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Cosmetic Surgery of the Eyelids

Face > Blepheroplasty (Eyelid Lift)

Brow Lift1

Baltimore plastic surgeon

Beauties of the eyes involves all structures around the eyes, and include the skin, eyebrow position, the tightness or laxity of the lower ids, the position of the upper lid, the shape of the eye and thus the position of the lateral canthus and  its color match, medial canthus, and finally the fat compartments.

Accurate detailed analysis of all aspects of the eyes and surrounding structures is important to plan for the right surgery and approach. Inadequate analysis will lead to disappointment and unsatisfactory results and complications.

Patients often complain of the "tired look", "angry look". The eye brows descend down along with excess upper lid skin, hoods the upper lids. This is usually is associated with puffiness of the upper and lower lids, also called bags, or herniated fat. In the upper lids the puffiness is more pronounced on the inside of the upper lid.

LOWER LIDS

The lower lids show their aging with wrinkles and excess skin. Bags of the lower lid, is herniated fat. In many patients there is Hollowness at the lid cheek junction, called the tear trough. There is much other condition that may be associated with the aging process. Upper lid can be droopy, one eye brow might be lower than the other, and one eye may look smaller than the other. The boney structure of the eye might be deficient, or abnormal.

THE PROCEDURE

The surgery is designed to rejuvenate the eyes by understanding the individual aging problem and correcting each component that is contributing to the aging process. Smoothes the puffiness, open the eyes, correct abnormal position of the upper or lower eye lids. Reposition the eyebrow. Correct the tear trough.

Blepheroplasty can be performed on the upper and lower lids or separately upper or lower eye lids.

Understanding the standards of beautiful eyes can help in planning for the appropriate surgical procedure. The most important advances in the recent years are the preservation of volume in both the upper and lower eyelids. These procedures avoid the hollow eye that accentuates the aged look.

THE UPPER LID

Evaluation of the upper lid must include the position of the eye brow. A droopy eye brow accentuates the upper lid aging. In those situations the eye brow must be positioned back to normal position. This is done with a forehead lift or a brow lift. The position of the upper lid in relation to the pupil must be examined and evaluated. This will determine the presence of droopy lid “ptosis”.

The incision is positioned in the eyelid crease. The crease should be positioned at the right height from the lash line; otherwise the scar will be abnormal and visible.

Excess skin is then removed; fat is very conservatively removed if any. Muscle is spared. A small slip of muscle is removed only in specific cases. All these precautions are taken to prevent the hollow eye, or the surgical look.

THE LOWER LID

Skin laxity and fine wrinkles are the first signs of aging of the periorbital region. Fat herniated through manifesting themselves as the lower lid bags.

New concepts in lower lid rejuvenation accomplish a full smooth convex lower lid. Conservative approach can involve micro lipo injections in the lower lid. Hollow lid check junction accentuates the appearance of bags in the lower lid. However the problem is really fat loss with aging and descent of facial fat thus lengthening the lid check junction. Treatment is fat transfer to the lower lid and lid check junction.

In some a Transconjunctival approach through the inside of the lower lid to redistribute the fat. The skin is smoothened by laser resurfacing, removal of excess skin, or skin peels.

Advanced laxity of the lower lid and excess skin and fat may require the traditional approach through an incision just below the lash line. The lid is tightened by a canthopexy procedure. Fat is redistributed to fill the hollow lid-cheek junction. Excess skin is removed, or smoothened with laser resurfacing.

Recovery is quick about one week. Swelling and bruises will completely disappear in 3-4 weeks. Back to exercise in 3-4 weeks.

Dr. Shureih, Baltimore cosmetic surgeon with certificate of advanced education in Cosmetic Surgery. He has 20 years of experience. He was named TOP DOC in Baltimore Magazine, and In the National Guide of TOP DOCS. Offers you his experience and excellence to achieve the results you desire.

MODERN APPROACH TO EYE LID SURGERY

Lower lid bags and excess eyelid skin are the most common complaints offered by both women and men alike.

There are multiple surgical and nonsurgical procedures for eyelid aesthetics.

Choosing the appropriate procedure depend on the accurate diagnosis of the real problems. There are several factors one has to take in consideration.

