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The eyes are often the first thing that people focus on when they first encounter someone, and for many patients, this is the first thing that they notice has changed as they age. Eyelid surgery is a great “eye-opener” and should not be confused with brow lift rejuvenation, although they are interrelated.
Youthful, natural-looking eyes are essential to provide harmony with the rest of the face, and eyelid surgery can be done in conjunction with other facial rejuvenating procedures to bring about a more alert, refreshed appearance. New York Plastic Surgeon Dr. Wallach recreates a natural-looking youthful eye by treating the necessary fat and skin from the upper and lower lids. He tries to conserve as much of the soft tissue in and around the eye to prevent the “hollowed-eye” look, which is a sign of aging. If possible, Dr. Wallach will treat the lower eyelids using an incision on the inside of the lid.
What is Eyelid Surgery?
Eyelid surgery is a procedure performed to improve the appearance of either the upper or lower eyelids or both. It requires general anesthesia and a recovery time of a week to a week and a half. The result is a long-lasting rejuvenation of drooping, aged eyelids and eye area skin that helps people look more alert and younger.
- Periorbital Rejuvenation
- Ancillary Procedures Approached Through The Upper Eyelid
- Lower Eyelid Rejuvenation
- Lower Lid- Cheek Problems
What Are the Steps of An Eyelid Surgery Procedure?
Blepharoplasty surgery varies in its techniques depending on the needs of the patients and the extent of rejuvenation desired. Generally speaking, a traditional eyelid surgery requires general anesthesia and is an outpatient procedure. During the surgery, Dr. Wallach will remove excess skin and fat from the desired locations, helping to tighten sagging skin and provide a rejuvenated look to the eyes. The upper and lower eyelids are addressed as needed for natural-looking, symmetrical results that are harmonious with the rest of the face.
Upper Eyelid Rejuvenation
The upper eyelid area focuses on the inter-relationship between the brow and the upper lids. If the brow is too low, sagging upper eyelids can be mistakenly assumed to be caused by excess upper eyelid skin when, in fact, many times it is caused by the descent of the eyebrow. When the brow is positioned in its ideal location, quite often there is little to no upper eyelid skin excess.
Sometimes an upper eyelid procedure is recommended with or without a brow lift. Since the upper eyelid also has two fat pockets, these may need to be addressed as well. The goal is to restore the youthful appearance of the eye area without removing too much natural tissue.
Skin Excision Only
For some patients, the only issue is a surplus of skin in the upper lid, which means a simple crescent-shaped excision of excess skin is all that is necessary.
Skin And Muscle Excision
For patients with a poorly defined eyelid crease, sometimes a skin and muscle excision is performed. If Dr. Wallach needs to remove muscle, it is usually done conservatively. He does not like to remove muscle in most cases, because it may create a hollow eyelid look and cause the patient to appear older.
Skin And Muscle Excision Along With Fat Removal
There are two fat pockets in the upper eyelids. If a patient has excess fat, loose upper eyelid skin, and a poorly defined eyelid crease, then some skin and muscle are removed along with the redundant fat. Usually this only affects one fat pad. Dr. Wallach does not like to remove central fat in most cases because leaving this fat maintains fullness in the upper eyelid.
Fat Injection, Fillers, And Neuromodulators
Non-invasive procedures using fat injection, dermal filler products, and neuromodulators can affect the appearance of the eyelid. Fat injection is performed for permanent fill (See Fat Injection). Injectable products like Restylane and Juvederm (See Fillers) can be used as well and last six months to a year. They can be used in the upper lid when the eyes appear a bit over-sculpted. They can also be used to raise the eyebrow when facial soft tissue atrophy has caused them to descend. Neuromodulators like Botox™ and Dysport can be used to help improve the position of the lateral brow and thus improve hooding.
“I believe true confidence comes from a feeling of self-assuredness from one’s inner self. However, I also believe that it is heavily impacted by a lack of confidence with one’s outside appearance as well. Plastic surgery can help improve confidence in this way.”
