Blepharoplasty

Both Ulthera and Exilis are non-invasive skin tightening procedures. Ulthera utilizes ultrasound while Exilis utilizes radiofrequency. In an effort to achieve the desired result, a series of treatments may be of benefit. One question that remains to be answered is how long the results last from either of these modalities. For patients seeking brow lift, I favor an endoscopic brow lift to achieve the desired result, with or without an upper eyelid lift( the decision for upper lid lift is determined based on how much excess upper eyelid skin is present.

I perform upper eyelid and lower eyelid surgery. The indications for upper eyelid surgery include laxity of upper lid skin resulting in a hooded appearance of the upper lids. Trimming of this excess skin can result in a brighter, more open, appearance to the eyes. When it comes to lower lid surgery, there are several factors that play into the type of surgery and the expectations. For example, some patients may present with fullness of the lower lids, a crease or hollowness between the cheeks and lower lids, and a loss of volume in the cheeks. In this setting, we perform surgery to remove some of the fat that causes the fullness in the lower lids, transpose or re-position some of the fat into the areas of hollowness, and lift the cheek, thus resulting in a more youthful contour between the lower lids and cheeks.

It depends. There are some medical conditions that cause puffy eyes, including allergies and thyroid disease. Surgery is not indicated for these medical conditions. However, if your issues are due to excess skin and/or excess fat of the upper eyelids, then an upper eyelid lift (blepharoplasty) is an excellent option for you.

Malar bags are a challenge to treat.  I would recommend an eyelid lift to address excess skin and/or fat of the eyelids, but I wouldn't recommend an eyelid lift specifically for the treatment of malar bags.  Malar bags have several potential causes, including but not limited to allergies, lymphatic drainage, salt intake.  Several treatment options exist, with variable results, including but not limited to laser, surgical excision, eyelid lift, radiofrequency, injection of medication, such as steroid and/or hyaluronidase.

Liposuction for the bags underneath the eyes is not a good option due to (amonth other things) thinness of skin, risk of contour irregularity, and injury to important anatomic structures. A preferred technique is blepharoplasty. The bags are usually due to fat pads we all have in our lower eyelids. If the fat pads are prominent, I perform blepharoplasty to address those fat pads. Usually, I re-position those fat pads into hollow areas in the junction point between the lower eyelid and cheek; this is called fat transposition or reposition. Sometimes, I remove the fat if there is a significant excess of fat. Dark color to the lower eyelid may be due to shadow effect from those fat pads, allergies, pigmentation within the skin, and/or blood vessels beneath the skin. I mention these factors because dark color to the lower eyelid may persist after surgery if it is not due to the shadow effect from the fat pads.

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.