Blepharoplasty to Rejuvenate the Eyes

Blepharoplasty is a common procedure to rejuvenate the upper eyelids. As we age, the skin on the upper eyelids accumulates and becomes lax. There is also the accumulation of fat behind the upper eyelids. A blepharoplasty procedure involves the removal of skin and fat from the upper eyelids. Typically, the incision is placed in the eyelid skin and the excess skin that hangs over the crease is excised.

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Blepharoplasty and Ptosis Repair

Blepharoplasty procedures are common procedures as patients tend to age. An upper blepharoplasty procedure involves removing the excess skin and fat from the upper eyelid compartments and then closing the skin at the location of the upper eyelid crease.  Occasionally, as people age, the muscle that raises the eyelid, the levator muscle, becomes weak or attenuated "stretched out".

This "stretching out" of the muscle that raises the eyelid can often cause one eyelid to appear more "droopy". This "droop" is called ptosis. At the same time that the blepharoplasty procedure is performed, the eyelid ptosis can also be corrected. Correcting the eyelid ptosis as well as the excess skin and fat can create a more rejuvenated appearance to the face.


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Blepharoplasty Surgery

Blepharoplasty surgery can be very effective for the rejuvenation of the face. As people age, the skin of the upper eyelids can accumulate and start to sag. This can often produce a tired appearance to the face. Not only can the face appear tired, the heaviness to the lids can cause the patient to feel tired.

This tired feeling often occurs at the end of the day as the lids work against the resistance of accumulated fat and skin.

Blepharoplasty procedures are usually performed under a general anesthesia. The procedure is an outpatient procedure so patients go home the same day of surgery. The procedure takes approximately an hour and a half. The patients are then in the recovery room for approximately 1 to 2 hours following surgery. Swelling persists for about one week. Bruising is variable among patients.

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Lower Face and Neck Lift

 

Lower face and necklift surgery is one of the most rewarding procedures that we perform in our practice. It is often one of the most powerful procedures for restoring a youthful look to the face. The areas of greatest improvement tend to be the neck, the jowls, the cheek, and the nasolabial fold.

During a facelift procedure, the bands formed by the platysma are sutured together to re-create the contour of the neck. The skin of the lower neck is then re-draped over the platysma. Not only is the area of the lower neck and mandibular border improved, but also the skin just above the clavicle or collar bones.

The volume of the lower third of the face is then lifted to its previous location that occurred many years earlier. The results are fuller cheeks and a softer contour along the mandibular border. During the facelift dissection the cheek is lifted to its previous position. This improves the contour along the nasolabial fold and replaces the lost volume beneath the eye.

After facelift surgery, the swelling tends to subside over several weeks. The facelift results tend to improve then over two, four, and six months and then reaches its full maturity at about one year.

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Facelift Surgery

Facelift surgery is one of the most rewarding surgeries for both the patient and the surgeon. I find that the goal of facelift surgery is to restore the patient to a younger version of themselves. This goal should be accomplished while also avoiding a "done" appearance to the face.

The typical patient who is an excellent candidate for facelift surgery is a patient who is starting to develop jowls, deepening of the nasolabial folds, and platysmal banding in the neck. Patients who are healthy pre-operatively tend to have a smoother recovery and an overall better aesthetic result.

The photograph above shows a patient who is three weeks post-operatively from a facelift.

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At six weeks post-operatively, the facelift begins to improve even more.

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Facelift Surgery

Facelift surgery can safely be performed in patients of all ages. Patients often come into the office and ask how old or how young does someone have to be to have a rejuvenation procedure performed.

Patients can be almost any age to undergo facial rejuvenation. I have had patients as young as early twenties undergo some sort of rejuvenation to the neck which may involve minor repositioning of the vector of the platysmal muscles.

I have had a patient who was ninety four years old undergo a facelift operation. The funny thing was that she asked me every day post-operatively, “When can I go back to playing racquetball?”

The point is that one can be almost any age to undergo surgery; they need to first have signs of facial aging that can be corrected with one or more methods. The last requirement, but most important, is that they need to be healthy to receive anesthesia and be able to comply with post-operative regimens. Blood pressure should be under control, other medical conditions stabilized, and exercise capacity should be high. Not only do physically fit patients recover well from anesthesia, they also get the best surgical results.

Facelift surgery is very helpful to restore the contour of the face, jowls, and neck. Facelift surgery not only improves facial contour, it also significantly improves the quality of the skin. After the deep plane facelift, the quality of the skin significantly improves both in tone and in texture.

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Facial Rejuvenation in the Male Patient

Facial rejuvenation in the male can be very powerful. There are subtle modifications of the facelift technique when performed in the male to maintain a masculine quality of the face and to also restore youth.

 
Male patients tend to see significant improvements in the lower eyelids following a facelift as now the cheek is restored to it's natural position. The lower eyelid is an important area to improve in facial rejuvenation, as this area can allow the face to appear better rested.


