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This can be done alone or with a skin resurfacing procedure, such as a deep chemical peel or fractional CO2 laser treatment, to peel off the upper layers and reveal the smoother skin below. Many patients will find that their lower eyelids age more quickly (or rather that the signs of aging are more readily apparent here) than the rest of their face. Holds, R. Anderson, and S. M. Thiese, "Lower eyelid retraction: a minimal incision surgical approach to retractor lysis, " Ophthalmic Surgery, vol.
Another useful technique is to leave the traction suture in beyond one week. Postoperatively, the patient can aid recovery with a few simple interventions—ice water compresses and head elevation. If the lower eyelid is loose or poorly supported at its outer corner (ectropion or lower eyelid laxity) a canthopexy or canthoplasty should be performed at the same time to tighten and support the lower eyelid. This 52 year old patient had extra skin that hung from her upper eyelids and fat pads below her eyes.
After the first week of healing, treat your scars nightly with Dermatix™ or other scar gel. Fat Transfer for Face. Are results of cosmetic blepharoplasty permanent? Pronounced or prolonged erythema is relatively uncommon and can be treated with topical 1% hydrocortisone cream or intense pulsed light treatments. Rapid treatment is critical. MINI PROCEDURES CAN BE COMBINED: more often than not patients choose to combine two or more procedures to achieve "optimal results. " Absorbable upper lid sutures either in the skin or buried, have a risk of tissue reaction or dehiscence. While a lower eyelid blepharoplasty may have a dramatic and long-lasting effect on lower eyelid enhancement, it is not the only option. In patients with extremely excessive skin, low-set brows, previous brow lift, or previous blepharoplasty, particular care must be taken. Post-surgery results can make you look 5-10 years younger. Expect compliments about how well-rested you appear – your face will not look "worked-on" when performed by Dr. Leong at Sistine Facial Plastic Surgery.
Increased risk exists in the patient with proptosis, such as a patient with thyroid eye disease or the patient with a large or projecting glaucoma bleb. Upper eyelid incisions are placed in the natural creases of your eyes. For lower eyelid blepharoplasty in Asians, transconjunctival fat removal yields far superior results to an external approach [34]. This is due to more rapid and wider diffusion of the local anaesthetic agent, affecting other structures such as cranial nerves. They usually present with some degree of excess lower eyelid skin and bunching under the eyes, but typically don't have significant 'pseudohernation' of the fat (often referred to as eyelid 'bags' by many patients). Oftentimes, these procedures are performed on both eyes during the same surgery session, as the cost is lower to treat both sets of eyelids at once than to perform them separately. Patients' concerns can vary immensely, ranging from a particular dislike of lateral hooding, a "staring" or "overdone" look (very common), a sunken look (a common concern in younger patients), to a fear of blindness to concerns about the length of the recovery period and intra- and perioperative pain. Figure 2 shows an example of upper lid retraction secondary to upper lid overcorrection. Swelling and bruising lasts up to 10 days at which time you are about healed. Performed under general anesthesia or local anesthesia.
Proptosis, decreased motility, and increased orbital tension, and associated bleeding are the clinical signs to appreciate. Why do the Eyelids Sag? Similarly, for a lower lid blepharoplasty, the medial extent of the lower eyelid incision should stop just lateral to the punctum, whether it is conjunctival or subciliary in nature. The fat under the eye almost appears to swell or become really puffy – this is sometimes after a time where that patient was hollow under the eye. Recognition is key, as is a rapid response. The lower eyelids are a common area of concern patients seek treatment for as excess skin and/or fat can make one look older or more tired than they actually are. In the transconjunctival approach, effective in improving lower eyelid bags and puffiness, Dr. Paul places the incision inside the eyelid. Dr. Mills removed the extra skin and fat to open up her eyes for a fresher, more youthful appearance. Lubrication, cool compresses, and observation are essential to resolution. The skin and muscles of the eyelids are half as thick as the rest of the face. The laser must always be directed away from the globe even through eye shields are in place.
Lower eyelid surgery, or lower blepharoplasty, is any surgery that's performed on the lower eyelid. The lower lid is then tightened if lax or given an upward vector with a minimal Elschnig tarsorrhaphy if not lax. Surgeon: Timothy Greco. In late cases, the relative contribution of lid laxity, skin shortage, and middle lamellar scarring is assessed by the "three finger test". CO2 skin resurfacing is useful to address skin redundancy and festoons (in patients with appropriate skin types). If essential, a lower incision is made and fat is teased forward between the skin and levator to prevent readhesion of these structures.
