William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 7

Question: Am I a candidate for lower eyelid surgery? 
Answer: The primary goal for lower eyelid surgery is to remove the fat bags through trans conjunctival approach on the inside of the lower lids. At age 33 you do not have inelastic skin, and therefore no skin removal is required.

Question: Can you get an upper blepharoplasty if you have had Restylene in the upper eyelid area?
Answer: Yes it is possible to get an upper blepharoplasty after you have had fillers placed in the eyelids. A full set of facial / eyelid photographs are required to make a determination about being a candidate for the procedure.

Question: Am I a good candidate for upper blepharoplasty? 
Answer: Yes indeed, your left upper eyelid is more hooded then you’re right side, so a conservative skin only upper blepharoplasty would be helpful to rejuvenate your upper eyelids. You also have low eyebrows, so give some consideration to a brow lift.

Question: Can malar implants be placed to add forward projection but not facial width? 
Answer: Malar implants are designed to be placed directly underneath the orbit and give forward projection. They are not placed at the outer corner of the eyelids which will widen the face. Best to talk with your plastic surgeon, since the implants are manufactured in a large variety of sizes, thicknesses, and shapes.

Question: Which procedure would help minimize the appearance of wrinkles in the general eye area? 
Answer: Consider an upper blepharoplasty procedure to get rid of the extra Hooded skin on the upper eyelids. With respect to the lower lids, you could have a conservative “pinch” performed for the extra skin. In our practice, that might be approximately one eighth of an inch skin excision. You may require laser treatment to get rid of all the fine lines. Botox is performed for crows feet.

Question: Is blepharoplasty my only option for sagging upper eyelids, or are there non surgical options like threads, fibroblast? 
Answer: Yes, an upper blepharoplasty procedure and accomplish removal of extra skin creating the hooded look in addition to a small amount of fat as well. The procedure can be performed under local or general anesthesia.

Question: Which surgery method for a brow lift?
Answer: In our practice we use the coronal approach to accomplish lifting the entire forehead and eyebrows as a unit. The Incision is located back in the hairline Area. Eve if you lift your eyebrows, you may still require a conservative upper eyelid skin blepharoplasty, since you have very hooded eyelids in addition to low set eyebrows.

Question: What procedures can fix my extremely hooded and uneven eyes? 
Answer: Much more information is needed such as a full set of eyelid photographs in a chin neutral position. A very conservative skin only upper blepharoplasty can accomplish lifting your upper eyelid crease to a higher position. It is also important to rule out ptosis on your left eye.

Question: Blepharoplasty – Transcutaneous or Transconjunctival for my lower eyelids? 
Answer: In our practice for over 30 years, we have only performed trans conjunctival approach for fat removal. The reason for this is that a transcutaneous approach can weaken the lower eyelid muscle and can give ectopion or scleral show.

Question: My eyelids are beginning to droop and create hooded eyes. What are signs that it’s appropriate to have a blepharoplasty? 
Answer: From the one very limited photograph, it appears that the eyebrow position is normal, and a brow lift is unnecessary. An upper blepharoplasty procedure can accomplish removal of the excess skin in your upper lids creating the hooded look. This can be performed under local or general anesthesia.

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