The eyelids are delicate structures within an important function: protecting the eyes while allowing us to see. Eyelid surgery planning and technique must therefore take into account the intricate anatomy, complex function, and aesthetic importance of this area. Furthermore, multiple treatment options, both surgical and nonsurgical, can be used to enhance the eyelids. The ideal result often involves using more than one modality in addition to surgery. Related procedures, like brow lifting, laser resurfacing, or autologous fat injection may also be critical to achieving the ideal result.
Choosing the best procedure for you requires a thorough assessment of the eyes, the eyelids, the surrounding areas, including assessing the quality of the skin and supporting structures of the eyelid. As is often the case, your personal goals may affect the choice of the ideal combination of treatments for you. Dr. Goldman has extensive experience with facial aesthetic surgery and is triple board-certified in Facial Plastic and Reconstructive Surgery, Plastic and Reconstructive Surgery, and Otolaryngology/Head and Neck Surgery (Ear, Nose, and Throat Surgery), making him uniquely qualified to treat this area.
Blepharoplasty (aesthetic surgery of the eyelid) can be performed on the upper eyelids, lower eyelids, or both, depending on your needs. With age, skin may become loose and redundant; periorbital fat (fat from inside the eye socket) may begin to bulge and form eyelid bags; upper eyelids may droop, interfering with vision; and lower eyelids may droop, exposing the inside of the eyelid.
Depending on a patient's physical findings and aesthetic concerns, different related procedures may be necessary. For instance, some patients may only need upper eyelid surgery, some lower, some both. If the brows are in low position, the ideal aesthetic result may involve a brow lift, but the patient may not be bothered by their brows, so a discussion regarding blepharoplasty with or without brow lift becomes important. Dr. Goldman therefore believes in tailoring each individual patient's surgical treatment plan to their needs, based on thorough evaluation and close communication with our patients.
Blepharoplasty usually involves removing excess skin from the upper or lower eyelids. In addition, bulging fat is removed and smooth to reduce eyelid bags. Removal of too much back can produce hollowed out, older appearance, so Dr. Goldman believes not just in conservative fat removal to preserve youthful volume, but also in repositioning tissues that have drooped over time, particularly in the lower eyelid and cheek. These are complex techniques, and different surgeons may have different styles. Dr. Goldman believes in achieving a dramatic but natural look using technically precise surgical techniques in combination with other modalities, like laser resurfacing, fat injection, and medical grade skin care.
Dr. Goldman performs an upper cheek lift (malar lift) in the majority of his lower blepharoplasty patient's. This raises and minimizes the crease between the eyelid and cheek (tear trough and lid cheek junction) in a youthful way that adds fullness. This allows him to achieve a more youthful and natural appearance than with traditional blepharoplasty techniques.
Ideal candidates are individuals who have sagging or drooping eyelids, puffiness, or excess skin around the eyes that affects their appearance or vision. During your initial consultation, we’ll review your medical history and carefully assess the physical characteristics of your eyelids to create a personalized treatment plan.
The eyelids are delicate structures. Risks specific to blepharoplasty include cosmetic issues, dry eye, ectropion (downward malposition of the lower eyelid), upper eyelid droop, difficulty closing the eyes, corneal abrasions, diplopia (double vision), and blindness, which is rare, but can be caused by bleeding around the eye. Generally, these are rare complications and are minimized by taking appropriate precautions before and after surgery. Dry eye is fairly common, even in patients who have never had surgery, but surgery can exacerbate it. Fortunately, choosing a skilled and experienced surgeon can help to minimize these risks and achieve a better outcome.
As the name implies, the primary goal of a brow lift is to elevate the brows into a higher, more youthful position. Low brows make the upper eyelid appear more droopy, with more excess skin. Some patients with sagging upper eyelids also require a brow lift if they want the ideal aesthetic result. In general, men have lower, flatter eyebrows than women. Thus, a lower brow position can be considered youthful in a man, which has to be taken into account when planning eyelid and brow surgery.
There are multiple types of brow lift available:
Toxin: The most common way that Dr. Goldman and his team elevate the brow is with Botox™, Dysport™, Daaxify™, and other neurotoxins. When injected in an artful, precise way to the crow’s feet, botulinum toxin will relax the orbicularis oculi muscle, which pulls down on the brow, allowing the lateral (outer) brow to drift upwards to a higher position with a more youthful arch. Dysport™ can also complement surgery to help maintain a nice long-term result.
Brow lifts are seldom used by themselves. Most commonly, they are performed concurrently with upper blepharoplasty. They are often part of comprehensive facial rejuvenation, being performed with facelift and blepharoplasty.
Furthermore, since eyelid skin tends to be thin and crepey, laser resurfacing and medical grade skin care with retinoids is often necessary to obtain the ideal result. And as noted above, botulinum toxin, not just to the crow's feet but also to the forehead and other areas of the face, can relax muscles, smoothing and rejuvenating the face. An injectable filler or autologous fat may be used to augment the cheek and a natural, full way to complement the blepharoplasty. Certain lower blepharoplasty patient's will need the addition of volume in some fashion to achieve an ideal result.
Understanding which combination of procedures will give you the best result requires a thorough consultation with a qualified, experienced, artistic, and skilled surgeon, like triple board-certified Dr. Steven Goldman. The rest of our knowledgeable, compassionate, professional team is also here to help to discuss cosmetic injectables, medical grade skin care, and laser resurfacing, as well as answer questions about surgical options.
