Posts

Lower eyelid blepharoplasty is commonly performed along with an upper eyelid blepharoplasty (eyelid lift). Lower eyelid blepharoplasty helps to remove baggy lower eyelids and take away the shadows that make your eyes look tired.  Here are the most common questions, with answers, that we get from patients about the procedure.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How is lower eyelid blepharoplasty performed?

Lower eyelid blepharoplasty is performed by making an incision through the inside of the lower eyelid (transconjunctival approach). Through this incision, the fat pads in the lower lids that form the bags are either removed or repositioned. This smoothes out the lower eyelids. Normally, skin is removed from the lower eyelid just below the eyelashes as well. This is closed with dissolvable stitches.

Question: What will I look like right after surgery?

Lower eyelid blepharoplasty normally causes some bruising and swelling of the lower eyelids, which can travel into the cheeks. The bruising lasts about 2 weeks. The swelling can take 2-6 weeks to completely resolve, depending on your age and the health of your skin.  I tell people they’ll look like they’ve been in a fight, but won’t have significant pain.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: What do I have to do after surgery so I heal properly?

The most important treatment for lower eyelid blepharoplasty is to use ice on the eyelids 20 minutes, on and off, for the first 48 hours after the procedure. This will reduce swelling and speed recovery. You’ll also use antibiotic ointment on the incisions 3-4 times daily for the first week.  Avoiding strenuous activity and not touching the incisions excessively is also important to allow healing.

Question: How long does healing take?

Lower eyelid blepharoplasty takes about 6 months to completely heal, but within 3-4 weeks, you’ll have a good idea of what your appearance will be like. You can conceal any of the mild redness with light makeup.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How long does it last?

While your skin will keep changing after surgery, you can expect the lower lids to look great for many years. It is uncommon that we have to repeat lower eyelid blepharoplasty.

Question: How much does it cost?

Costs vary around the country and depending on if you have lower eyelid blepharoplasty along with other procedures.  As of March of 2016, when this article was written, we charge $2500 for the lower eyelids alone, when done in our office.  When done together with the upper eyelids, the cost is $4000. We also recommend having an anesthesia provider present, which costs around $300 extra.  When done in conjunction with other elective surgery in a surgery center, we charge $1500 for the lower eyelids, which doesn’t cover the extra facility and anesthesia charges.

Brow lift surgery, as mentioned in our last post, can be achieved by several different methods. We’ve already mentioned coronal and pre-trichial techniques. In this post, we’ll talk about endoscopic brow lift surgery, direct brow lift surgery, and the internal browpexy.

 

Endoscopic brow lift incisions

Endoscopic brow lift incisions

Endoscopic brow lift surgery

Endoscopic brow lift surgery is performed by making 2-3 small incisions just behind the hairline. Through these incisions, the forehead and brow skin and muscles are lifted off the bone, pulled up, and then held in place with either stitches or a fixation device. Like the other brow lift surgeries mentioned before, the head is wrapped for a few days afterward. Recovery is usually fast with minimal pain. Incisions are closed with staples, which are removed after about a week. Bruising tends to be minimal, unless paired also with an eyelid procedure. Pros: Less invasive than coronal or pre-trichial brow lift surgery due to the smaller incisions; scars are hidden within the hairline; it raises the forehead and brows giving a nice outcome. Cons: Because no tissue is removed, results can be temporary; may not be any more effective than browpexy, but has harbors more risk. My conclusion: Endoscopic brow lift surgery was once my surgery of choice for droopy brows. It seemed to offer the lowest risk of scarring and resulted in a nice looking brow elevation.  After performing dozens of these procedures and then watching patients long term, I found that the results just weren’t as compelling as I wanted. It seemed that most of the improvement came from the eyelid surgery done at the same time. I have almost completely stopped doing this procedure for this reason.

Internal browpexy

The internal browpexy is a way of lifting or supporting the brows using the same incision made to lift the eyelids. After excess eyelid skin is removed, further dissection is made under the eyebrows, which releases the muscles that hold them down, allowing them to rise. The brows are the stitched in a higher position. The eyelid surgery is then finished and the wound is closed. The eyelids are covered in antibiotic ointment. No bandages are needed.  Recovery is just like that of eyelid surgery, with some tenderness of the brows. The deep stitches take 6-8 weeks to fully dissolve, which can cause tenderness when the brows are touched.  Pros:  Least invasive of all the brow lifting techniques; can lift the brows 3-4 millimeters and prevent them from falling further; scars are well hidden. Cons: Because no skin is removed, it is likely to eventually fail as gravity and skin changes continue. My conclusion: I use browpexy on many patients who either don’t want or couldn’t tolerate a larger brow lift surgery. In many cases our goal is to simply keep the brows from falling further, which can happen after eyelid surgery. Browpexy does this well. I always explain that it isn’t a true brow lift and shouldn’t be expected to make a striking difference in their appearance. It is most helpful when the vision is being blocked by both the eyelids and brows and both need some attention.

