People convey their mood with their eyebrows. If the eyebrows are sagging, the person looks tired or old. If the eyebrows are too low on the nasal side of the brow, the person looks angry. Low brow position on the ear side looks sad. But if the brows are arched above the bony rim the person looks happy.
Our goal is to learn about the concerns our Charlotte, NC plastic surgery patients have about their eyelid appearance. We then make a diagnosis as to what is causing the problem, i.e. too much eyelid skin, too much brow skin or both. We then formulate a plan to solve the problem. If the patient has extra upper eyelid skin, the solution may be to remove the extra skin. But if the extra upper eyelid skin is from drooping brows the best operation is a brow lift, which will improve both the appearance of the brow and the upper eyelid. Again, an accurate diagnosis is very important to performing the right cosmetic surgery procedure.
Brow lifts and eyelifts (blepharoplasties) are performed in our office under general anesthesia but local anesthesia can be done if appropriate. Patients are totally asleep, feel no pain and remember nothing, but they are still breathing on their own. Blepharoplasties take approximately two hours to perform and involve removing extra skin, fat and muscle on the upper eyelids, lower eyelids or both as needed to produce a more youthful look. The incisions are placed in the upper eyelid crease and just below the lower lash line. The lids are commonly done at the same time but may be done separately if the lids have aged at different rates. The incisions heal very well because the skin is very thin and under no tension. Patients are dismissed after the cosmetic surgery procedure with instructions, medication and an appointment for their first follow-up visit. The first post-op visit is at 3-5 days when the stitches are removed. Patients can wear contact lenses and makeup at approximately 7-10 days. Most people return to work at 5-7 days, depending on their job, but the eyelid appearance will continue to improve for up to 6 months.
Frequently, blepharoplasty is all that is needed to greatly improve the eyelid appearance. Sometimes, however, dark circles under the lower lids persist because of pigment stains left in the remaining skin. Even if the lower eyelid skin is tight and wrinkle-free, if the quality of the skin itself is poor then the best results have not yet been achieved. In order to remove the stained skin, laser resurfacing or chemical peel can be done to remove the damaged skin and regenerate new pigment-free skin. This cosmetic surgery procedure can be done simultaneously with transconjunctival blepharoplasty, but must be staged if standard blepharoplasty is indicated. Laser resurfacing can also be used to improve the ultra-thin, crepe-paper type skin under the lower lid. Blepharoplasty and laser or chemical peel are frequently used together to improve the quantity and quality of the skin around the eyes.
As mentioned above, a transconjunctival blepharoplasty is for people who have excess fat in the lower lids and no redundant skin. This fat is approached through an incision inside the lower lid and therefore there is no external incision. The procedure is nearly painless and can be combined with skin resurfacing if needed.
Eyelid Surgery Recovery
Post-operatively, everyone is swollen and bruised to some extent. We recommend ice compresses for 48 hours and head elevation until the swelling is resolved. There is very little pain due to the cosmetic surgery procedure, but the eyes may feel tight. Vision may be slightly blurred for several days due to swelling around the eyes, but will return quickly.
Brow lifts are routinely done via the new endoscopic approach. Or for bald patients or patients with very high hairlines, the incision is made just above the brow or in a prominent forehead crease. Endoscopic brow lifts use fiber optics through 2 cm. incisions behind the hairline to release the drooping brow from the bony orbital rim. We remove muscles that produce frown lines and suspend the brow up to produce the desired results. The procedure takes about 1 1/2 hours to perform and typically produces so little bruising that many patients are at work the next day. The advantage of the endoscopic approach is that the incisions are very small and downtime is short. As new technologies become available, we will evaluate them for safety and efficacy. When new procedures meet our high standards and surpass the results of the current procedures, we will adopt them.
Complications are few with eyelifts, but include dry eyes, asymmetries in the amount of skin remaining in the lids, lid position asymmetries and ectropion. Ectropion is when the lower lid pulls down so far as to show the white part of the eye. This is very unattractive. We are very aware of this potential problem and prevent it by placing a suspension suture that supports the lower lid.
A new approach using “threads” or long non-absorbing sutures to suspend the brow using only local anesthesia has not produced durable results and is not now a viable alternative in our practice. As new technologies become available, we will evaluate them for safety and efficacy. When new procedures meet our high standards and surpass the results of the current procedures, we will adopt them.
Eyelid Surgery Risks and Complications
Complications consist of swelling, bruising, temporary or permanent numbness of the forehead, temporary or permanent brow paralysis and brow asymmetries. Because the endoscope provides such an improved view of the operation, nerve injuries are unusual but need to be mentioned for complete understanding of all essential risks.
This overview is meant to act as a guide to what blepharoplasty and brow lifts are and who is a candidate for them. We have briefly reviewed the procedure, the post-operative care and potential complications. The procedures are reliable and will faithfully and predictably improve the appearance of the eyes. For many people, this is all they need to help them feel better about themselves.