Eyelid surgery is very safe but complications can occur when patients over exert themselves. These should usually be delayed for 3 months or more if possible after the primary procedure to avoid surgical "tail chasing. " The patient was also treated with Botox in her forehead after surgery. Another mechanism is direct or indirect injury to the inferior oblique during surgery. The punctum is a useful landmark for the upper lid and lower lid incision. This gives dramatic skin tightening without cutting away skin. It is important to note that the pinch technique will not correct moderate to severe sagging, undereye bags, or heavy droopy eyelids. 32-year-old woman with wished rejuvenation of the fullness of the lower eyelids. The swelling can also cause the puncta to turn inwards or evert by swelling or tissue contraction caused by incision lines or laser resurfacing, which also causes epiphora. Erases a tired look in the upper facial third. The after is a photograph taken during a virtual follow-up.
C. D. McCord Jr. and J. W. Shore, "Avoidance of complications in lower lid blepharoplasty, " Ophthalmology, vol. True canalicular injury may require late repair if epiphora results. In some patients having traditional lower lid blepharoplasty the lower eyelid can end up being pulled down giving an eyelid malposition. What does blepharoplasty recovery look like? The patient will also have asymmetrical pain and decreased vision. A tweezers or forceps are used by the surgeon to pinch the excess lower eyelid skin, just below the eyelashes.
Ice water compresses should be utilized continuously for 3 days (except when eating or sleeping). More serious risks include asymmetry, dry eyes, scarring, or pulling down of the lower eyelids. To smooth eyelid wrinkles and tighten eyelid skin.
5mL of Restylane was added to further enhance the surgical results. This woman came to Dr. Levin complaining of hooded upper eyelids and dark circles. Cautery is performed as needed to ensure the site is bloodless. M. Hawes and G. Jamell, "Complications of tarsoconjunctival grafts, " Ophthalmic Plastic and Reconstructive Surgery, vol. Fat removal will help the first two causes, and laser skin resurfacing can aid the third if the pigment is relatively superficial. After lifting and smoothing the remaining eyelid skin, sutures will be used to close the incision. Remember also that when the preaponeurotic fat is grasped and the septal attachments divided, it is possible to pull the superficial levator aponeurosis up with it. Modern trends in upper blepharoplasty are designed to avoid creating a hollow upper eyelid.
This procedure is done alone if the patient doesn't have excess fat under the eyes as well. And how to compare and vet the doctors you're considering so you can choose the plastic surgeon or cosmetic physician who's best for your under eye surgery – and the "right one" isn't necessarily the same for everyone. At 1 month, mild redness of the incisions is expected, and usually goes away by 2-4 months after surgery. To avoid this, use a Q-tip backstop immediately behind the fat incision made by the CO2 laser. You just want to avoid makeup above the eye that could fall down into the incision line, so avoid placing makeup too close up to those incision lines. What does blepharoplasty not treat? Transconjunctival fat resection alone should be considered in younger patients who may have very little excess skin and whose skin may be resilient enough to tighten itself spontaneously postoperatively. Beware, that functional surgery, covered by insurance is not as comprehensive as cosmetic eyelid surgery. The Limitations include: bags and eye hollows are not addressed since the fat and muscle is not transposed or eliminated…only extra skin is removed with this mini procedure and it may need future maintenance as many mini's do.
If under "eye bags" are a concern, Dr. Thompson would like perform a lower blepharoplasty with or without fat repositioning instead or at the same time. No incision is required. Milder eyelid laxity is treated by a form of lateral canthal tendon plication at the time of lower lid blepharoplasty, and dehiscence here is less common and of milder extent, and hence can usually be managed supportively [7]. Beautifully, naturally defines the upper eyelid crease. The combination of procedures may require a few more days of recovery to heal fully. This patient underwent an upper and lower blepharoplasty to rejuvenate her eye area. People generally experience one of two symptoms with fat under the eyes: - There is a lack of fat, which creates an indentation that deepens over time and will often continue down the cheek in one deep continuous indented groove. Similarly, corneal epithelial breakdown can result in transient pain, foreign body sensation and tearing. Up to 24 hours, cantholysis and pressure release (if the orbit is still tense) and steroid treatment can be utilized. With appropriate case selection, thorough discussion with surgical candidates, and careful surgical technique, most of these can be avoided.
It may be necessary to lighten the patient's sedation to gain an accurate assessment of lid height, and sitting them upright is also useful. In rare cases where an exterior "skin pinch" incision is necessary, it is placed a millimeter below the lower lash line so that it is well camouflaged. We often recommend combining a few procedures to not only extend the longevity and durability of your result, but because there are economies of scale in regards to total costs that make doing a few things together make more financial sense – and because this often allows for a more natural result by ensuring each part of you reflects the same age. Similarly, when using the CO2 laser to cut fat lobules free, one needs a "back stop" (usually a Q-tip) to absorb the transmitted laser energy and avoid damage to the structures that lie beneath (levator, Muller's muscle, conjunctiva and globe).
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