William Portuese MD

acial Plastic Surgery Questions and Answers: Part 3

Question: Eyelids naturally heavy & sty may have left with with ptosis – best minimal procedure? 
Answer: It’s difficult to tell from the photographs presented, but you do have a symmetrical creases on your upper lids. An – person examination is going to be required to make a determination about how best to proceed. The asymmetrical skin and creases can be improved with a cosmetic blepharoplasty, while ptosis repair requires tightening, one or both of the muscles that open the eyelids.

Question: Do I need eyelid surgery? 
Answer: A very conservative upper eyelid lateral skin only blepharoplasty can accomplish your goals in the outer 1/3 of your upper lid. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: 1.73cm, 80kg, male, 28 years old, brown skin – I want to know if have ptosis or not? 
Answer: Your photographs are rather limited, but it does appear that you may have ptosis on your upper eyelids, which is a weakness of the eyelid muscle. Ptosis repair is usually performed by a ocular plastic surgeon. A cosmetic blepharoplasty procedure will not help with this issue.

Question: Possible candidate for lower eye blepharoplasty?
Answer: The photographs demonstrate herniated fat pads in the lower lids, and you are an excellent candidate for a lower lid blepharoplasty. The primary goal for lower eyelid blepharoplasty is to remove the fat bags in the lower lids. The fat is removed through a trans–conjunctival approach completely located on the inside of the lower lid. If there is excess skin at rest ( not when smiling), then a small external pinch of excess skin could be performed at the lash line. In our practice, we close this incision with tissue glue. No stitches are required.

Question: I’m 37 and my eyes are aging me. Could upper and lower eyelid surgery help the appearance of this area? 
Answer: From the photos presented, your upper eyelids are certainly showing some excess skin which is touching your eyelashes and you are great candidate for an upper blepharoplasty. Regarding the lower lids, there does not appear to be any fat bags in the lower lids. A conservative pinch technique of excess skin at rest( not when smiling) can accomplish improvement in that area. This incision Is located directly at the mascara line and is closed with tissue glue. Upper eyelid surgery can be performed under local or general anesthesia as an outpatient procedure.

Question: Am I a good candidate for lower eyelid surgery?
Answer: From the one very limited photo, there does appear to be herniated fat in the lower lids. A full set of eyelid and facial photographs are going to be required to make a better determination. When the fat bags are present in the lower lids, a transconjunctival approach on the inside of the lower lid can accomplish removal. This is performed under a brief general anesthesia as an outpatient procedure.

Question: Do I need brow lift or upper blepharoplasty to reduce the outer crows feet? 
Answer: Crows feet are best treated with Botox, not surgery. The height of your eyebrows is acceptable, and a browlift is totally unnecessary. There is not enough extra skin on your upper eyelids, therefore, eyelid surgery is not necessary.

Question: Lower blepharoplasty, RGP contact lense wearer – How long would I have to wait before wearing my lenses again after surgery? 
Answer: A trans conjunctival lower blepharoplasty can accomplish removal of the puffiness in the lower lids created from the herniated fat bags. There’s two small incisions located on the inside of the eyelids. We recommend not wearing contact lenses for two weeks after the surgery.

Question: Upper, lower blepharoplasty, brow-lift? Which combination do I need? 
Answer: The 1 Limited photograph demonstrates adequate brow position even though your raising them to lift upper eyelid skin skin. Performing a brow lift will make you look very surprised, since your eyebrow position is higher than normal. A brow lift is only performed for patients who have low set eyebrows. An upper blepharoplasty procedure can accomplish removal of the hooded skin touching your eyelashes, while a trans-conjunctival approach lower eyelid surgery can accomplish removal of the fat pad bags creating the puffy look. The incision is located completely on the inside of the lower lids. After you have performed the eyelid surgery, then consider Botox in your forehead for the horizontal lines.

Question: Can lower eyelid fat repositioning damage the tear trough area?
Answer: In our practice, we only do fat repositioning for upper eyelid surgery when needed. We perform a transconjunctival conservative fat removal through the inside of the lower lids to rejuvenate them.

    Contact Dr. William Portuese