Blepharoplasty surgery – also referred to as eyelid surgery, eyelid lift surgery, eyelid bag surgery or simply cosmetic eyelid surgery – is one of the most common facial plastic surgical procedures performed today. Numerous surgeons from varied subspecialties perform eyelid lift surgery. The problem is that blepharoplasty surgery is a very specialized cosmetic surgery which can easily lead to a poor outcome if not performed by the appropriate surgeon.
So who performs eyelid lift surgery?
- Oculoplastic or ophthalmic plastic surgeons. These specialists are first trained in eyes (ophthalmology) and then further trained is eye plastic surgery.
- Facial plastic surgeons. These are ear nose and throat trained surgeons who do further training in facial cosmetic surgery.
- General plastic surgeons. These are surgeons trained only in plastic surgery – but of the entire body (head to toe).
- A variety of other surgeons without any specific training in plastic surgery.
Clearly the best trained and most experienced surgeons for your eyelid bag surgery are oculoplastic surgeons http://drmassry.com/#/6-0 , http://drmassry.com/blog/?p=116 . All other fields do not have the depth of training in surgery of this very complex area of the face.
Cosmetic oculoplastic surgeons specialize in blepharoplasty (eyelid or eyelid bag surgery) http://drmassry.com/blog/?p=754, http://drmassry.com/blog/?p=603, http://drmassry.com/blog/?p=546 , http://drmassry.com/blog/?p=531 . They also specialize in fixing surgery that has turned out poorly. No other field in cosmetic surgery has this form of training. If you have had a poor outcome to your eyelid bag surgery – please see only an oculoplastic surgeon to correct the problem. This is the best way to ensure a good outcome to your redo (revisional ) procedure.
Common problems encountered after poor result eyelid lift surgery are inability to close the eyes, pulled down lower lids, problems with the canthus (outer corner of the eyelids), residual puffiness, and a slew of other issues.
These problems can be corrected in many cases. However, to do so, only a specialist in the field should be seen.
Bell’s palsy is a form of facial paralysis which can lead to the loss of the ability to close your eyes. The Upper eyelid has muscles which open the eyes (levator muscle and Muller’s muscle) and a muscle which closes the eyes (orbicularis oculi muscle). When the elevator muscles become weak or mal-functions what results is a droopy lid referred to as ptosis. The orbicularis muscle is supplied by the 7th Cranial nerve also called the facial nerve. In Bell’s palsy and other forms of facial paralysis this nerve is damaged and leads to weakness of eyelid closure. As the closing of the lids is reduced, the patient experiences dry eyes, red eyes, eye irritation, possible infections and potentially loss of vision. For this reason it is critical to see an eyelid specialist who performs eyelid reconstructive surgery – or an oculoplastic surgeon.
The eyes are one of our most important organs as they control vision our most important sensory function. In addition the appearance of the eyes and eyelids is vital to how we present ourselves to society and for our self-esteem. We must do all we can to attain the best visual function and appearance after suffering from Bell’s palsy or other forms of facial paralysis.
For more information on the subject of Bell’s Palsy, inability to close the eyes and how to correct these issues please open the following links: http://drmassry.com/blog/?tag=eyelid-paralysis, http://drmassry.com/blog/?p=488 , http://drmassry.com/blog/?p=521
Today cosmetic eyelid surgery (blepharoplasty) is one of the commonest facial aesthetic procedures performed in the world. Often times to perform appropriate eyelid lifts (blepharoplasty) it is necessary to also address the brow. There are numerous forms of formal brow lifts such as the endoscopic brow lift, which are very powerful, but also expensive and very involved surgical procedures.
For those patients who are concerned with costs, recovery from surgery and invasiveness of the procedure, there is an alternative. This other form of brow surgery is called a browpexy. A browpexy is a procedure which minimally elevates or stabilizes the brow so that it will not be lowered even further when eyelid surgery is performed. In many cases when the brow is low (or borderline low) and eyelid lift is performed the brow will be pulled even lower. This has negative consequences on appearance and function after surgery.
A browpexy is a suture suspension of the brow to the underlying bone. It can be performed from within the eyelid (internal browpexy) or from a small incision above the brow. The later procedure is called the external browpexy (developed by Dr. Guy Massry – Ophthalmic Plastic Surgeon - Beverly Hills, California). Below are a few of Dr. Massry's published articles on the procedure:
- The External Browpexy
Now a browpexy is not for everyone. Appropriate patient selection is critical to attain the best results. However, in the right patient and with the right doctor performing the procedure, high patient satisfaction and excellent results are obtained. Below are examples of patients who underwent the external variant of the browpexy as described by Dr. Massry. When viewing these photos (before surgery - left/after surgery - right) only pay attention to the correction of brow asymmetry - which was the purpose in each case.
