William Portuese MD

Facial Plastic Surgery Questions and Answers: Part 9

Question: Is it possible to have Volbella removed surgically while doing a lower bleph?
Answer: It is not possible to remove fillers while performing a lower blepharoplasty. Best to have it reversed with Vitrase 2 weeks before lower eyelid surgery.

Question: Will a cheek implant or fat grafting address my flat mid-face area or would I need a lower eyelid lift as well? 
Answer: From the photos presented, there does not appear to be a flat mid- face and the fat volume in your mid-face appears acceptable. Cheek implants are placed for patients who have a flat maxilla and a flat mid face offer permanent augmentation to that area. The Implants are placed through an intraoral approach under a brief general anesthesia as an outpatient procedure.

Question: Doing lower eyelid surgery to get rid of wrinkles. Will the old scar stay or should it be removed?
Answer: Much more information is needed, such as a full set of facial photographs of the eyelids. The primary goal for lower eyelid surgery is to remove the fat creating the puffy look. If there is excess skin in the lower lids, a pinch technique can remove it. It’s difficult to remove wrinkles in the lower lids since only conservative amount of skin can be removed in that area.

Question: What can I do to minimize the appearance of drooping eyes caused by aging? 
Answer: An upper blepharoplasty procedure can accomplish removal of the extra hooded skin and a small amount of fat from the upper eyelids to rejuvenate them. This procedure can be performed under local anesthesia as an outpatient procedure.

Question: 68 y/o interested in eyelid surgery – would transcutaneous or transconjunctival blepharoplasty deliver best results? 
Answer: For over 30 years, we have performed all fat removal through a trans- conjunctival approach with the incision placed on the inside of the lower lid to remove the fat deposits. If and when there’s excess skin located on the outside, then a very small incision is placed directly below the eyelash line and a very conservative small pinch of skin is performed. We close that incision with tissue glue. No stitches. Transcutaneous lower blepharoplasty can create with scleral show and ectopion at your age. The transcutaneous approach weakens the lower eyelid muscle and is not advisable.

Question: 32 year old male – what are my options to reduce the appearance of puffy eyes? 
Answer: First of all you could try a low salt diet to see if that helps with the puffiness in your lower lids. The photographs demonstrate herniated fat pads in the lower lids which usually requires a lower blepharoplasty procedure to improve. A trans conjunctival approach lower eyelid surgery can accomplish removal of those bags with two small incisions on the inside of each eyelid. No external incisions are required. The Procedure is performed under a brief general anesthesia as an outpatient procedure.

Question: Upper eye puffiness and asymmetry – am I candidate for a brow lift, blepharoplasty or something else? 
Answer: There’s always a symmetry in the upper eyelids, both before and after the procedure. Your eyebrow position is normal, therefore a brow lift is not necessary. A conservative upper blepharoplasty procedure can accomplish removal of some of the excess fat creating the puffy look, and a conservative amount of extra skin. In upper blepharoplasty procedure can be performed under local anesthesia As an outpatient procedure.

Question: Which procedure would help minimize the appearance of under eye bags while delivering a more youthful appearance? 
Answer: A trans conjunctival approach lower blepharoplasty can accomplish removal of the herniated fat compartments your lower lids to rejuvenate them. The Incision is located on the inside of the eyelids, no external incision is required unless there’s lots of loose skin present. The procedure is performed under a brief general anesthesia as an outpatient procedure.

Question: Upper blepharoplasty or brow lift? 
Answer: From the photos presented, your eyebrow position is acceptable, so a brow lift would just make you look too surprised permanently. You also have more hooded skin on your right eyelid, and during the upper blepharoplasty procedure a differential amount of skin is removed to make them look more symmetrical. In our practice, we perform upper blepharoplasty under local anesthesia which takes about 30 minutes in our surgery center.

Question: In breast cancer remission would like to undergo upper blepharoplasty and alar reduction Is it ok? 
Answer: Probably best to wait for several months after all your treatments have been completed clearance from your primary care physician to make sure that urine excellent health before undergoing elective eyelid and nasal surgery.

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