Cosmetic Surgery

Blepharoplasty

Blepharoplasty, often known as an “eyelid lift,” refers to procedures of the upper and lower eyelids where skin and fat are removed or redraped to create a natural, rejuvenated appearance. Sun damaged and sagging skin due to age related changes can lead to unwanted redundancy and wrinkles around the eyes.

Upper lid blepharoplasty

Upper lid blepharoplasty removes excess skin and bulging fat via a small incision along the natural eyelid crease. It may help to improve peripheral vision and restore a more youthful, less tired appearance.

Lower lid blepharoplasty

Lower lid blepharoplasty addresses puffiness, hollowness, and skin wrinkles of the lower eyelids. Fat may be removed directly, either from the front or inside of the eyelid. Fat removal from inside the lower lid is called a transconjunctival approach, and there are no visible incisions on the outside of the lids. Lower lid blepharoplasty from the skin surface allows for both fat removal and skin tightening with reduction of wrinkles. This reduces sagging skin and eyelid bags while providing a smooth lid contour with a natural appearance.

Upper and lower lid blepharoplasty can be performed under local anesthesia, however many patients prefer the addition of some form of sedation. Especially for upper blepharoplasty, some level of patient cooperation is desirable, so we prefer to avoid general anesthesia. Both right and left sides can be done at the same surgical setting, and often patients elect to combine these procedures with other procedures such as ptosis surgery or brow lift.

Ptosis Surgery

Eyelid ptosis refers to a “droopy upper eyelid.” Eyelid ptosis can occur on one side or both sides and creates a sleepy appearance. Ptosis can also cause difficulty with peripheral vision. The most common cause of ptosis is due to weakness of the levator muscle which assists in opening the eyelid. Ptosis may present from birth (congenital ptosis), or caused by neurologic disorders, muscle problems, surgery or trauma. Surgical approaches include tightening or shortening the muscles that open the lid and can be performed from a hidden incision underneath the lid or through the natural eyelid crease. An upper lid blepharoplasty can often be combined with this procedure to address any excess skin.

Asian Eyelid Surgery

Upper lid blepharoplasty in the Asian population requires expert attention to the unique differences in the Asian eyelid anatomy. The upper lid skin may not form a crease or may form an incomplete or low lid crease. Additionally, the lid is often fuller in appearance due to the location of fat along the lid. The goal in eyelid crease revision is to create a change in the position of the crease while maintaining the natural and full contour of the Asian eyelid.

Brow Lift

Congenital and gravitational settling of the brows (brow ptosis) causes forehead lines, low or asymmetric brows, and redundancy in the upper lids, particularly laterally (temporal hooding). Botulinum toxin and fillers can be useful in helping manage mild brow ptosis and forehead wrinkling. However, with time, this becomes less effective and surgical options must be considered. Browpexy through an upper eyelid incision, direct brow lifting, and endoscopic brow and forehead elevation are the three most common approaches used in our practice.

Browpexy

Browpexy is typically used to stabilize the brow, with little effect on the forehead. This technique uses a suture or device to attach the deep brow tissues to the skull bone through an upper lid incision. Upper lid skin is usually excised as well.

Endoscopic Brow Lift

The most elegant brow and forehead elevation technique is the endoscopic brow and forehead lift. This is done through small incisions behind the hairline (can also be done on bald men). The scalp is freed from the bone using endoscopic instruments and elevated to a more desirable position. Various techniques are used, including absorbable Endotines or sutures, to fix the scalp and brows in position. For patients with high hairlines, a trichophytic forehead lift may be done with an incision along the hairline in an effort to shorten the forehead.

Direct Brow Lift

This direct approach removes tissue above the eyebrow and thus can stabilize or raise brows, as well as somewhat decrease forehead wrinkles. The scar is concealed in the upper brow hairs.

A brow lift may be combined with liposuction, rhytidectomy (face lift), ptosis repair, and upper and lower blepharoplasty.

Rhytidectomy

Rhytidectomy refers to procedures designed to elevate sagging areas of the lower face and neck. This is frequently referred to as “face and neck lifting.” The primary focus is to smoothe facial contours, elevate sagging nasolabial folds and jowls, smoothe the jaw line and redrape neck tissues. Sometimes, a small incision endoscopic sling procedure can be adequate. More often, an incision is made around the ear allowing access to the lateral face. The goal is to try to hide the incision in the creases around the ears and in the hair. A separate chin incision is sometimes necessary to maximally tighten the neck. This procedure may be combined with liposuction, brow lift, ptosis repair, or blepharoplasty.

Fat Grafting

Loss of facial volume can be restored using fat from other areas of your body. Areas including upper eyelid hollows, sunken lower lids, and deflated cheeks can be corrected with expert surgical technique to enhance volume and create a more youthful contour.