Repair of other Eyelid Abnormalities:
Blepharoplasty is a surgical eyelid procedure, which corrects drooping upper eyelids and puffy bags below the eyes. These conditions may make an individual look older than he or she truly is, and may give the false appearance of being weary or fatigued. Drooping upper eyelids may even result in diminished peripheral vision due to limitations in the upper and lateral fields.
At Glow, the physician will decide if you are more of a candidate for non-surgical lid rejuvenation with Thermage, or if that excess skin or fat can only be treated with surgery.
Blepharoplasty may enhance appearance, widen the field of peripheral vision, and in some cases, even resolve “eye strain” in those individuals using forehead muscles to help elevate their upper eyelids. This procedure won’t remove “crow’s feet,” lift sagging eyebrows, or remove dark circles under the eyes. Patients of Asian ancestry may choose to have an upper eyelid crease similar to a more Caucasian look, or maintain their more natural eyelid appearance. Blepharoplasty may be combined with a facelift or browlift in patients who so choose.
The best candidates for blepharoplasty are patients who are realistic in their expectations. Individuals with certain medical conditions may have increased risk with blepharoplasty. These conditions include hypothyroidism, Grave’s Disease, dry eye syndrome, high blood pressure, and diabetes. Be sure to discuss any medical problems with your Surgeon before proceeding with surgery.
Most blepharoplasty procedures are completed under local anesthesia, with or without mild sedation. The procedure is typically performed in an out-patient facility or in the office. All four eyelids may be operated on or just the upper or lower ones. The procedure is typically painless, although you may have occasional mild discomfort during the procedure. If your surgeon elects for you to have twilight anesthesia, you will sleep through the procedure. The entire procedure may take from one to three hours, depending largely on whether all four lids are being operated on, or just the upper or lower ones. At Glow Aesthetics and Surgery, we like to combine the Lid Lift procedure with injections of Botox. Botox injections will help the healing process by minimizing the appearance of the scar, because the muscle will be weakened and not pull against the incision to make the scar more prominent.
Most commonly, your surgeon will make incisions along the natural creases of the upper eyelids, and just below the eyelashes for the lower eyelids. These incisions may be made with a traditional scalpel or a laser depending on what the surgeon decides is best for you. The upper eyelid incisions extend from the upper inner corners of the eyelids to the “crow’s feet” region. The surgeon will remove excess skin, muscle, and fat as necessary to produce the desired result. The incisions are then closed with tiny sutures, which are often removed in about a week.
If the lower eyelids are being operated on, the surgeon will proceed with a transconjunctival blepharoplasty when excess skin does not need to be removed. This procedure entails a small incision only on the inside of the lower eyelid. This allows the removal of a fat pocket in the lower eyelid and prevents any visible scar, while still producing the desired result
You will likely be allowed to leave the surgical facility shortly after surgery. Most often, bandages are not required. You should plan to apply cold packs to your operated eyelids for the first 48 hours after surgery to help control swelling. This is then followed by warm packs, which will improve circulation. You should expect swelling and some bruising, and this may vary greatly from one individual to another. If you have been on a blood thinner medication, such as aspirin or Coumadin, you are likely to have more bruising. Bruising and swelling should begin to decrease after the first few days, but may not resolve entirely for up to a month after surgery.
Your eyes may feel tight and sore, especially the first week after surgery. You may require oral pain medications for the first few days as well. In some cases, the eyes may become dry and somewhat irritated. In this case, it is probably best to apply non-preserved lubricating tears or lubricating ophthalmic ointment as prescribed by the surgeon. If your swelling is quite significant, your vision may be blurred or, occasionally, even double. This will resolve once the swelling subsides.
After the first couple of weeks, you will begin to see the aesthetic results of your surgery. However, you won’t have your best results for up to 6 months following surgery. During this period, the incision lines will fade from slightly pink color to nearly invisible thin white lines. In most cases, you may begin to wear makeup again (on the eyelids) about 7 to 10 days after your surgery. Rubbing ophthalmic Vitamin E ointment on the scar can also help soften it.
The results are often dramatic and are likely to restore a more youthful appearance to your face. You may also enjoy improved peripheral vision. In most cases, the results last for many years or even a lifetime.
In some cases, blepharoplasty is covered under medical insurance, if the skin is so droopy that it blocks vision. This will depend, however, on the degree of peripheral vision loss due to drooping eyelids. In general, surgery for the lower eyelids is not covered by insurance plans. Check with your surgeon’s to better explain what is covered or not.
Ptosis repair is usually completed under twilight anesthesia and or under local anesthesia. The surgeon must make an incision in the drooping eyelid, and carefully advance and tighten the levator muscle, which elevates the upper eyelid, this muscle become sloose as we age and causes the lid droop. The eyelid is often carefully compared to the opposite eye in terms of lid height. In children with poor levator muscle function, a “levator sling” may be used. This is a more complex procedure in which muscles of the brow or forehead may be used to assist in elevation of the upper eyelid. Once the lid height is secured in the desired location, the eyelid incision is closed with tiny sutures. One or both eyes may need to be treated.
Most patients will tolerate the procedure very well and have a rapid recovery. Cold packs may need to be applied to the operated eyelid for the first 48 hours following surgery. Antibiotic ointments applied to the incision are sometimes recommended. The elevation of the eyelid will often be immediately noticeable, though in some cases bruising and swelling will obscure this finding. Most patients will have sutures that need removing about a week following surgery. In children, absorbable sutures are often used. The bruising and swelling associated with the surgery will usually resolve in two to three weeks. Some patients may need adjustment of the sutures to better align the lid height. This may or may not require additional anesthesia or a trip to the operating room.
