Posts Tagged ‘blepharoplasty’
Friday, September 30th, 2011
Q: Dr. Eppley, I am a 46 year-old female. I would like to get an upper and lower blepharoplasty. However, I have problems with my nose due to a sinusitis and a collapsed septum. I got an x ray last week and the doctor said I have a deviated septum as well as thickening of turbines. I have been on antibiotics for five days. This problem wears me out a lot. I am often tired with headaches and my face always looks puffy due to continous allergy symptoms. My question Dr Eppley is what do you suggest for me to have first or not to have- a Rhinoplasty/Septoplasty to correct the nose issue and then a blepharoplasty? Please doctor I would appreciate your advise. I found your website very helpful, thank you again.
A: There is no question that septorhinoplasty and blepharoplasty can be performed together. This is not a technical nor a safety issue. It is an issue exclusively of how much recovery do you want and how long can you tolerate (socially and workwise) the way you will look during this recovery. When combining rhinoplasty and blepharoplasty the swelling and bruising around the lower eyes can be quite severe, particularly when nasal osteotomies are performed. Otherwise, there is no reason why the two facial procedures can not be performed together. There may also be other advantages beyond one single recovery period for combining them, such as cost.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, indianapolis, rhinoplasty
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Monday, September 12th, 2011
Have you ever looked in the mirror and seen that tired look and wondered why? If you are over forty, this might be a near daily occurrence. Fullness or extra skin of the upper eyelid is one of the most common causes of tired looking eyes. You may be wondering what’s the best way for me to remove this fullness and restore the youthful, attractive look to my eyes. Is it an eyelid lift (blepharoplasty), a browlift or some combination that is right for me?
Fullness and heaviness of the upper eyelids occurs for two reasons. The most common reason is too much skin and fat. Due to the constant stretching of opening and closing your eyes (the upper eyelid accounts for most of eyelid closing) extra skin is created over time. Eventually this can become so significant that it hangs down onto your eyelashes, known as hooding. The other contributing reason can be the position of the eyebrows. If the eyebrows have dropped down and are too low (gravity does usually win) this can also add fullness to the upper eyelids as it pushes the eyelid skin down.
To really know whether it is the eyelid skin, the eyebrows or a combination of both that is causing those full and tired looking upper eyelids, you must do an eyebrow placement test. By putting your eyebrows in the proper aesthetic position (by pulling up on the forehead skin until you have the desired eyebrow position) and then opening and closing your eyes, one can see the true amount of upper eyelid fullness remaining. By so doing, there are three possibilities for correction which will be revealed.
When the eyebrows are lifted to a better position, all the upper eyelid fullness is gone. This means the fullness is due to low eyebrows and the solution is some form of a Brow Lift. In this situation if only an eyelid lift was done, it would actually cause your eyebrows to become lower.
When the eyebrows are lifted, some but not all of the upper eyelid fullness gone. This means a combined browlift and eyelid lifts are ideally needed. It would also be perfectly appropriate to just do an eyelid lift and accept the lower eyebrow position. For men this is usually more common than in women as most men have naturally lower eyebrows.
If the eyebrow is already in a good position on the lower end of the forehead and all of the eyelid fullness remains, than only eyelid lifts are needed. This is , by far, the most common tired eye scenario particularly if one is under the age of 55 or so.
Plastic surgery correction of aging of the upper eyelids must consider its upstairs eyebrow neighbor to determine the best solution to a less tired and rejuvenated look.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, browlift, dr barry eppley, indianapolis
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Wednesday, September 7th, 2011
Q: Dr. Eppley, I am 54 years old and am interested in getting a facelift, rhinoplasty, and blepharoplasty surgery. I’m trying to achieve a more youthful look, less sagging, and not so tired looking appearance. I have attached some pictures of me so you can show me by imaging what the results may be like.
A: Thank you for sending your pictures. Here is some imaging for the following procedures; a facelift (neck-jowl lift) and a rhinoplasty.You could get a really significant improvement in your neck wattle as it is a large amount of loose hanging skin. That would dramatically change your neck-jawline profile. It is interesting as to why you have such a large amount of hanging neck skin even though it appears you are relatively thin. Perhaps you have lost a lot of weight ?? Regardless a full facelift will remove inches of skin from the neck and tighten up the entire jawline.
