William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 06

Question: What type of brow lift would be the best choice for correcting asymmetry (naturally hooded eyes)? 
Answer: Much more information is needed, such as a full set of pictures at rest.  Consider Botox, or an upper blepharoplasty.

Question: I am an Asian female considering lower eyelid surgery. How important is it to find a doctor with experience with Asian eyes?
Answer: Best to look for a very experienced eyelid surgeon to accomplish rejuvenating your eyelids. A trans-conjunctival approach lower blepharoplasty can accomplish removal of the fat bags giving you the puffy look in the lower lids themselves.

Question: What can I do about my eyes? Any way I can move the fat rather than remove it completely? From the inside? 
Answer: The photograph presented is inadequate to make a determination about how best to proceed. From that one odd angle looking upwards, the protrusion of fat is worse than looking straight ahead. A trans-conjunctival approach lower blepharoplasty is the gold standard technique to remove fatty deposits creating the puffy look in the lower lids. The Incision  is completely located on the inside of the eyelids.

Question: What is the best procedure/treatment for my wrinkles and saggy under eyes? 
Answer: The primary goal for lower eyelid surgery is to remove the fat bags creating the puffy look. This is accomplished with the trans- Conjunctival approach lower lid blepharoplasty. This incision is located on the inside of the lower lids. If there is excess skin at rest( not when smiling), then a  pinch technique of excess skin can be performed directly below the eyelash line on the lower lids. In our practice, we close this incision with tissue glue.  No sutures are required for the lower lids. It will not be possible to remove all the wrinkles, just an improvement.  An in-person examination is going to be required to make a determination about the laxity of the lower eyelid skin. Fractionated laser resurfacing can also be of some benefit once the extra skin has been removed.

Question: Will getting a brow lift pull my eyelid skin upward?
Answer: Yes, performing a brow lift will also lift the upper eyelid skin and open up the eyes to some degree. Some patients do require an upper blepharoplasty performed at the same time as the brow lift, but this must be determined at the time of the consultation and examination.

Question: Does it look like I need a nose job or maybe do something to my eyes or eyelids? 
Answer: Performing cosmetic surgery is personal  decision, and only the patient can make that decision. A full set of facial photographs in a chin neutral position from all angles are required to make a determination about two different surgical procedures. Digital computer imaging would also be helpful to understand what can be accomplished with your nose upon your facial features.

Question: Hooded eyes are making my eyes look small. Will I need an upper blepharoplasty? 
Answer: The photographs demonstrate hooded upper eyelids for which an upper blepharoplasty can improve. Upper eyelid surgery accomplishes removing excess skin and fat creating  the hooded appearance. The incision is placed directly in in  upper eyelid crease. The procedure can be performed under local or general anesthesia depending on the patient’s desires.

Question: Sculptra, Filler or fat to fill under eyes & cheeks – What are the pros & cons of a fat transfer to (face) cheeks?
Answer: In our practice, we have found  cheek implants to be a very reliable and consistent  augmentation of the mid-face, especially  when all of the other modalities have failed. Fillers work quite well for a temporary augmentation, while cheek implants offer a permanent augmentation. The implants themselves are manufactured in a large array of thicknesses, sizes, and shapes which is best determined at the time of the consultation and examination. In our practice, we placed these implants through an Intra- oral approach under brief general anesthesia as an outpatient procedure. 

Question: Why do my eyes have that fold of skin at outer corners? What would fix it? 
Answer: The fold of skin at the outer corners of your eyelids occurs because of aging process of the eyelids themselves. An upper eyelid blepharoplasty can accomplish improvement of this area. This procedure is called an upper blepharoplasty, and can be performed under local anesthesia as an outpatient procedure.

Question: Is it possible to have lower eyelid surgery without causing dry eyes to worsen?
Answer:

Much more information is needed such as the degree of dryness of your eyelids in addition to a full set of pictures to make sure your candidate for the procedure itself. The primary goal for lower eyelid surgery is to remove  fatty deposits creating the puffy look in the lower lids. This can be performed through trends conjunctival approach through the inside of the lower lid which usually does not affect dry eyes.

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