Tag Archives: blepharoplasty

Eye-opening concepts.

It has been said that the eyes are the windows to our souls. Certainly we often remember our friends and love-ones faces with the eyes playing a prominent role in facial identification. Unfortunately the aging process can strike this region relatively early leading to appearances that project fatigue, disinterest, and lack of vitality. Aging will result in skeletal changes around the eye, shrinkage of muscle and fat volume in the temples causing lateral brow descent, thinning and loss of elasticity of the skin of the eyelids, prominence of the fat pads of the upper and lower lids as a result of a weakening of the eye socket surrounding these structures, and in some cases the muscles that control upper eyelid position stretch or change leading to the upper eyelid drooping with respect to the pupil giving a sleepy appearance. All these symptoms of aging can hide the bright and vibrant person inside giving the false impression of a tired worn out individual. Take back the youthful appearance that is hidden under the veil of aging by consulting a board certified plastic surgeon who has expertise in eyelid and brow rejuvenation.

Brow

As with all anatomic areas deformities of the upper third of the face can span a wide range of severities. Many times women in their late thirties and early forties can show signs of early brow descent which can narrow the opening of the eye and brow skin resting on the upper eyelids. Many times in these milder forms of age and gravity related deformities we can correct with muscle balancing procedures utilizing neurotoxins such as Botox to weaken the depressors of the brow and allow unopposed brow elevators to prevail and elevate the resting tone of the brow.

Another targeted area to correct non-surgically, the brow position, is to restore volume to the temple region of the skull. This area in front of and superior to the ear and lateral to the brow represents the temporal fossa. This houses a large flat muscle that helps to elevate the jaw and is surrounded by soft tissue including fat and covered by hair bearing scalp tissue. Bony and muscle remodeling coupled with overlying fat shrinkage can lead to a hollowed out appearance which causes the brow to fall downward making the brow skin begin to cover the upper eyelid skin. Volume restoration can be accomplished with any number of filler agents but I prefer to correct the volume with a guided tissue regeneration product call Sculptra which is a polymer of lactic acid which promotes collagen deposition over time restoring volume and allowing the brow to be supported at a higher level compared to a depleted state.

As the brow tissue descends lower, further concealing the upper eyelid, the options narrow to surgical intervention. I prefer an endoscopic assisted brow lift over an open approach to avoid scars and hairline shifts. Just a few small openings spread out over the hairline allows for the complete release of the forehead and fixation internally to correct brow drooping leading to a pleasing brow position which looks natural without changing the hairline and allowing for improved visualization of the upper eyelid. In most cases the upper eyelid skin will require modification to give a harmonious smooth result. Errors such as trying to remove excess upper eyelid skin which includes excess brow tissue instead of performing a simultaneous brow lift will result in a poor result with very high eyelid crease scaring and the inability to close the eyelids resulting in dry eyes. Expertise in the aesthetic and functional evaluation of the upper third of the face is important.

Upper eyelid

The most common cause of excess upper eyelid skin is the underlying result of periodic eyelid swell causing excess thinning tissue. This can be addressed with conservative blepharoplasty techniques which can include some judicious fat removal. Of course a thorough exam to determine if the resting eyelid position with respect to the pupil is too low because not correcting the drooping of the upper lid will give a less than adequate rejuvenation because the patients eyes will still seem tired due to the lid lag.

Lower eyelid

Common aesthetic problems of the lower eyelid include excess skin, lack of lateral support of the lower eyelid giving a rounded eye appearance and excessive show of the whites of the eye ball, large fat pads with or without loose skin, increased separation of the eyelid cheek junction, and lastly crow’s feet. If skin quality is reasonable without excessive crepey skin and there is increase separation of the eyelid cheek junction then a conservative injection of a hyaluronic acid placed on the cheek bone under the muscle that closes the eyelids can smooth out the tear trough as well as build up the lateral eyesocket boney rim hiding some mild bulging of the lateral lower fat pad of the eyelid. This can create a Photoshop effect smoothing out the eyelid. Another conservative approach to helping the aging lower eyelid is to diminish activity of the lateral muscle that closes the eyelids with neurotoxins which can lead to a reduction in crow’s feet and can slightly help to elevate the lateral third of the brow.