From a nose standpoint, you tip is wide and thick and turns down slightly. There is also a small bump higher up on the nose. A full rhinoplasty would take down the bump, shorten and narrow the tip with some lifting and narrow the size of the nostrils. This type of nose change at your age changes the structure of the nose and makes it look smoother and more refined, a look that has a more youthful quality.
The combination of these two procedures, as the imaging illiustrates, would make significant rejuvenative changes to your overall facial appearance
As an addendum, I did not do nor is it possible to do realistic blepharoplasty computer changes. It is clear from the pictures that you have some extra eyelid skin that can be removed as well as some herniated fat from the lower eyelid. Your lower eyelid shows no significant skin excess, however, other than a few millimeters. Together, this type of upper and lower blepahroplasties will make you look less tired.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, facelift, indianapolis, rhinoplasty
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Tuesday, August 16th, 2011
Q: Dr. Eppley, Thank you so very much for the information you have provided on blepharoplasty. I found you through a Google search hoping to find some information on whether insurance will cover surgery in severe cases. My hooding is genetic; insurance paid for my grandmothers surgery by the age of 50. Now at almost 50, I look 20 years older all because of my hooding. My huband doesn’t understand my desire to have surgery because he sees me as beautiful the way I am. After reading your information and seeing the images, I can see that perhaps someday there is hope for me as well. Thank your for your encouragement.
A: Hooding or extra skin that hangs on the upper eyelids is easily and often dramatically improved by the blepharoplasty procedure. Of all the anti-aging surgeries of the face, an upper blepharoplasty is one of the ‘simplest’ in terms of the results, short recovery and very low risk of any significant complications.
When it comes to medical coverage, things have changed dramatically since your grandmother’s time. Insurance rarely covers an upper blepharoplasty anymore and, even when they say they will, they often reverse their position when the procedure is done and the physician submits their charges. For this reason, many plastic surgeons no longer process a cosmetic or even a functional blepharoplasty as a medical procedure to an insurance company. It is done on a cosmetic fee basis only.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, indianapolis
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Monday, March 21st, 2011
Q: I am developing deep folds on the sides of my mouth and my eyelids have extra skin that make me look tired. I have attached a picture so you can see my concerns. What type of plastic surgery will get rid of these problems?
A: Thank you for your inquiry and picture. There are two comments that I can make based on your pictures. First, you have a thin and lean type of fat. As a Caucasian, this makes your skin thin and extremely prone to wrinkles particularly around the mouth area. Such wrinkles around the mouth, known as smile lines outside the corners of the mouth, are virtually resistant to any treatment other than temporary injectable fillers. There is no surgery that can provide a cure or any long-lasting treatment for that resistant wrinkle problem. It is resistant because the one thing that would help in not making them continue to develop is to stop smiling or moving your mouth…not only an impossible but not a good social habit to develop.
From an eyelid standpoint, you have deep set eyes (again due loss of fat around the eyeball area or, in your case, you may have never had it to start with) with some moderate skin redundancy of both upper and lower eyelid skin. The real issue is whether the skin on your upper eyelids needs to be removed (eyelid tuck or blepharoplasty) or whether lifting of the eyebrows is better. You can determine that by doing a simple lift test on your eyebrows and see what it does to the skin on your upper eyelids and the new brow position.
For all of these reasons, I don’t think computer imaging is helpful in making these facial aging treatment decisions. It would be better to come in and sit down and go over the options that are available…and see what they can and cannot do.
Dr. Barry Eppley
Indianapolis Indiana
Tags: blepharoplasty, dr barry eppley, eyelid tuck, indianapolis, treatment of smile lines
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Wednesday, February 2nd, 2011
Q: Hello! Do you perform the laser eyelid rejuvenation procedure? I am 48 and have eye hooding and really don’t want to have the surgery at this time. I have read that there is laser treatment that is quite successful. Thank you for your help!
