William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 03

Question: Should I do a lower facelift with blepharoplasty at the same time? What would the best option to address my eyes? 
Answer: A facelift and a blepharoplasty procedure can certainly be performed together which is a very frequent combination in our facial plastic surgery practice. Before making a determination about the facelift, a full set of facial photographs from all angles are going to be required to make a determination about being a candidate for the procedure, since you’re only 45 years of age. Anticipate two weeks of visible bruising swelling with both procedures.

Question: Would blepharoplasty be the right option for me to have my eyes more open? 
Answer: The goal of an upper blepharoplasty procedure is to remove excess skin which is creating the hooded/tired look. That is not appear to be the case according to the photographs. A better set of photographs are going to be required. A blepharoplasty procedure is not going to open up the aperture of the eyes any more. Everyone has some degree of asymmetry on their eyelids, and asymmetrical eyelid surgery can accomplish improvement in that by taking extra skin on one side versus the other, but the overall opening of the eye  won’t change  with a blepharoplasty procedure.

Question: What can I do about a completely uneven face? I plan on a rhinoplasty/septoplasty but what can I do with my eyes?
Answer: Its impossible to make a judgment call  about  any type of eyelid surgery with your eyelids closed.  A full set of facial photographs including the eyelids from all angles are going to be required.   Everyone has some degree of facial and eyelid asymmetry, which is normal. With respect to your crooked nose, a  closed rhinoplasty can accomplish straightening it with  all of the incisions placed on the inside of the nose itself.No external incisions are required.  A septoplasty is performed in the back of the nose   when there is very significant airflow restriction once medical necessity has been documented at the time of the examination. A septoplasty will not change the shape of the nose, and is only performed for improvement of air flow dynamics.  Both a cosmetic rhinoplasty and a functional septoplasty can be performed together under one anesthesia with one recovery period.

Question: I’m 57 years old and happy with my eyes – Am I a good candidate for a mini facelift? 
Answer: A mini lift will give you mini results , and will not address your aging neck issues. A lower face and neck lift can accomplish tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fat deposits in the neck to restore your jawline.

Question: I have suffered from bags under my eyes for years. Am I a good candidate for under eye surgery? 
Answer: Yes indeed, the bags that are present in your lower lids can be removed with a transconjunctival approach lower blepharoplasty. All of these are incisions are placed inside of the eyelids. No external incision is needed.

Question: Should I get a blepharoplasty or eyebrow lift for my hooded eyes? 
Answer: Based on the limited photographs, you do not appear to be a candidate for either upper eyelid surgery or a brow lift. Your eyebrow proposition is normal. Best to leave well enough alone.

Question: Can a person with dry eye have a new trans- Conjunctival lower blepharoplasty and upper blepharoplasty surgery?
Answer: Yes, when patients have dry eyes it is possible to perform an upper and lower blepharoplasty procedure. It’s important to be conservative on the amount of skin removed from the upper lids, and not remove any muscle from the upper eyelid structure as well. There is a small chance that your dry eyes may become drier after a cosmetic blepharoplasty. Always best to document the amount of dryness by your ophthalmologist before the surgery.

Question: 40 yrs old and my eyes are showing signs of aging. What would you suggest for a more youthful appearance? 
Answer: As long as you don’t have any ptosis, then a cosmetic upper/ Lower blepharoplasty procedure can accomplish rejuvenation of both upper and lower lids. The fatty bags in the lower lids can be removed with a trans-conjunctival approach lower blepharoplasty. The excess skin creating the hooded look on the upper lids can be removed with an upper blepharoplasty with the incision placed directly in the crease itself.

Question: Will a second facelift (or a facelift revision) eliminate returning jowls?
Answer: Much more information is needed, such as a full set of facial photographs from all angles in addition to your pre-op and postoperative photographs. It’s also important to understand what type of facelift procedure was performed. Best to wait a year before undergoing another procedure.

Question: How do people with dry eyes have a facelift?
Answer: A facelift procedure will not affect dry eyes. It’s important to be very conservative with upper blepharoplasty when patients have dry eyes.

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