The jawline is also a significant factor for creating a youthful appearance in the male. Great attention should be placed on the neck contour and the position of the neck angle in relation to the thyroid cartilage.


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Blepharoplasty Surgery (Eyelid Surgery)

Q: What is commonly involved in a blepharoplasty procedure?

A: Anesthesia: Upper Blepharoplasty procedures are commonly performed under general anesthesia. I find that patients are often most comfortable under general anesthesia during an eyelid surgery.

The Incision: Incisions are made in pre-existing eyelid creases. Occasionally, if the creases are at different heights, then creases are set to a level close to approximating each other. The incision is then typically closed with sutures, skin adhesives or surgical tape.

After Surgery: Some swelling or bruising may occur, but will subside. The result will be a refreshed, younger looking you.

Q: What is the recovery time for upper blepharoplasty?

A: I typically tell patients that if surgery is done on Friday, they are fine going back to work on Monday...meaning e-mails, cell phone, phone conference meetings, or paperwork. Typically, I prefer if patients wait for a full two weeks before performing any heavy lifting or straining.

Patients are instructed to sleep with the head of their bed elevated for 48 hours to reduce swelling. Bruising can occur and can be visible for anywhere from 3 days to 3 weeks.

There is usually one suture placed on each eyelid that is removed at approximately 5 days following surgery.

All patients are given pain pills such as Percocet or Vicodin. Typically, patients do not complain of any pain following upper eyelid surgery and can easily convert to Tylenol or Motrin within a day or two.

Facelift Surgery and CO2 Laser: A Powerful Combination

 

 



Facelift Surgery is one of the more commonly performed operations for facial rejuvenation. Facelift surgery focuses on improving several signs of aging. When the fractionated CO2 laser is used in combination with a facelift, the results can be quite dramatic.

1.       Of all the areas on the face associated with facial aging, the neck is almost invariably the region that patients would like corrected. As we age, the platysma muscle in the neck becomes more lax. As the muscle becomes more lax, a banding appearance appears on either side of the midline of the neck. One of the most important maneuvers in facelift surgery is to improve the appearance of these bands.

2.       Another common area on the face that patients would like to improve are the jowls. As we age, the cheek tends to fall. As the cheek falls, the skin and subcutaneous tissue tend to hand below the level of the mandible. In the mid-portion of the mandible, the retaining ligaments are loose. This areas tends to lead to an ill-dfined mandibular border.  When a facelift is performed, attention is placed on lifting this area of the cheek so that the border of the mandible can be more readily seen.

 

 



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Facelift Surgery

One of the earliest signs of facial aging is the lower face and neck. Facelift surgery is one of the more common procedures performed in our practice.

Facelift surgery is designed to rejuvenate those areas of the face that have been affected by time. The most common areas that are improved in facelift surgery are the platysmal bands, the jowls, the nasolabial folds, and the area beneath the lower eyelid.

One of the rejuvenating benefits of the facelift is the restoration of volume beneath the lower eyelid. Typically, by lifting the cheek or restoring the volume beneath the lower eyelid, the face takes on a more youthful appearance.


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Male Blepharoplasty Surgery

There are an increasing number of male patients who present to our office who are excellent candiates for upper blepharoplasty surgery. Typically male patients begin to notice that they have developed an obstruction of their visual fields. This often is described as having difficulty seeing when driving out of their peripheral vision, a feeling of heaviness, or feeling tired early at work or in front of the keyboard.

When blepharoplasty surgery is performed for male patients, there are subtle differences in terms of the amount and pattern of skin to be excised as well as the positioning of the eyelid crease. Satisfaction is quite high with male patients who undergo blepharoplasty surgery.

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Blepharoplasty Surgery, Upper Eyelid Surgery

Blepharoplasty is a common procedure among young women. Women typically come into the office in consultation with a complaint that their eyes feel tired or heavy at the end of the day. They often describe a sensation of fullness on the lateral aspect of their upper eyelids that either makes them feel tired or look tired. 

Q: What is commonly involved in a blepharoplasty procedure?

A: Upper blepharoplasty procedures are very common. Blepharoplasty procedures are commonly performed under general anesthesia. I find that patients are often most comfortable under general anesthesia when performing surgery on the eyelids. I find that when the patient is relaxed, the entire surgical experience is much more enjoyable.

Q: What is the recovery time for upper blepharoplasty?

A: I typically tell patients that if surgery is done on Friday, on Monday they are fine going back to work...meaning e-mails, cell phone, phone conference meetings, or paperwork. Typically, I prefer if patients wait for a full two weeks before performing any heavy lifting or straining.

Patients are instructed to sleep with the head of their bed elevated for 48 hours to reduce swelling. Bruising can occur and can be visible for anywhere from 3 days to 3 weeks.

There is usually one suture placed on each eyelid that is removed at approximately 5 days following surgery.

All patients are given pain pills such as Percocet or Vicodin. Typically, patients do not complain of any pain following upper eyelid surgery and can easily convert to Tylenol or Motrin within a day or two.

