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Blepharoplasty Procedure Palo Alto

View Before and After PhotosThere are many different procedures designed to improve the appearance of the eyelids and the orbital area around the eyes. A list of improvements might include: giving the upper eyelids a more open look, altering somewhat the native ethnicity of the eyelid when requested, or diminishing the puffiness, lining or hollowness of the lower eyelids. Eyelid surgery may involve either lid or both upper and lower lids.

Upper Eyelids

With time, upper eyelids become saggy with excess lax skin, redundant or lax muscle and excess fat. Hooding or heaviness of the upper eyelid occurs on a congenital basis or is acquired with age. This heaviness often results in a tired or sleepy appearance. Cosmetic improvement is not the only reason to consider an upper blepharoplasty. Function can also be a factor. Vision can be compromised when the upper lid droops (ptosis) and partially covers the pupil. The individual actually has a “field of vision” restriction, due to the hooded skin. If substantial, insurance companies may partially cover the upper eyelid procedure. They will want photographs and/or a visual field computer test to establish the patient’s candidacy prior to surgery. This will be evaluated at the time of your consultation.

Correction involves a delicately planned skin excision in the eyelid crease that must defy detection. Redundant muscle and excess fat can also be addressed. Whether cosmetic or functional in nature, the natural shape of one’s eye is restored to their more youthful appearance by enhancing or redefining their natural crease.

The ethnicity of the upper eyelid can be somewhat changed by establishing the upper eyelid crease when there is none. This is at times requested by Asian patients who may lack the supratarsal crease. Sometimes it is referred to as the westernization procedure. When this is done, it is important not to disturb the beauty of the Asian eye. Maintaining the medial canthal area in its natural state and keeping the new crease no higher than 6 mm achieves a pleasing result. At times removal of a little fat is also indicated according to the patient’s desire.

An upper blepharoplasty opens the eye in 100% of patients. However, some may prefer an even more open look if the eyebrow position is very low or encroachment is a problem. This can be done via a brow lift procedure. The different options will be covered in the forehead section of this website.

An additional treatment that can be added to the upper eyelid procedure if desired, involves the overactive frown muscle (corrugator). It can be adjusted to minimize the frown activity via the eyelid incision. It is easy and efficient and takes a minimal amount of time during this procedure.

Lower Eyelids

A lower blepharoplasty can correct excess lax skin, puffy fat deposits and/or hollowness evidenced by the eyelid-cheek demarcation. The conventional lower eyelid incision is made just under the lashes and is designed to defy detection. Patients sometimes ask about making the incision inside the eye. This technique is called a transconjuctival incision. This approach should only be considered for fat removal. Although some mid face work is possible, it is awkward and often sore for some time. In addition, the transconjunctival incision allows no excess skin removal which is essential for a nice result in many patients.

Fat of the lower eyelids should be retained and repositioned in 98% of the patients. Congenital based lower lid fat may be in excess and a little removal may be okay. Almost no one over the age of 35 has excess eyelid fat. Many become fat deficient about the eyes and face with age. Age promotes a hollow skeletal appearance. We must save the fat and reposition it in deficient areas. This works beautifully. I emphasize again; lower eyelid fat should almost never be removed. Fat loss is an aging indicator.

Customarily, lower eyelid procedures involve just excess skin removal, repositioning excess fat or removing some fat. It behooves us however, to consider the 20 year old appearance and compare it to an older person. In the younger person it is often hard to see where the cheek ends and the eyelid starts. There is a distinct lack of eyelid/cheek junction definition. There is no line of demarcation. No line where you can say this is definitely eyelid and this is definitely cheek. This is the appearance of youth! As aging increases, the distinct demarcation becomes obvious. Sure, there will be exceptions to the rule, but 97% of the time, the cheek/eyelid demarcation becomes increasingly obvious with aging. Fat herniates from around the eye and we see puffiness. It is not excess fat and should almost never be removed. Using the same blepharoplasty incision, demarcation can be improved and often nearly eliminated by gently elevating the underlying cheek tissue and securing it to the orbital bony rim at the same time as a lower lid blepharoplasty. Muscle suspension with some skin removal and fat transfer to the concave areas will further enhance a youthful restoration. Another benefit derived from adding this procedure to the blepharoplasty, is an improvement of the nasolabial folds (lines from the corner of the nose to the corner of the mouth).

Historically, much fanfare has been made about procedures referred to as a mid face lifts, cheek lifts, malar component lifts or composite lifts. It is definitely true that a facelift performed simultaneously with the lower eyelids, adequately lifts the cheek with a high SMAS (high support) and eradicates the eyelid cheek junction demarcation. However, even in this case, the mid face cheek elevation via the lower eyelid incision is so straight forward and productive, that I like to do it for an even better result. The facelift, eyelid, and mid face combination gives the maximum enhancement with longevity

To subdue eyelid wrinkles or to smooth crinkled eyelid skin, the surgeon must remove the upper layer of the skin and let it heal smoother and hopefully a little tighter. This is accomplished by either using a laser, chemical peel or electrocautery technique. I have found laser improvement of the lower lids very short lived and unimpressive at best. Pushing the laser to create greater skin contraction could result in a pulled down “hound dog” look. The laser sounds good, high tech and all, but I have found it not nearly as effective and safe as a chemical peel. Laser is also a lot more expensive.

In conclusion, the incisions for both upper and lower blepharoplasty defy detection when properly placed. This “out patient” procedure is performed either awake or asleep, depending on the health and the patient’s desire. Eyelid surgery can be performed separately or in combination with other procedures. Pain is minimal and recovery is rapid. Sutures are removed in 4 to 5 days. Activities that would elevate the blood pressure should be avoided for two weeks. After two weeks full activity is allowed.

For more information on having eyelid surgery in Palo Alto or San Jose, San Francisco areas – contact board certified plastic surgeon George Commons today.

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