A forehead lift or “browlift” is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
In a forehead lift, the muscles and tissues that cause the furrowing or drooping are removed or altered to smooth the forehead, raise the eyebrows and minimize frown lines. Your surgeon may use the conventional surgical method, in which the incision is hidden just behind the hairline; or it may be performed with the use of an endoscope, a viewing instrument that allows the procedure to be performed with minimal incisions. Both techniques yield similar results — smoother forehead skin and a more animated appearance. At Glow Aesthetics and Surgery of Long Island, your Surgeon will decide what technique is best. Thermage in combination with Botox, can also provide you with a non-surgical option if you are looking for a subtle lift.
A forehead lift is most commonly performed in the 40-60 age range to minimize the visible effects of aging. However, it can also help people of any age who have developed furrows or frown lines due to stress or muscle activity. Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this procedure.
Forehead lift is often performed in conjunction with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a forehead lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a forehead lift better meets their surgical goals.
Patients who are bald, who have a receding hairline, or who have had previous upper-eyelid surgery may still be good candidates for forehead lift. The surgeon will simply alter the incision location or perform a more conservative operation.
Remember, a forehead lift can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them in detail with your doctor.
Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed.
Most patients are back to work or school in a week to 10 days. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.
Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better.
Most patients are pleased with the results of a forehead lift, no matter which surgical method was used. Often, patients don’t realize how much their sagging forehead contributed to the signs of aging until they see how much younger and more rested they appear after the lift.
Although a forehead lift does not stop the clock, it can minimize the appearance of aging for years. As time passes, you may want to repeat the procedure
Bells palsy is a condition that causes the facial muscles to weaken or become paralyzed. It’s caused by trauma to the 7th cranial nerve, and is usually not permanent. It can lead to the eyelid on the effected side to appear wider than the other eye.
If the effected eye lid appears wider than the other, you may need surgical repair of the lid to improve the cosmetic appearance of the lid. In most occasions a small gold weight can be hidden inside the lid to add more strength to the weakened muscle and help closure of the eyelid.
Botox for the Hypertonicity or spasticity of the eyelid.
In the early 1970s botox was used to relax overactive eye muscles in cross-eyed patients. It has since been approved for many uses, including for spasmodic neck, facial and eyelid muscles. Facial muscles have a tendency to become hypertonic (overactive) after paralysis. Weakening or re-paralyzing the muscles with Botox can temporarily ease the effects of overactive muscles. Spasms can be reduced along with the pain and discomfort associated with them.
With Botox injected into the eyelid muscles, the squint associated with synkinesis or hypertonicity can be lessened; sometimes significantly. If there is tightness or spasms in the cheek area, the Botox injected in the muscles around the eye may also reduce those spasms. Botox can also be injected into the muscles of the cheek or neck areas directly. The overall result can be a more symmetrical appearance plus increased comfort.
An entropion is an inwardly turned (inverted) eyelid. The condition occurs primarily as a result of advancing age with subsequent weakening of certain eyelid muscles. The imbalance between eyelid muscle groups results in the inward turning of the eyelid. The condition almost always affects the lower, rather than the upper, eyelids.
Repair of involutional entropion (associated with aging) may be completed with a variety of procedures. Most cases are completed with an incision in the lateral corner of the eye or an incision just beneath the lower eyelashes. In either case, a tightening of tissues is required to resolve the imbalance between the muscle groups of the lower lid.
Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Most cases will require removal of sutures located along the lower eyelashes or the lateral corner of the eyelid. Minor bruising or swelling may be expected and will likely resolve in one to two weeks following surgery.
A non-incisional entropion repair, known as a Quickert procedure, may be completed as an in-office procedure. This form of entropion repair requires two or three strategically placed sutures which will evert the eyelid. The procedure can be completed under local anesthesia with little if any discomfort.
The most important drawback of this procedure is that there is a significantly higher chance of recurrence of the entropion subsequently. The Quickert procedure, however, is an excellent procedure for patients who do not desire, or are not good candidates for, a trip to the operating room.
An ectropion is an outwardly turned (everted) eyelid. The condition most often is associated with aging, though it may also occur congenitally, as a result of scarring or other surgeries, or secondary to facial nerve paralysis (Bell’s Palsy). If not repaired, the condition may lead to thickening of the mucosal surface on the inside of the eyelid with resulting inflammation of and danger to the health of the eye itself.
The best method of repair for an ectropion often depends on the underlying cause. In the involutional type of ectropion (associated with aging), the surgeon will likely elect to shorten and tighten the lower lid, thereby resolving the outwardly turned lid. This typically is completed with an incision of the skin at the lateral corner of the eye. The surgeon then excises a small segment of the lateral aspect of the lower eyelid, and subsequently reconnects the eyelid to underlying tissues and the upper eyelid.
Usually only a few stitches are placed in the skin at the lateral corner of the eye, and these are often removed 7 to 14 days later. There is typically almost immediate resolution of the condition. Most patients have little if any discomfort with the procedure. There may be mild bruising and swelling following the procedure. This should resolve within about two weeks.
Ectropion which occurs as a result of scarring (cicatricial ectropion) is most likely to follow another surgical procedure of the face or eyelids, especially excision of skin lesions such as skin cancers. This type of ectropion repair often requires skin grafting. The donor site for the skin graft is most often taken from the patient’s upper eyelid or from behind the ear. The skin from these sites will most closely match that of the patient’s lower eyelid skin. Both the donor site for the graft and the surgical site will usually heal nicely within two weeks following the surgery