As you can see, there are many ways to lift the brows. Brow lift surgery is well tolerated and most patient have great outcomes with better peripheral vision. If you have questions, feel free to call us at (801)264-4420.

Dark Circles Under Eyes: 5 deep tear trough treatments

We’ve talked before about dark circles under eyes. One of the most common causes is a deep tear trough.  The tear trough is that depression extending from the inner corner of your eye diagonally toward your cheek.  This depression occurs where the facial fat has thinned out and dropped down into the cheeks. The bone of the eye socket is now right below the skin and the two are fairly well attached to each other.  As the skin above and below age and change, this area becomes even more apparent. It can become dark and develop a noticeable shadow, which makes one appear tired and more aged.  There are many options to treat this, and the methods are changing as we better understand facial aging.

dark circles under eyes - Facial filler Juverderm

Juvederm treatment under eyes and around mouth.

1. Make-up:

Many women (and even some men) utilize concealer in this area to lighten the skin and diminish the shadow.  When the problem is subtle, make-up is a great, non-invasive and inexpensive treatment.  As the problem worsens, however, make-up cannot fully hide the changes and may begin to accentuate it.

2. Skin lightening creams:

In certain people and ethnic groups, the skin in this area darkens. This can be due to actual pigment changes in the skin or from very shallow blood vessels just below the thin skin. When it is pigment related, skin lightening creams, such as hydroquinone, can be effective.  When starting this type of treatment, it is helpful to consult a skin specialist or aesthetician highly experienced in its use. Start with a weaker concentration (no higher than 4%) and use it for a short time until you are sure you aren’t especially sensitive.  Slowly increase the use and concentration until the desired effect is achieved. Rarely will these types of creams completely fix the problem, but they can make a noticeable improvement.

dark circles under eyes - Hydroquinone skin cream

Hydroquinone skin cream

3. Phototherapy:

Intense pulsed light, and even some laser treatments, are used to lighten skin pigmentation and tighten skin in the under eye area. Often this is proceeded by use of a topical lightening cream and possibly a short course of Retin-A to maximize effect.  Again, this should be done by someone with a lot of experience in administering the whole treatment.  Different skin types react differently, so be sure your practitioner explains how they are tailoring your treatment to you personally.

4. Facial Filler:

Hyaluronic acid fillers such as Juvederm, Belotero, and Restylane are well suited to treating the tear trough area when the problem is loss of facial fat volume.  Filling this area back up with a substance that is similar to the building blocks of normal collagen can give a new youthful appearance to the mid-face. It is relatively inexpensive, costing around $500 for a treatment. In many cases it lasts 12-18 months.  Filler is injected with a small needle into the space directly above the bone and then massage around until it appears smooth.  In a few weeks, it softens up be hardly be felt.  It is a safe procedure with some occasional bruising taking place. When injected deep, the chances of it getting into a blood vessel and causing problems in uncommon, although this is the greatest risk. See Dr. Harris explain more about facial filler in a short video here.

dark circles under eyes - Belotero facial filler

Belotero facial filler

5. Lower eyelid fat repositioning and blepharoplasty:

When fat in the lower eye socket begins to come forward, it creates a bag in the lower eyelid. A crease forms at the bottom of the bag over the bone of the eye socket. Lower eyelid surgery (blepharoplasty) is performed to move fat from this bag into the upper cheek and tear trough, which fills in the depression and returns the fat to a normal location, where it was before it descended into the cheek.  In some people, a portion of the fat is also removed. In others we also remove a small amount of skin below the eyelashes. All of these techniques serve to smooth out the transition from the eyelid to the cheek, which is a hallmark of a youthful, rested appearance. See our gallery for eyelid before and after photos.

If under eye shadow or bags are a problem for you, give us a call for a free consultation at (801)264-4420, or email Dr. Harris directly at [email protected].

