lift and the surgeon does not remove or cut away the excess facial skin.

This is the biggest limitation and drawback to the feather lift, thread lift, and Russian lift facelift techniques. Although with proper surgical technique the threads can be used to pull the cheek up, if you don’t do surgery to remove the excess skin you will be left with an unsightly bulge of excess skin. Most websites recommending this procedure say it is only for younger patients who don’t have much excess skin for this reason.

Summary

The feather lift, thread lift and Russian lift facelift techniques may well in the future be useful techniques for younger patients with minimal skin sagging when performed by board certified plastic surgeons in an appropriate safe surgical facility. At present this technique is not recommended by the major plastic surgery societies. I would recommend waiting until this procedure has been studied further.

I certainly feel that much of the web advertising I have read is misleading especially when ads refer to this facelift procedure as “lunch time”, “no down time”, “no bruising” and “non surgical”.

As always “caveat emptor” let the buyer beware. Always seek the opinion of a surgeon certified by the American Board of Plastic surgery. (215-587-9322, www.abplsurg.org)

Also read chapter 10 of my book “Save your Face – The Truth About facial Aging, Its Prevention and Cure? entitled “Don’t Let Just Anyone Touch Your Face”. Contact me for any questions.

Dr Seckel

Boston, Massachusetts