Surgical interventions of the lower eyelid include judicious removal of the two lower eyelid fat pads through the inside of the lid with transposition of the fat on to the cheek to hide the tear trough, surgically removing excess skin from under the lash line vs skin tightening with a C02 Laser, lateral lid support to the bone enhancements with or without shortening the horizontal length of the lid. These procedures need to be selected based on clinical exam with the goal to provide a youthful eyelid with good support while avoiding excessive hollowing of the lower eyelids and poor lid support leading to rounded eyes and increased exposure of the eyeball.

The upper third of the face contains the aesthetic units of the brow, upper and lower eyelids and are a very unique region of our body for both special senses of vision, and provide our unique individuality of facial appearance. Aging can have a detrimental effect on both the aesthetics and function of this region which can bias people’s opinion of our vitality and mental sharpness. Non-surgical and surgical corrections can be important tools to correct these deformities restoring our appearance and giving back self confidence.

Look as good as you feel in 2016

So you work out, eat smartly and watch your calorie consumption but your face looks tired, and you look older than you feel. Trust me, you’re not alone. The good news is something can be done that is predictable and sustainable to make you look and feel better about your face.

The key to success is a thoughtful facial analysis, which evaluates your bone structure, muscle activity, soft tissue volume, skin quality and the position of your forehead, brows, eyelids, cheeks and neck. I approach a patient’s face much like an engineer with a sculptor’s artistic eye. I create a problem set followed by a detailed treatment plan, tailored to each of my patient’s wishes and financial parameters.

Treatment plans often include skin quality improvement with techniques such as serial chemical peels and micro-needling. Please see previous blogs on these therapies on my website. If excessive muscle activity leads to a harsh appearing forehead and brows, muscle modulation with Botox can be an excellent approach.

Looking at the upper third of the face, I evaluate brow position with respect to the bony orbital rim and its relationship with the upper and lower eyelids. On women you want the brow to be above the orbital rim with the outer third being elevated compared to the inner 2/3 of the brow. Heavy hanging brows make the eye aperture appear small and tired.

Another important factor in evaluating the upper eyelids is eyelid ptosis (the muscle mechanism which elevates and maintains resting tone of the upper lids). Eyelid ptosis must be addressed with the blepharoplasty to prevent a tired sleepy appearance despite correcting the fat pads and excess skin.

The lower eyelids must be evaluated carefully in comparison to the bony anatomy surrounding the eye and the supporting structure of the lateral canthus, which anchors the eyelids to the lateral bony orbit. Great care must be taken if you have a prominent eye compared to your cheeks and have deficient lower eyelid vertical skin coverage. Weak lateral canthi can result in disastrous results with excessive eye exposure leading to pain and visual disturbance.

Finally, the lower eyelid cheek junction must be inspected. A large tear trough and bulging fat pads can detract from a youthful appearance. Taking out too much fat can result in a hollow eyelid, which can actually create an even older appearance. Current techniques include judicious removal of some of the fat and then actually transposing the fat pad down onto the cheek mass obscuring the demarcation and giving volume to the cheek and avoiding a hollow look.

The midface is all about volume. As we age, the cheek fat pad shrinks in size leading to the face falling with accentuation of the nasolabial folds. In most cases midface restoration can be corrected with volume-added techniques of either fat or filler agents making tissue repositioning in this area less important. A non-invasive injection of Voluma can be a great treatment option.

The lower facial third and neck are evaluated with regard to the jaw line, chin neck angle, and the draping of the soft tissues including the skin and neck muscles. Younger people with good skin quality may well be treated with liposuction alone to achieve a pleasing neck line. If the lower jaw is small with respect to the rest of the face, a chin implant or chin repositioning may help your neck appearance, in addition to liposuction to improve results and create harmony with the lower facial third compared to the rest of the face.

Older skin, with bands of the platysma muscle showing through, is less compliant and is best treated with a neck lift procedure. This surgery includes fat equilibration, neck muscle tightening and soft tissue repositioning and stabilization around the ears.

Facial rejuvenation is not painful, although swelling and bruising will occur. After the dust settles, results can be natural and youthful in appearance with long-lasting results that will boost your confidence beyond any wardrobe or hair makeover.

Look as good as you feel in 2016. Happy New Year!

What can a comprehensive plastic surgery center offer to men?

