William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 4

Question: Can a Blepharoplasty help hooded eyes and uneven folds? 
Answer: Yes, a skin only conservative upper blepharoplasty can accomplish removal of the small amount of extra skin and the extra skin fold that you have on the one eyelid. This procedure can be performed under local anesthesia as an outpatient procedure. A properly performed blepharoplasty does not change the shape of the eyelids.

Question: Brow lift before or after eyelid surgery blepharoplasty? 
Answer: If the hooded and extra skin on your upper lids is all that is bothering you, then perform a conservative skin only upper blepharoplasty. This procedure can be performed under local anesthesia. The eyebrow position appears normal. When performing a browlift, the entire forehead comes up as a unit including both eyebrows.

Question: Would eyelid surgery work for me, or should I take another route? 
Answer: If the only thing that is bothering you is the heaviness in your upper/outer eyelids, then consider conservative skin only upper blepharoplasty. This can be performed under local or general anesthesia. A brow lift may make you look too surprised.

Question: Can I get away with just doing a lower blepharoplasty?
Answer: The 1 photograph is rather limited, but there does appear to be a small fat pads located on one Lower eyelid.. A trans-conjunctival approach lower blepharoplasty can accomplish removal of the fat pads that are herniated creating the puffy look. Fat grafting is not necessary. There also appears to be ptosis in your upper lids.

Question: Do I need eyebrow lift or/ and blepharoplasty to look less tired/angry? 
Answer: The photographs demonstrate hooded and excess upper eyelid skin for which an upper blepharoplasty procedure can accomplish significant improvement. The eyebrow position is totally acceptable and a brow lift is not required. A brow lift would only make you look surprised. The Horizontal wrinkles between your eyebrows are related to hyperactive corrugator muscles. Botox would be the most conservative treatment for those vertical lines.

Question: I live in the Charlotte area. Several consults, all different. What do I really need? 
Answer: From the photographs presented, you show the normal signs of aging in your neck and jowls for which a lower face and neck lift is going to be required. 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 the fat deposits in the neck above and below the platysma muscle which also includes a platysma-plasty to significantly improve your jawline. Regarding your lower lids, you have Festoons and a lower blepharoplasty procedure is not going to help with that. You have excess skin on your upper lids, and an upper blepharoplasty can accomplish a Nice improvement. Study your prospective surgeon’s eyelid and facelift photo Gallery to make sure that it is extensive with results that you like.

Question: Would I benefit more from fillers or a facelift? 
Answer: The photographs demonstrate significant facial asymmetry which can be improved, but your face will not be perfect. Consider placement of a chin implant to augment your recessive chin forward, and custom carved to build up your left side of your chin more than your right. This can be done in combination with the lower face and neck lift to lift the Jowls, tighten loose facial and neck skin, tighten loose facial and neck muscles, and remove any fat deposits in the neck.

Question: What are my permanent options to correct my eyelids and achieve a less tired look?
Answer: A trans-conjunctival lower blepharoplasty accomplishes removal of the fat bags that are creating the puffy look in the lower lids. The incisions are completely located on the inside of the eyelid, and there are no external incisions.

Question: Order of facial and scalp cosmetic surgeries?
Answer: Hairline lowering surgery and an eyebrow lift should be performed together. Hair transplant would be done separately. Facelift, eyelid surgery, rhinoplasty and chin implant can be performed together simultaneously under one anesthesia with one recovery. A full set of facial photographs from all angles are required to make a determination about being a candidate all these procedures.

Question: Can endoscopic brow lift make my eyes worse?
Answer: Much more in information is needed, such as a full set of facial photographs to determine if your candidate for the procedure, and it history of any eyelid or forehead surgery. Also important to know how dry your eyes are, if that is an issue already.

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