William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 1

Question: What is the likely cause of my eyelid asymmetry and how can it be balanced? 
Answer: Everyone has some degree of eyelid asymmetry due to the embryologic development of the face from both the left and right half. A conservative skin only upper blepharoplasty can accomplish improvement of the asymmetry. This can be performed under local anesthesia as an outpatient procedure.

Question: Am I a candidate for eyelid surgery? 
Answer: You have low eyebrows which are creating the hooded look on your upper lids. Consider a brow lift procedure to raise the eyebrows and lift your lower lids off your eyelashes.

Question: Blepharoplasty quandary. How does a surgeon determine the amount of filler to be used?
Answer: In our practice, we simply remove the herniated fat bags in the lower lids through a trans- conjunctival approach on the inside of the lower eyelids. Some patients over 50 years of age requires pinch of skin when there’s extra skin present which is located on the outside of the lower lid directly underneath the eyelash line. For long list of reasons, we do not recommend fat injections to the eyelids or fillers in that area.

Question: Would having upper and lower lid surgery help with bags/darkness under eyes? 
Answer: The photograph demonstrates herniated fat in the lower lids for which a lower eyelid surgery can certainly improve. The fat is removed through a trans conjunctival approach on the inside of the lower lids. If there’s excess skin at rest (not when smiling) then a pinch of extra skin at the eyelash line can be performed to tighten the lower lids. In our practice, this incision is closed with tissue glue. No stitches are required.

Question: How common is entropion after lower blepharoplasty done from outside the eyelid? 
Answer: In our practice for over 30 years, we remove all fat through the inside of the lower lid, which is the gold standard to prevent ectropion. If there’s loose and extra skin present on the lower lids, then we make an incision just underneath the eyelashes only remove a small pinch of the skin itself. The reason for the incision on the inside, and the incision on the outside is to prevent any disruption of the lower eyelid muscle, which can cause an ectropion.

Question: Do I need upper and lower blepharoplasty, please?
Answer: From the one limited photograph, it appears that you have significant asymmetry between your left side and right side. Your left upper lid is more hooded than your right, so a conservative skin only left upper blepharoplasty can make left eyelid Look more like your right. You also have fat bags on your left lower lid, and a left-sided trans-conjunctival lower blepharoplasty can make your left eyelid Look more like you’re right lower lid.

Question: What sort of eye procedures would I benefit from? 
Answer: The picture that you’ve sent is rather blurry,so makes it very difficult to make a determination about how best to proceed. It appears that your upper eyelid skin is rather hooded and resting on your eyelashes, therefore consider an upper blepharoplasty procedure which can be performed under local anesthesia as an outpatient procedure.

Question: Mini facelift: what does it include and cost?
Answer: A mini facelift lift tends to give mini results, and we rarely ever perform them. A mini lift does not include any work in the neck. In our practice, the goal of a lower face and neck lift is to tighten loose facial and neck skin, tighten loose facial and neck muscles, lift the jowls, and remove fat deposits in the neck, which also includes a platysma plasty. Regarding your eyelids, upper blepharoplasty and lower blepharoplasty are two different procedures. All of these can be combined when necessary. A full set of photographs would be required to make a determination about being a candidate for these three procedures.

Question: Is it preferable to have eyelid surgery (upper, lower blepharoplasty, eyebrow lift) after I’m done nursing?
Answer: It is probably best to wait at least 3 to 4 months postpartum before looking to undergo cosmetic eyelid surgery.A full set ofUpper and lower eyelids photographs Are required to make A determination about how best to proceed.

Question: Am I a good candidate for upper eyelid surgery? 
Answer: A conservative skin only upper eyelid surgery can accomplish, lifting the crease on your upper lids, especially on your right side, where your more hooded. This procedure can be performed under local anesthesia as an outpatient procedure, and usually takes about 30 minutes.

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