Plastic surgery for males is a relatively new phenomenon. Historically, men have viewed this venue of services as mostly for women. My father’s generation was not working out in gyms and drinking protein shakes to stay healthy and active in middle age and beyond. Undeniably, the aging baby boomer population refuses to be defined by chronologic age and embraces the concept of wanting to look as good as you feel. With this is mind, why let women have all the resources to age gracefully and look young and vibrant? Men can now maintain a youthful appearance proportionate to our level of health and to our significant others.

What services are available to men?

Skin care: The concept may seem too metrosexual at first glance, but there is a health benefit as well. Sun exposure has a cumulative effect, which damages the outer skin, and dermis making the skin look dry and leathery. Loose, inelastic skin coupled with blotches of dark pigmentation makes the skin appear older than chronologic age would suggest. This is also a set up for skin cancers. Skin care may include skin resurfacing with peels to remove the damaged skin along with micro-needling to induce collagen production and improve skin tightening to provide a much-improved appearance and reduce the potential risks of skin cancers.

The use of Botox, which will weaken the overactive muscles between the brows and around the eyes, can prevent the deep furrows of the skin thus smoothing the appearance. This agent can be employed to hide some of the muscle bands in the neck as well.

Filler agents, such as Voluma, can be easily injected into areas of programed fat atrophy which occurs in aging and results in the cheek falling causing accentuation of the cheek folds and may produce hanging on the jaw line. Voluma, which is a highly crosslinked stiff hyaluronic acid filler, can manage to lift the cheek without making the face look fat.

Rhinoplasty: This is the art and science of the interactions of skin, bone and cartilage of the nose to provide an aesthetically appealing appearance with normal function. Rhinoplasty is a very meticulous surgery with the goal of providing a balanced appearance between the various components of the nose as well as creating harmony with the rest of the face. This surgery can provide a real boost to someone’s appearance and self-esteem.

Gynecomastia: This is a condition in which the male breast increases in size with fibro-glandular tissue mixed with added volume of fat giving it a feminized appearance. Gynecomastia can occur at any age creating self-conscious situations both with and without clothing. Fortunately the correction is very straightforward and very predictable. We recommend the use of ultrasonic energy mixed with traditional liposuction to facilitate fat and fibro-glandular removal of tissue to sculpt the breast back to a masculine appearance. There are occasions when direct excision of tissue directly under the nipple-areolar complex is necessary in addition to the liposuction to achieve the desired results, but the scaring in minimal. Without question a very power surgery that gives wonderful results.

Lipo-sculpturing: Unfortunately diet and exercise can’t cure all problems with the contour of the abdomen and posterior flanks. With metabolism changes, even a meticulous healthy eater with an active lifestyle can still experience abdominal bulges and flank adiposity. For patients with good skin quality without a great deal of skin excess, liposuction can provide a means of sculpting the torso to give a more pleasing shape and enhance confidence with and without clothes. The surgery is generally not that difficult to recover from, and results can be effective.

Eyelid rejuvenation: Do people say you look tired? Do your lids hang over your eyes giving the appearance of sleepiness? Do you have puffy lower eyelids giving you a less vibrant persona? Then you may want to consider eyelid surgery to give you a refreshed look. It’s been said that the eyes are the windows into the soul; so don’t have outdated window treatments. The surgery is mildly uncomfortable with swelling being the biggest issue related to return of feeling comfortable in social situations. Careful consultation with your surgeon is required to avoid complications depending on the anatomy of your eyelids. People will notice the refreshed look after the recovery has taken place.

Neck rejuvenation: A hanging neck with loose skin and excess fat can give the appearance of an aged and out-of-shape individual. It may also project being overweight. Depending on the degree of tissue excess and skin quality, this may be correctable with liposuction alone. However if the skin quality is poor and there is the presence of muscle bands in the neck, a true neck lift will be required. This surgery can take an old-looking neck and transform it to a smooth crisp neckline with well-defined jaw contours. Neck rejuvenation can take years and pounds away from how you look.

In summary, plastic surgery offers men many options to consider feeling good about the skin you’re in. It’s not just for women anymore. For more in-depth discussions of procedures and spa services, visit thelucascenter.com or call 865.218.6210 to schedule your personal consultation with me.