Blepharoplasty

Yes, you can have both upper and lower eyelid surgery performed at the same time. If you had the upper eyelid surgery performed in the past, I would like to evaluate the position of your eyebrows. If the eyebrow position is low, you may benefit from an endoscopic brow/forehead lift to address the hooding of the upper eyelids. Regarding the lower eyelids, I would like to evaluate the relationship of the lower eyelids to the cheeks. In patients who had previous lower eyelid surgery, they sometimes benefit from addition of volume to area of hollowness between the lower eyelid and cheek. That volume can be achieved with transposing or re-positioning the fat pads of the lower eyelid into areas of hollowness. In patients with previous lower eyelid surgery, there may not be enough fat to re-position. In this case, a non-surgical option is injection of hylauronic acid filler (such as Juvederm) to correct hollowness and create a more youthful contour between the lower eyelid and cheek. Finally, if the skin of the lower eyelid is crepe in appearance, a skin resurfacing procedure, such as fractionated CO2 laser or chemical peel with either Jessner's solution plus 35% TCA peel or an 88% phenol peel, may be of benefit for you.

Most of my patients wish to address heaviness or hooding of the upper eyelid. Hooding of the upper eyelid may be due to excess skin of the upper eyelid. If this is the case, then I recommend an upper eyelid lift, also known as an upper blepharoplasty (click here for more information on upper eyelid surgery). Occasionally, the hooding of the upper eyelid may be due to the eyebrows. Over time or for hereditary reasons, the eyebrows may drop slightly. If your eyebrow has dropped or is contributing to the hooding of the upper eyelid, I would recommend a brow lift. I use an endoscopic technique to perform brow lift. For the crow's feet region, I may recommend Botox or skin resurfacing. For the lower eyelid, I may recommend either Botox, filler, skin resurfacing, and/or surgery (click here for more information on lower eyelid surgery/blepharoplasty).

A blepharoplasty would address the bags under the eyes. The bags are caused by fat pads that become more prominent with time. A blepharoplasty is designed to either remove those fat pads or re-position those fat pads into a crease that sometimes occurs between the lower lids and cheeks. There are other potential causes of these bags, including allergies and thyroid disease, therefore, it may be worthwhile to have an evaluation for these potential causes.

Bags under the eyes may be due to medical conditions, such as allergies or thyroid disorders. Another potential cause is the fat bags of the lower eyelids. Assuming your bags are due to the fat from the lower eyelids then, yes, a lower lid blepharoplasty will address this issue for you. During my exam, I look at the area beneath the bags. If there is a hollowness beneath the bags, then I like to perform a lower lid blepharoplasty that re-positions those fat pads into the area of hollowness, thus effacing the hollowness and providing a more youthful contour between the eyes and cheeks.

Good question. The answer is: it depends upon the position of the eyebrow and the amount of excess skin in the upper eyelid. If the brow is in good position, then an upper eyelid procedure (blepharoplasty) would be indicated for you. If the brow is low but there is minimal-to-no excess skin of the upper eyelid, then an endoscopic brow lift would be indicated for you. If the brow is low AND there is excess skin of the upper eyelid, then BOTH an endoscopic brow lift and upper lid blepharoplasty would be indicated for you.

I am sorry to hear of the stroke you suffered last year. As a result of the stroke, you may have lost the ability to raise your eyebrow on one side, thus giving the appearance of a droopy upper eyelid. An endoscopic brow lift may be the better option to address the droopy eyelid if indeed the cause is a droopy eyebrow. However, if it is simply a droopy eyelid, one option may be a ptosis repair to reposition the eyelid. Prior to either of these options, one must first confirm that you can properly close your eye. If you cannot close your eye properly, then these procedures may increase the risk of dry eye. As such, a thorough evaluation is necessary before giving definitive recommendations for your situation.

Following an eyelid lift (also known as upper blepharoplasty), the eyelids may become swollen. This swelling may result in difficulty with opening and closing the eyes. As the swelling resolves, so will this difficulty. During this period of difficulty, it is important to keep the eyes properly hydrated with artificial tear drops throughout the day and eye ointment before sleeping. One potential risk of eyelid surgery is an inability to completely close the eyes. I minimize this risk by making very careful measurements to identify how much excess skin can be safely removed.

One of the risks of eyelid lift is dry eye. In your case, the procedure may exacerbate your dry eye.

If the dark bags are due to fatty tissue, then a blepharoplasty would be a good option. Liposuction of the lower eyelid fat may result in contour irregularities as the skin of the lower eyelid is very thin. During lower blepharoplasty, I like to preserve some of that fatty tissue and re-position it at the junction between the cheek and lower eyelid; this junction is referred to as hollows or tear trough deformity. This technique of re-positioning the fatty tissue provides a more youthful contour between the cheek and lower lid.

One risk of upper and/or lower eyelid surgery is dry eye syndrome. Given the fact that you suffer from dry eyes to begin with, this risk is increased for you. A few things to consider...First, conservative amount of upper blepharoplasty is performed to minimize risk of dry eye syndrome. Second, evaluation and correction of lower lid malposition helps minimize risk of dry eye syndrome. Finally, the approach undertaken for the lower eyelids must be considered. A transconjunctival incision (incision through inside of the lower eyelid) versus incision through the skin just beneath the lower eyelid lashes are 2 approaches to the lower lids. Depending upon your skin type, quality of skin of lower lids, position of lower lids, you may benefit from one approach versus the other.