Eyelid surgery or blepharoplasty is a procedure performed on women and men alike of all ages. The result of this procedure restores the eyelids to a more well-rested and youthful appearance, removing fat bags and tightening loose skin. While usually performed for cosmetic reasons, this procedure can also treat the impaired vision created by droopy upper eyelids.
In upper eyelid surgery, an incision is made along the crease of the eyelid making the scar virtually invisible. The excess fat, muscle, and loose skin is removed and delicate sutures are used to close the incision.
In lower eyelid surgery, Dr. Epstein exclusively uses the transconjunctival technique which involve making an incision is made along the inside of the lower eyelid through which the excess fat is either removed or when there is a tear trough deformity, the fat is repositioned over this trough and thus, providing filling in a smoother contour. In the minority of individuals who require removal of both excess fat and skin, an inconspicuous incision is made just below the eyelash line.
Usually performed as a single procedure, blepharoplasty is sometimes performed with laser or chemical peals to treat dark circles or fine wrinkling or with an endoscopic brow lift to restore the eyebrows to a more youthful position.
Brow Lift Techniques
A variety of techniques exist to elevate low brows. These include: endoscopic (minimal) incisions, mid-forehead incisions, and within-the-hairline incisions. All of these procedures address the problem with brows that are too low and/or associated with prominent forehead lines and vertical wrinkles around the lower aspect of the forehead where it joins the nose (frown lines).
The endoscopic brow lift utilizes tiny scopes that maximize visualization while minimizing the size of the incision made in the scalp. Once the desired position of the brows is obtained, the brows/forehead can then be kept in the desired position by insertion of absorbable screws into the forehead. This technique is excellent when there is not very much excess forehead skin, as well as in those patients concerned about even a small, fine-line incision scar. This technique is excellent when there is not very much excess forehead skin, as well as in those patients concerned about even a small, fine-line incision scar.
The mid-forehead technique is a particular favorite of Dr. Epstein. It is designed for men, as the incision can be placed into deeper forehead horizontal wrinkles, avoiding any hairline incisions that can or will become visible with hair loss. The big advantage of this procedure is that it is performed under local anesthesia, with or without a mild oral sedative, and the fine-line scars typically heal in four to six weeks to be nearly undetectable.
Before and after mid-forehead brow lift and upper and lower blepharoplasty. Note the absence of any visible scars.
Finally, the hairline incision, which is most commonly used on women, allows the fine-line scar very low chances of becoming exposed. The incision is designed for the hair to actually grow through the scar and it is located high and far enough from any expected visible location.
In women and older men who desire a lower hairline, the brow lift can be combined with a hairline advancement procedure.
Dr. Epstein has authored an article that appears in Archives of Facial Plastic Surgery on the treatment of dark circles under the eyelids. Click here to view the article.