William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 2

Question: Do you have any advice please as I am going to get a facelift and under eye fat removal? 
Answer: It’s very important to look at your prospective surgeon’s before and after facelift and eyelid photo Gallery to ensure that you’re going to get a great result. Big hospital systems tend to concentrate on reconstructive plastic surgery, so it’s important to find out how much elective cosmetic facelift and eyelid surgery that your surgeon is performing on a routine basis. It’s best to make appointments with three busy facelift surgeons and then make your decision.

Question: I just turned 50, is it time for an eyelid lift? 
Answer: The photograph is rather limited, however it does appear that there’s excess and loose skin on your upper lids for which an upper blepharoplasty procedure can improve the hooded look.

Question: Tear trough deformity? Or fat? 
Answer: You have herniated fat in the lower eyelids which can be removed through a trans conjunctival approach with two small incisions made on the inside of the lower lids. Since you’re only 27, a conservative amount of fat would be removed.

Question: Would a lower blepharoplasty help my bags? 
Answer: Yes, a lower blepharoplasty performed through a trans-conjunctival approach can accomplish removal of the fat bags creating the puffy look. Two very small incisions are made on the inside of the eyelid, and those fat bags are removed. At age 40, you should not need any tightening of the skin from the outside. Choose your surgeon wisely based on extensive experience producing natural results.

Question: Would I benefit from upper eyelid surgery? 
Answer: From the one limited frontal photograph, you have very mild extra skin on your upper lids. Your right eye is worse than your left because your right eyebrow is lower than your left eyebrow. A very conservative skin only upper blepharoplasty under local anesthesia could give you some improvement. If you’re complaining of eyelid droopiness, it’s important to make sure you don’t have any ptosis present.

Question: What is causing my upper eyelids to be droopy? Would I need surgery or are there less invasive options? 
Answer: The picture demonstrates excess skin on the upper eyelids known as dermatochalasis. The skin appears to be resting on your eyelashes, therefore you are great candidate for upper eyelid blepharoplasty. This procedure takes about 30 minutes and involves removing excess skin on the upper eyelids to rejuvenate them. The procedure can be performed under local anesthesia or general anesthesia.

Question: Ocularplastic surgeon versus general plastic surgeon for upper & lower blepharoplasty? 
Answer: In our practice for over 30 years, we’ve never heard of a blepharoplasty causing decreased vision. If anything, a functional blepharoplasty increases a peripheral vision by removal of excess hooded skin. It’s very important to go to A surgeon who has lots of experience performing blepharoplasty. Study your perspective surgeon’s before and after eyelid photo gallery to make sure that it is extensive with Lots of results that you like and they look natural.

Question: I was told I need an eyelid surgery and blepharoplasty. Should I use an ocular surgeon? 
Answer: Much more information is needed, such as a full set of facial photographs from all angles looking straight into the camera( Not smiling) and why were told you needed eyelid surgery? Cosmetic or functional purposes?? Plastic surgeons, facial plastic surgeons and oculoplastic surgeons all perform eyelid surgery depending upon what you need. Regarding jowls, facial aging and considering a facelift, that should be performed by a facial plastic surgeon.

Question: Follow-up question: Regarding first consult for lower eye blepharoplasty. Thoughts? 
Answer: In our practice, we definitely do not perform fat injections to cheeks for a variety of reasons. If you are trying to augment the cheeks, use fillers placed in the office setting, or cheek implants for permanent augmentation. A simple transconjunctival lower blepharoplasty can accomplish improvement to rejuvenate your lower eyelids.

Question:Am I a good candidate for a deep plane facelift?  
Answer: The goal of upper eyelid surgery is to remove mostly excess skin and a small amount of fat on the inner corners of the upper eyelids. The goal of lower eyelid surgery is to remove the fat bags through trans-conjunctival approach on the inside of the lower lids. In our practice we do not recommend a deep plane facelift due to higher risk of facial nerve damage. We perform a high-SMAS lower face and neck lift. This procedure accomplishes lifting the jowls, tightening loose facial and neck skin, tightening loose facial and neck muscles, and removing fat deposits in the neck which also includes a platysma plasty. It is very important to look natural after all of these procedures.

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