It has been said the eyes are the window to the soul. If this statement is true, then tired looking eyes are the windows to a tired soul!
I will be discussing upper eyelid surgery in this blog. The patient typically complains of excess skin of the upper eyelid and droopiness of the eyelid skin, making their eyes look “sad or tired”. It is important to rule out actual ptosis of the eyelid, since removal of excess skin will not address the droopiness of the actual eyelid itself. It is also important to look for ptosis of the eyebrows as the whole eye brow/eyelid unit may be dropped causing or exaggerating the excess skin of the upper eyelid. These patients will have “hooding” of the lateral eyelid skin (the lateral eyelid skin actually hangs over the crow’s feet of the eye).
If the patient has excessive droopiness of the entire eyebrow, then a brow lift should be done first, followed by upper eyelid surgery (upper blepharoplasty). If this is not done in this sequence, too much eyelid skin may be removed, and a brow lift may not be possible due to inadequate residual skin, thus leading to an inability to close the eyelid.
Some patients have borderline eyebrow ptosis. Recently, I have been treating these patients with Botox to elevate the eyebrow, followed by upper eyelid surgery. The use of Botox allows a natural and subtle lift in the eyebrow, which is not possible to obtain with surgery. The patient understands he/she will need maintenance treatment with Botox every 3-6 months, but are willing to accept this in lieu of a brow lift.
Above is a before and after photo of a patient who was treated with 20 units of Botox to the glabella (medial eyebrow region) and 20 units to the crow’s fee region. Please note the subtle yet dramatic improvement in the appearance of the eyelid.
Two weeks after Botox treatment, the patient had upper eyelid surgery, which is depicted in the video. Many years ago, it was routine to remove fat from the upper eyelid as well. However, with time, patients developed a hollow upper eyelid which is not consistent with a youthful look. Please look at any fashion magazine, and pay close attention to model’s upper eyelids. All eyelids have some skin present, and the upper globe of the eye is not visible. I, therefore, rarely remove fat from the upper or lower eyelid.
Below is a photo of the patient one week after surgery. There is still healing process present and the incision will fade with time, but the improvement is noticeable yet natural.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call (714) 834-0101.
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