For more information on this novel and non-invasive form of brow lifting, please schedule a consult with Dr. Massry by calling us at 310.657.4302.
Eyelid surgery is a general term for any surgery on the upper or lower eyelids. When performed to improve appearance or field of vision, eyelid lifts are referred to specifically as blepharoplasty surgery. Blepharoplasty surgery is one of the most common facial surgical procedures performed today in the United States and the world in general. Eyelid lifts involve the removal of variable amounts of skin/muscle and fat from the eyelids. This allows the lids to be more open, less prominent and more youthful.
Eyelid lifts can be covered by insurance if there is sufficient impairment of field of vision. This applies only to the upper lids. Lower eyelid lifts are always cosmetic in nature, and as such, are a fee for service procedure for the patient.
There are numerous types of surgeons who perform eyelid lift surgery. These surgeons include general plastic surgeons, facial plastic surgeons and oculoplastic surgeons. General plastic surgeons operate on the body head to toe, facial plastic surgeons on the face only, and oculoplastic surgeons on the eyelids only. Without a doubt oculoplastic surgeons are the most experienced and well trained eyelid surgeons in the world. Only an oculoplastic surgeon should perform your eyelid lift surgery. This will allow the greatest chance for success with surgery.
For examples of eyelid lift surgery open the following link http://drmassry.com/#/1-3 . Here you will find up to date information on blepharoplasty surgery and before and after photos which demonstrate what to expect.
Fillers have become a very popular and standard treatment for lower eyelid dark circles and hollows. The two most common filler used for this purpose are Restylane and Juvederm. On occasion after the filler is placed a bluish color to the area can occur. This is called the Tyndall effect – and is named after the 19th century physicist John Tyndall. The Tyndall effect is caused by light reflection from particles in a clear material (suspension). These fillers (Restylane and Juvederm) are clear materials with many particles within them. When light is scattered from these particles the bluish color (Tyndall effect) can result.
While a Tyndall reaction can occur in the best of hands it is minimized by appropriate placement of the filler around the eyes. This means deeper placement in small amounts. Before treating this problem it is best to wait a few weeks to assure that the color change is not due to late effects of bruising.
The blue color can be removed with injection of hyaluronidase (Vitrase) which dissolves the filler – removing it in part or total – depending on patient needs. This is what is nice about fillers for the lower lids. They accomplish their task – filling hollows – yet are reversible so that problems are easily overcome. This is in stark contrast TO SURGERY which often times can lead to permanent issues.
While fillers are routinely injected to the lower lids by many cosmetic doctors it is best to have this done by an eyelid specialist.
For any questions regarding lower lid fillers or the Tyndall effect you can contact Dr. Guy Massry, Beverly Hills ophthalmic plastic surgeon, at his office (310) 453-8487 or at his website http://drmassry.com
Swelling After Lower Eyelid Fillers (Juvederm, Restylane) Treated with Hyaluronidase (Vitrase,Hylenex)
Lower eyelid fillers are now a common treatment for dark circles, lower lid hollows and “Bags.” The most common fillers used for these purposes are from a family of gels called Hyaluronic Acid gels. In the lower lids Juvederm and Restylane are two fillers from this material that have been used the most.
Placement of these fillers is generally safe with few complications. The most common issues are too much put in, too little put in, a bluish hue to the area of the fillers (called a Tyndall effect), and a swelling reaction (hydrophilic reaction). These issues can be managed by adding more filler when there is too little, and dissolving the filler for the remaining problems. The material we use to dissolve the filler is called Hyaluronidase. This is an enzyme with degrades (melts) the filler away. It is given by injection and within a short time the results are evident. The two most common brands of Hyaluronidase available are Vitrase and Hylenex. They both work and there are ongoing studies as to which may be better.
I only use Restylane in the lower lids as I feel its properties make it less prone to these issues as compared to Juvederm. While still possible, I have not seen these issues with Restylane.
Below (left) is an example of a woman who had a swelling reaction to Juvederm filler which is still present over a year after injection. On the right is her appearance within a day of Vitrase treatment to dissolve the Juvederm. As you can see it is much improved. What remains on the right lower lid (seen in the frontal view) is the natural fat (prominence) of her lower lid which can be removed surgically should she desire.
I am happy to answer any questions regarding the treatment of lower lid dark circles, hollows and bags with filler should you be interested http://www.drmassry.com