  1. The position of the eye brow. Drooping brow can give the illusion of excess skin of the upper eye lids.
  2. Actual excess eyelid skin
  3. Herniated fat, causing severe fullness of the upper lids.
  4. Lower lid bags of fat
  5. Deep tear tough giving the appearance of bags in the lower lid.
  6. Excess skin
  7. Festoons or lid cheek bags

Making the proper diagnosis and the appropriate treatment will restore beauty to the eyes. Restoring the youthful eyes is probably the most dramatic change in facial rejuvenation.

An open eye, with properly positioned eyebrow, eye lids devoid of bulges or wrinkles is the ultimate goal in eye lid rejuvenation.

Fat is lost from the aging face, causing hollow features and loss of youthful look.

In the eye lids, Hollowness is treated restored by fat transfer. Fat transfer is an office surgical procedure. It involves harvesting the fat by gentle liposuction. The harvested fat is then carefully cleaned, then centrifuged to separate it from the anesthetic solution and debris, then placed into smaller syringes for injection. The one or two tiny incisions made to introduce the cannula to harvest the fat require no sutures.

Fat can be also injected into the lateral brow area to restore the natural fullness.

Fine skin wrinkles around the eye lids are erased by laser resurfacing.

Lower lid bags are approached through a Transconjunctival incision (inside the eye lid). Some fat may need to be removed, but the majority of the fat is redistributed to fill hollow area and prevent Hollow eyes created by surgery, and aided by age.


Many changes occur around the eye region with aging. These changes can make you look tired, angry, or sad. Bags around the eyes and dark circles are the most common complaints. Wrinkles and excess skin is common. Some of the wrinkles at the smile lines area can be treated with Botox®.

Plastic surgery of the eyelids is effective in smoothing puffy, baggy eye lids, tired eyes look more youthful and in many cases more awake. In particular, it can produce open eyes by removing excess skin. It lifts heavy folds in the upper lids. Cosmetic surgery eyelid surgery (Eye lid lift) can even change Asian eyelids by redefining the crease of the upper eye lid. Surgery must be tailored to each individual, depending on their concerns and the condition of their eyelids. The position of the eye brow is very important in how the upper lid looks.

Dr. Shureih is a Board Certified Plastic Surgeon Practices Cosmetic Surgery in Baltimore and Ellicott City. He has over 20 years of experience and thousands of procedures. He was chosen TOP DOC in Baltimore Magazine, twice, and in the National Guide for TOP DOCS for many years.

The bags in the lower lids are pockets of fat misplaced or herniated. Deep crease in the lower lid cheek junction becomes prominent, known as the tear trough, to improve these problems a thorough knowledge of the aesthetics and anatomy is essential for proper evaluation and formulating a plan to improve on the eye lid aesthetics. It is imperative to avoid the operated on look and the hollow eye look after surgery.

Evaluation of the upper lid must include the position of the eye brow. A droopy eye brow accentuates the upper lid aging. In those situations the eye brow must be positioned back to normal position. This is done with a forehead lift or a brow lift.

In the upper lid the incision is hidden in the upper lid crease, once healed it is hardly noticeable. The crease should be positioned at the right height from the lashes.

Through that incision excess fat is removed only when absolutely needed other wise a hollow eye will result. In most cases only skin is removed to keep the full youthful eye and avoid the hollow look.

Lower lid lifts are more involved and require experience and artistry. The approach is through either of two incisions:

  1. Transconjunctival, that is through an incision inside the lower lid. Bags are dealt with, and the skin can be smoothed either by laser resurfacing or skin peel, or pinch excision.
  2. Subcilliary, or through the skin just below the eye lashes. The bags of fat are redistributed to fill the hollow crease in the lower lids, and occasionally some of that fat is removed. The lower lid is supported with special sutures (Canthoplasty), and the excess skin is conservatively removed to smooth the skin.

Scars heal very well and are hardly noticeable.

Cosmetic eye lid surgery requires accurate planning and excellent surgical skills.

Dr. Shureih is a TOP Baltimore Plastic surgeon who can deliver excellence on cosmetic surgery.