Lower Eyelid Rejuvenation Techniques
The lower eyelid contributes to the overall aesthetic of the eyes. Proper evaluation and treatment of the skin, muscle, and fat will improve the appearance of an aging eye. Some of the characteristic changes in the lower lids with age includes: loose skin, herniated fat, accentuation of the lid-cheek junction and tear trough region (by the nose), and weakness of the lower lid leading to lid laxity and scleral show (too much white of the eye is seen).
When not addressed, lower eyelid laxity can contribute to scleral show, or worse, ectropion (the turning out of the lower lid). When the lower eyelid is weak a supporting procedure is necessary. This can be done by performing a canthopexy or canthoplasty procedure.
Skin Excision Only
This technique is used when there is only loose excess skin causing an issue. An incision can be made just below the eyelid margin and the skin is elevated off the underlying muscle and then the excess skin can be removed. More commonly a “skin pinch” technique is performed without elevating a skin flap off of the muscle. With this technique, the skin is literally pinched together and the excess is removed. The reason to do it this way is that there may be less scarring and risk for negative side effects.
Skin And Fat Excision
The philosophy regarding how to treat the lower lid has changed over the years. Some surgeons feel that “violating” the muscle layer may lead to a higher incidence of scarring which can lead to scleral show and even ectropion.
A transconjunctival blepharoplasty (TCB) approach is performed to remove fat from the three lower lid fat compartments. A transconjunctival blepharoplasty uses a hidden incision inside the lower lid. The incision is made in the tissue between the eyeball and the lower lid and through this, fat is removed.
If there is loose skin a simple skin excision or skin pinch approach can be performed. This eliminates the more traditional skin muscle flap procedure which has a higher risk of scarring. If patients have weak lower lid, canthopexy or canthoplasty can be performed.
Skin And Muscle Excision
The “classic” incision used for lower lid surgery is performed using a skin-muscle flap that is incised just below the eyelid margin with the skin and muscle being elevated as one unit. This is still performed by some plastic surgeons, and is recommended for some patients. If the lower lid is weak then a canthoplasty/canthopexy can be performed as well.
Skin, Muscle, And Fat Excision
Sometimes a skin-muscle flap technique is used to treat the herniated fat. Again, if the lower eyelid has poor support, a canthoplasty or canthopexy may be required.
Complementary Procedures For Blepharoplasty
A brow lift, or browpexy, is a limited incision procedure that surgically lifts the brow. This can be performed through an upper eyelid incision as a further rejuvenation strategy with upper blepharoplasty. With a brow lift, the eyebrows can be raised on the forehead to reduce the appearance of a resting tired or aged appearance.
The mid-face lift is a procedure that focuses on the cheek and lower lid junction. The goal is to elevate the cheek fat pad and treat the lower lid region as well. This can be done as an isolated procedure using only a lower lid incision. The soft tissue around the cheek is freed and secured to the temporal fascia of the face. A canthopexy or a support procedure for the lower lid is also performed at the same time. Commonly, mid-face treatment is performed during other facelift procedures such as in a deep plane facelift.
What Should I Expect After Eyelid Surgery?
Depending on the specific plan for your eyelid lift surgery, you’ll need up to a week of downtime to recover from the procedure. Sutures are usually removed within 5-7 days. The eyes will be swollen and bruised for the first few days, which slowly dissipates within the first week. More detailed instructions are given in the office for post-op care, based on your overall health and specific surgical plan.
How Much Does Eyelid Surgery Cost?
Eyelids surgery can cost between $3,500-$5,000 for only upper eyelid surgery or lower eyelid surgery and about $7,500-$10,000 for both.
Blepharoplasty in New York City
If you would like more information about blepharoplasty surgeon Dr. Steven Wallach and his success with New York City eyelid procedures, don’t hesitate to contact our Manhattan offices at (212) 257-3263 or by filling out our online contact form to schedule your consultation about cosmetic eyelid surgery.