William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 10

Question: Facial rejuvenation procedures in stages or all at once? 
Answer: At age 50, you’re aging very well. From the photographs, it appears that you really only need your upper eyelid blepharoplasty done. This procedure can be performed under local anesthesia as an outpatient procedure which takes approximately 30 minutes. You do not need a brow lift since your eyebrows are in excellent position. Performing a brow lift would make you look permanently surprised. You do not have any excess fat in the neck jowls or loose skin, therefore you’re not a candidate for a lower face and neck lift procedure.

Question: Suggestions on how to fix my sagging brow? Temporal brow lift? 
Answer: From the photographs presented, you do not have sagging eyebrows, you have hooded upper eyelids. You’re not a candidate for a brow lift, since you would look very surprised permanently. Consider performing an upper blepharoplasty to rejuvenate your upper eyelids. The procedure can be performed under local anesthesia which takes about 30 minutes as an outpatient procedure.

Question: Concerned about eyelid retraction and ectropion – What are the chances of this happening?
Answer: First of all, a transcutaneous lower eyelid surgery can result in ectropion. Consider having the procedure performed as a trans conjunctival approach with the incision located on the inside of your lower lids. We do not recommend fat injections to the eyelids because we have seen very poor results from that procedure. Much more information is needed such as a full set of eyelid pictures to make a determination about a canthoplasty procedure that you’re considering undergoing.

Question: I’m 30 and have excess eyelid skin that results in a “third eyelid”. What procedures would be safe and would age well? 
Answer: The photo demonstrates asymmetrical skin creases on the upper lids and then differing amount of fat in the 2 eyelids as well. An upper blepharoplasty procedure can accomplish a more symmetrical single eyelid crease and a small amount of fat grafting from the more full eyelid to the more hollow eyelid may be helpful as well.

Question: Would i benefit from lower eyelid surgery? 
Answer: From the one photograph, it appears that you have significant eyebags related to herniated fat in the lower lids. A trans conjunctival approach lower blepharoplasty can accomplish removal of those bags. The fat is removed from two small incisions on the inside of the eyelid. No external incisions are required. This procedure is performed under a brief general anesthesia as an outpatient procedure.

Question: What kind of treatment(s) would be most suitable for my hooded upper eyes? 
Answer: An upper blepharoplasty procedure can accomplish improvement of the excess skin creating the hooded look on your upper eyelids. Your Eyebrow position is normal, therefore a brow lift is not necessary. An upper blepharoplasty can be performed under local or general anesthesia depending upon patient’s desires.

Question: Age 50 & increasingly tired looking face – brow lift and/or upper blepharoplasty? 
Answer: The position of your eyebrows is acceptable, therefore just an upper blepharoplasty can accomplish removal of the hooded skin on your upper eyelids to rejuvenate them. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: What would be best for fat under the eyes: Thermismooth or Microneeding RF? 
Answer: Noninvasive treatments simply will not have any effect upon fat bags located in the lower lids. A surgical lower blepharoplasty is required. There are three fat bags located under each eyelid, and those fat bags are usually removed from two small incisions on the inside of the lower lid call the trans- conjunctival approach. This procedure takes approximately 30 minutes under a brief general anesthesia as an outpatient procedure. A full set of eyelid photographs would be helpful to make sure that you’re a candidate for the procedure.

Question: Can eyelid surgery make your eyes appear larger?
Answer: A full set of facial photographs are required to make a determination about how best to proceed. The primary goal for upper eyelid surgery is removal of extra skin and a small amount of fat creating the hooded appearance of the upper eyelids.

Question: Would I benefit from a brow lift in addition to a blepharoplasty? 
Answer: When making the decision about a brow lift, your eyes must be open then we look at distance between your eyelids and your eyebrows. From the limited photographs, it appears that your eyebrows are in an acceptable position. You do have extra skin on the upper lids for which an upper blepharoplasty can improve. The goal of lower blepharoplasty is to remove fat bags creating the puffy look.

    Contact Dr. William Portuese