Asian Blepheroplasty

Asian "double eyelid surgery,” Asian Blepheroplasty is a cosmetic surgery procedure of the upper eye lid where the skin around the eye is reshaped (Blepheroplasty). The purpose of the procedure is to create an upper eyelid with a crease (i.e. "double eyelid") from an eyelid without a crease (i.e. "single eyelid" “the sleepy look). Anatomically, there are a number of differences in the upper eyelids of East Asians compared with the differences in the eyelids of other races. The single eye lid is the most common complaint, other differences a\is the epicanthal fold, where skin covers the inner part of the upper eye lid.

While there are some Asians with a double eyelid and some without, there is also a large variation in the crease position (double eyelid size) of the East Asian upper eyelid. The upper lid fold can range from 1 mm above the eyelash line to about 10 mm. Several methods can be used to create the double eyelid--including the full-incision, partial incision. Each has its advantages depending on the patient's anatomy and desires.

Asian Blepheroplasty have been reported to be the most common aesthetic procedure in Taiwan and other parts of East Asia. There are some risk of complications involving the procedure, but it is generally quite safe if done by an expert plastic surgeon. The procedure to remove the epicanthal fold (epicanthoplasty) is often performed in conjunction with an Asian Blepheroplasty. It involves a form of double Z-Plasty.

The procedure opens the eye and gives the orbital region a more beautiful look.


Risks and complications are rare but do occur:

Infection: Eye lid infection is rare; antibiotics are given to decrease the chances of infection.

Bleeding: It is a rare complication, It is due to bleeding in the fat compartments after the surgery is over.

Blurred vision: This is due to swelling, or damage to any of the muscles that surround the eyeball and coordinate its movement. Most often, these symptoms are temporary. Fortunately, this is a rare problem.

Dry eye syndrome: This can be due to a variety of reasons, however the most common is preexisting dry eye that has not been recognized, or fully manifested itself.

Inability to close your eyes (LAGOPHTHALMUS): This is usually due to removal of too much upper eyelid skin. In severe cases, skin grafting may be necessary to correct this problem.

Corneal abrasion: This can occur during ANY operation, whether it is on the eyes or any part of the body, because the eyes may sometimes open during surgery, rendering them susceptible to being scratched. Treatment involves antibiotics and taping the eye shut for 2-3 days while the abrasion heals.

Hollow (sunken) eyes: occur when too much fat removed from the eyelids. This can usually be prevented by conservative removal of fat or no removal at the time of surgery.

Ectropion: Where the lower lid hangs down.

Prolonged swelling

Bruising

Eyelid Surgery Recovery

Recovery may take up to one week.

surgery is usually done under local anesthesia with sedation.

Surgery time is one to two hours.

It is highly recommended to have an ophthalmology exam done prior to eye lid surgery.

Dr. Shureih and staff will assure you of excellent medical care, in a safe and confidential environment.


POST-OPERATIVE INSTRUCTIONS

WHAT TO EXPECT:

  1. Mild burning and discomfort
  2. Some swelling of the eyelids
  3. Some bruising, it varies from one individual to another
  4. May see minimal amount of blood
  5. Vision may be blurred when using eye ointment

HOW TO CARE FOR THE EYELIDS:

  1. Elevate the head between 30-45 degrees
  2. Cold ice compresses to the eye, a bag of frozen peas mold to the contour of the face. Use continuously for 24-48 hours
  3. May wash face and shower
  4. No heavy activity, no lifting, pushing, or straining for at least one week
  5. Avoid alcohol, aspirin, nicotine, and vitamin E supplements
  6. Avoid driving, flying, or operating heavy machinery while recovering and while on pain medication
  7. Rest the first 48-72 hours
  8. Take your medications:
    • antibiotics
    • pain medication only when there is pain
  9. Diet normal
  10. Watch for infection
    • sudden increase in pain
    • increased swelling
    • redness around eyes
    • purulent discharge

    Contact Dr. Shureih immediately if you think there is infection and/or go to the nearest emergency room.

  11. Watch for bleeding
    • increased swelling and bruising
    • increased pain of the eyes
    • vision disturbances
    • double vision
    • blindness
  12. No eye make-up until the sutures are removed about 4-5 days post operative
  13. Schedule your first post operative appointment 4-5 days post-op, call for an appointment
  14. DO NOT FORGET TO TAKE YOUR REGULAR MEDICATION