A: I am not aware of any laser eyelid procedure that does not involve making incisions to do a blepharoplasty or eyelid tuck. The term ‘laser eyelid rejuvenation’ may suggest that there is some type of a laser which magically tightens eyelid skin without surgery, but that is not the case. When eyelid hooding exists, the only known effective treatment is actual skin removal. When upper blepharoplasties are done alone, they can be performed under local anesthesia and, in some cases, may even be done in an office setting. Mini-blepharoplasties exist using a pinch technique which is also an office procedure done under local anesthesia. Given the effectiveness of even these more limited skin removal procedures, any non-surgical approaches have never yet been developed that remotely compares.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, eyelid tucks, indianapolis, plastic surgery of the eyelids
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Monday, January 24th, 2011
Q: I would like to get my eyelids done as they are very heavy looking and make me look bad. People tell me all the time that I look tired even though I am not. I am sick of hearing that! My only real concern about the surgery is recovery. How long is the recovery and what will I look like?
A: Thank your for your inquiry. Recovery after blepharoplasty surgery is largely social…meaning how do I look? (how much bruising and swelling will you get) That would depend on whether one is doing only upper eyelids, only lower eyelids, or all four eyelids.. When all four eyelids are done, most people will have noticeable bruising and swelling for up to 10 to 14 days after surgery. If only one set of eyelids is done, it will be less than that. Lower eyelids develop more welling and bruising than the upper eyelids after surgery. There are also different types of blepharoplasties done in which the overall swelling and bruising may well be less, what we call limited blepharoplasties which are either of the pinch type or lower eyelid which use only a transconjunctival (inside the eyelid incision) approach.
There are numerous strategies for keeping the amount of swelling and bruising as limited as possible. This includes pre-and postoperative oral Arnica, keeping one’s head elevated above one’s heart for the first few days and a good icing of the eyes the night after surgery. I also use gentle surgical technique with delicate amounts of cautery to keep down the amount of bruising that can develop.
Dr. Barry Eppley
Indianapolis Indiana
Tags: blepharoplasty, dr barry eppley, eyelid surgery, indianapolis, plastic surgery, recovery after eyelid surgery
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Sunday, January 2nd, 2011
Q: Dr. Eppley, My droopy eyelids are driving me crazy. While I have always had very fleshy and heavy eyelids, they have gotten worse as I age. After my 40s (I am 55 now), they began to sag badly. Putting on makeup has become very difficult. What’s even worse is that it is making my forehead wrinkle. My eyelids are heavy and they seem to be in the way of me seeing. Without realizing it, I tense my forehead muscles to lift my brows up. This lifts up some of the eyelid skin and makes me see better. All of this forehead muscle tensing has given me permanent creases in my forehead. Should I just have my eyelids done or both my eyelids and my forehead?
A: Droopy and heavy eyelids, besides interfering with you seeing, can make you look sad and tired. Blepharoplasty (eyelid lift or tuck) can open them up dramatically and give you a fresher and more alert appearance. (some call it a youthful change) That is certainly what you would benefit from as you have realized.
A browlift is a good complementary procedure to blepharoplasties if your brows have dropped with age. Lifting one’s brows up can signify that it is either a reaction to drooping eyelid skin or that the brows are too low as well. That is an important distinction to make. I suspect that it is more of a reaction to your eyelid skin issue. Therefore a browlift is not what you really need. More likely you would benefit from Botox injections to ‘detrain’ your forehead muscles from the muscular responses they have now learned to do.
Dr. Barry Eppley
Indianapolis Indiana
Tags: blepharoplasty, browlift, dr barry eppley, indianapolis, plastic surgery of the face
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Saturday, October 9th, 2010
Has anyone ever said to you that you look tired…have puffy eyes…or commented on the bags under your eyes or your dark circles? If you are over 35 or 40 years of age, you have undoubtably been told that at least once. Many have been told that more than just a few times. While I could espouse on the merits of pointing out the good in people rather than the bad, that would be a pertinent subject for a different column that has little to do with plastic surgery.
Without being told, most people that develop tired-looking eyes know it from looking in their own mirror. Women are particularly sensitive to how their eyes look as they engage in the daily ritual of make-up application. The vast majority of men, however, are unaware until their tired eye problem almost interferes with their vision. While there are some useful simple home ‘remedies’ that can help, such as astringents and endless numbers of creams, they do not remotely produce an improvement that is comparable to what blepharoplasty surgery can do.