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Ptosis Repair & Eyelid Surgery

Eyelid ptosis occurs when the levator muscle of the eyelid can no longer lift the eyelid or maintain it in its proper position. This commonly occurs with aging and often also occurs concomitantly with the accumulation of excess skin along the upper eyelids. The accumulation of excess skin along the upper eyelids is called dermatochalasis. It is not uncommon for the excess skin to accumulate along the upper eyelids and eventually obstruct the visual fields. Removal of the excess skin of the upper lids is called and upper blepharoplasty surgery. Often ptosis repair and upper blepharoplasty surgery can be done at the same time.

Not only can these two surgeries restore a youthful appearance to the face, they can also improve the patient's visual field. These improvements can have a significant positive impact on a person's quality of life as they now look and feel well rested.

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Lower Blepharoplasty, Lower Eyelid Surgery

Blepharoplasty surgery is common. Typically patients who wish to undergo blepharoplasty surgery complain of bags beneath their lower eyelids that do not disappear after a good night of sleep. As a result, patients often feel tired. Typically lower blepharoplasty surgery is performed on an outpatient basis. The incisions tend to be placed in the conjunctiva or pink part of the eyelid so incisions can be concealed. The fat from the lower eyelids is then carefully removed so as to not remove too much. At the same time fat can be transferred from one region of the body to the nasolabial folds or tear trough area.

Blepharoplasty in Facial Rejuvenation

Blepharoplasty is one of the more effective aesthetic procedures for facial rejuvenation in the right surgical candidate. Patients who present for upper blepharoplasty often complain of excessive skin or fullness in the upper outer quadrant of their eyes. Occasionally, this excess skin can obstruct their visual field or can simply cause a heavy feeling in the eyes giving the patient a tired appearance or tired outlook. Typically patients who undergo upper blepharoplasty report not only do they begin to look younger, but also feel younger.

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Laser Facelift:Fractional CO2 Laser for Young Women

The fractional CO2 laser is becoming a very effecitve tool for managing early signs of aging in the younger population. Early signs of aging such as crow's feet, lower eyelid skin laxity, and irregular pigmentation or dyschromias may be effectively managed by the CO2 laser. Many women who are in their early thirties and who present with early signs of aging often choose to undergo facial rejuvenation with the CO2 laser and then undergo facelift surgery years after CO2 laser resurfacing.

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Adjustment of the Platysma Position and Chin Augmentation to Improve the Neck

The relative position of the inferior portion of the chin to the neckline can have a significant appearance on how youthful a neck can appear. For example, to the untrained eye it may appear in the before picture that the neck would need to be tightened. In reality the chin needs to be lowered to the position of the neckline. The addition of a chin implant, mild submental liposuction, a platysmal repositioning can have a significant impact on the youthful appearance of the neck.

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The Laser Facelift: The Mixto Fractional CO2 Laser Facelift

The Laser Facelift can be very effective in patients with Fitzpatrick Skin Types I-III. The fractional CO2 laser can effectively tighten the skin around the upper and lower eyelids, the nasolabial folds, and the pre-jowl area. The CO2 laser is also very effective at reducing dyschromias or pigment irregularities on the face due to sun exposure.
The fractional CO2 Laser works by producing a controlled burn to the surface of the skin as well as stimulating collagen formation in the dermal layer of the skin. It is therefore quite common for the appearance of the face to improve up to one year or more after the procedure.
It is becoming more common for many women with Fitzpatrick Skin Types I-III to undergo fraction CO2 Laser skin resurfacing to improve the skin texture and then returning to undergo a formal facelift 2 to 3 years following the laser treatment.


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Facelift Surgery. Deep Plane Facelift & Fractional CO2 Laser

While the neck is often a significant area of concern for many patients who present for facial rejuvenation, I find that the deep plane facelift is very effective at restoring the position of the cheek.

In the youthful face, the cheek is positioned beneath the lower eyelid so that a smooth contour exists between the lower eyelid and the cheek. As we age, the cheek begins to descend, causing a gap to be created between the lower eyelid and the cheek.

When performing facelift surgery, the surgeon repositions the cheek back to beneath the lower eyelid to restore this contour. Often after patients have a facelift they remark about the improvement in the appearance of their eyes. This is because the volume of the cheek is now repositioned into the proper location.

The patient in the above photograph underwent deep plane facelift, and CO2 laser to her lower lids and peri-oral rhytids or “wrinkles”. In the before photograph she is 89 years old, in the after photograph she is 89 years and 10 months.

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Facelift. Male Necklift

Traditionally as male individuals age, the greatest signs of aging occur in the neck. Males often do not have deepening of the nasolabial fold as seen in females. Therefore, I often find the best way to rejuvenate the face in males is to address the neck.

This can be done with the same incision as seen in female patients to address the lower face and neck or it can, in some males, be performed with the z-plasty on the anterior aspect of the neck. The incision is limited to the area beneath the chin and above the thyroid cartilage.

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