In our office, we see people everyday who are dissatisfied with the appearance of their lower eyelids and are seeking lower eyelid blepharoplasty. Whether it be due to bags that have formed or deep tear trough lines, the lower eyelids can make give us a tired or even ill appearance. We’ve written before about lower eyelid bags and shadows and it is important to figure out if your problem can be easily remedied, or if surgery is in order. When, with the help of an oculoplastic surgeon, you determine that you will need some surgical intervention, it helps to know your options and the best techniques to achieve a good result.

 

lower eyelid bags

Lower eyelid bags

What lower eyelid blepharoplasty (eyelid lift) complications can occur?

Over the past 30-40 years, lower eyelid blepharoplasty has changed tremendously. As surgeons have gained a better understanding of facial anatomy, facial aging and how the tissues respond to surgery, their techniques have evolved. The standard practice for lower eyelid blepharoplasty used to be creating an incision below the eyelashes, dissecting through the muscles and soft tissue layers, exposing and removing fat, then removing excess skin and closing up.  This technique worked for some, but very often caused scarring in the lower eyelids, which pulled them down and/or out away from the eye.  Patients would end up with dry, irritated eyes, eyelid redness, and possible inability to close the eyes.  Others may not have scarring, but the removal of fat alone would cause a hollow appearance, especially in thinner patients.

How is lower eyelid blepharoplasty performed today?

Techniques evolved and most surgeons have updated how they perform the surgery.  We now commonly make our incisions through the inside of the eyelid to access the excess fat.  This avoids dissecting through tissues that commonly cause detrimental scarring.  The three fat pockets of the lower lid can be partially removed, or the fat can be moved into areas, such as the tear troughs, where it is missing causing a sunken appearance. Once the fat is repositioned or removed, a small amount of extra skin can be removed through an incision below the eyelashes, without any dissection that can cause scarring.  We also will often tighten the lower eyelid from the outside corner to ensure it stays in a youthful position and doesn’t pull down or away.

What is the recovery for lower eyelid blepharoplasty?

Eyelid surgery almost always causes bruising and swelling, though this may vary in intensity.  Bruising resolves in 1-2 weeks and swelling can take 1-4 weeks, but longer in some individuals.  Pain is minimal, but some have itching as they heal.

What will I look like after lower eyelid blepharoplasty?

Check out our before and after photos by clicking here.  Here are a few examples:

upper and lower blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty

If you have questions, email Dr. Harris at [email protected], or call our office at (801)264-4420. To read what other surgeons have written on the subject, start by clicking here.

Our second day of lectures and surgery was much like the first, only the Vietnamese doctors were eager to get their hands into the work and apply what we were showing them. On day one, a certain doctor followed me closely, recording with his cell phone several of my procedures.  He stood so close with his phone that at times it blocked my view.  I could tell he was paying close attention because he would comment if I did something slightly differently than I had explained in our lectures.  I would explain that every case is a little different and there is a time for following the textbook and a time for customizing your surgery for the patient. He wanted to know what prompted my every decision and was clearly a very perceptive and intelligent man.  On this second day, when I returned to start a particular case after scrubbing, I found him in my chair at the head of the bed.  I asked him if he was ready to lead the case, which he said he was.  I let him at it and he did a marvelous job.  He clearly had some surgical experience as he handled the instruments with confidence.  He would clarify the surgical steps with me just to be sure, but it was amazing to me how fast these doctors picked up our techniques.  I have no doubt they’ll be able to continue performing many of the surgeries we taught them. 

Dr. Call giving instruction

 
Recovery
 

Dirty feet, happy patient

 Our last day in Dong Anh was spent doing a few extra surgeries in the morning.  We then left our hotel there and moved to downtown Hanoi.  On our way we met with a few other hospital administrators.  It seems once word gets out that you are willing to come to Vietnam and bring equipment with you, lots of hospitals want to convince you to come the them on your next trip.  The following day we travelled out to Ninh Binh, an outlying area with a large eye hospital.  We looked at their needs and assessed what we could do on a future trip.  They then took us to a few of their nearby tourist sites, which was very nice.  We saw a thousand year old Buddhist temple and a newly built, massive pagoda.  The country-side was beautiful the people were all very gracious.  We look forward to returning soon.

 

God of Ninh Binh

 

Big pagoda

I came across this video segment from ABC news about men and facial plastic surgery.  Botox use and eyelid surgeries among men are becoming increasingly popular.  I’ve seen and operated on quite a few men the past few months, many of whom were told by their wives that it was time to address their drooping eyelids. Check out the video below.