Blepharoplasty, or ‘cosmetic eyelid’ surgery, is one of the most successful of all facial plastic surgery procedures. By removing loose and extra skin and fat from the eyelids, one can look refreshed again helping restore an eye appearance that one used to have. But many people are unduly hesitant about undergoing it because of misconceptions about recovery and pain after the surgery.
The thinness of the eyelid tissues and their superb blood supply make swelling and bruising an inevitable, but temporary, sequelae of the surgery. Despite how it looks, it is not painful and most patients only comment that their eyelids initially feel a little tight. There may be some slight stinging discomfort around the eyes the first night after surgery, but that passes quickly by the next day. Bruising and swelling are what persists and that will take up to two weeks after surgery until one is fully in the ‘benefits’ period. For some, this is a time for social reclusion. For others, they embrace it and do not let it be a hindrance for returning to work or getting out and about.
One of the great things about blepharoplasty surgery is that it is not a ‘one size fits all‘ procedure. There are different types of eyelid tucks based on how slight or severe the tired eye problem appears. If one has a lot of droopy or hanging skin then the traditional blepharoplasty would apply. But for those that have just a little extra skin or lower eyelid wrinkling, then the new ‘pinch and peel’ blepharoplasty can be done where just a pinch of skin is removed and the wrinkles reduced by a chemical or laser peel at the same time. If one is just bothered by their undereye bags, that protruding fact can be removed from inside the eyelid, having no external incision at all.
While the eyes may be the window to the soul, the eyelids are the window shades. They create, fairly or unfairly, an impression of our alertness and liveliness. A crisper and refreshed eye appearance is readily possible through blepharoplasty surgery and is easier to go through than most people think. Whether one’s tired eyes are just beginning or are quite advanced, blepharoplasty surgery can be customized to just the right amount needed to put that twinkle back and still fit into one’s lifestyle.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, eyelid tucks, indianapolis, plastic surgery, tired eyes
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Tuesday, June 15th, 2010
Although eyelid surgery (blepharoplasty) treats only a small area of the face, it has a dramatic impact on facial appearance. Dollar for dollar, blepharoplasty surgery has the best value of any plastic surgery procedure of the face because it is seen by all in everyday conversations. The eyes show age more than any other body part due to smiling, squinting, frowning, sun damage , and heredity. A lot of what you perceive in other people has to do with how their eyes appear. Most of us know this because when we go into work, more often than not, what does someone seem to frequently say…you look tired!
Upper eyelid surgery gets rids of hooding and excess skin that may be hanging down on your eyelashes. Upper blepharoplasty helps restore a natural, youthful appearance by removing skin through an incision in the eyelid crease. In some cases, fat may also be removed or redistributed. Since the incision is carefully placed, it is undetectable once healed. The only way that fine little scar can be seen in the upper eyelid is if they look while you are sleeping!
The lower eyelids are one of the first areas of the face to show age-related changes. Most of us know this because the appearance of bags and wrinkled skin. Loose skin and muscle create a droopy appearance and a protrusion of fat, which normally is under the eyeball, creates that classic but dreaded appearance of lower eye bags. These bags are really prone to absorbing fluids which is why they are more swollen in the morning or if you have eaten really salty foods the day before. The lower eyelids can be improved by an incision which is hidden either inside the eyelid (if fat only needs to be removed) or just below the lashline. (when all tissues need to be treated) The muscle, support tendon, and skin are reshaped and tightened back up against the eye. That protrusion of fat is either removed, tucked back in, or repositioned over the edge of the eye socket bone, dependent upon what will look best. In some patients, chemical peels or laser resurfacing can be done at the same time (only when the incision is on the inside of the eyelid) to improve wrinkles and loose skin on the lower eyelid and crow’s feet area.
One of the most interesting things about these procedures is that most patients say… the most surprising thing about eyelid surgery is the lack of pain during recovery. While eyelid surgery may look bad, it actually produces very little pain. Your recovery is largely social and about how you look.
The other comment that patients often say is…why did I wait so long? I spent a lot of money on creams and other potions and none of them worked…and they promised they would! (hope still remain the #1 selling point) Eye creams are beneficial but they are largely about prevention and not about reversing the age changes that are already there. They simply can not tighten or lift skin to any visible degree.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: blepharoplasty, dr barry eppley, eyelid surgery, indianapolis, plastic surgery
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