A canthoplasty is a surgical procedure whereby the terminal portion of the lower lid is secured to the bone of the outer orbit.  In essence THE LID IS TIGHTENED.In reconstructive surgery the tarsus (the cartilage skeleton of the eyelids) is typically trimmed and sutured to the periosteum (tissue lining the bone).  In cosmetic surgery less disruptive techniques have been developed so that distortion of the canthal angle (angle where the eyelids meet) is not distorted.  A canthoplasty, or its more simplistic cousin (the canthopexy) is often performed in cosmetic...

Every day I see patients who want refreshed, less tired looking and more youthful eyes.  They all ask about how to do this surgically.   Clearly surgery is the mainstay to improving sagging and puffy eyelids.  However, non surgical treatments such as Botox and fillers (Restylane, Juvederm, etc.) can be a powerful alternative, especially in patients under the age of 45-50. We tend to think of Botox as a wrinkle treatment because that is the way it is marketed.  In reality it is a muscle weakening agent (which in turns secondarily reduced wrinkles).  The forehead,...

The choice of what type of anesthesia to use for surgery is a critical component of the surgical experience and should be thoroughly reviewed by the patient and surgeon.  The goal is to make the procedure as comfortable as possible while doing it in a way to assure the best possible outcome.  This decision is easy when surgery can performed without the need for any patient cooperation.  This is true of most plastic surgical procedures (but not all eyelid procedures).  In this instance the surgery can be performed under general anesthesia.  This is the deepest...

Cosmetic eyelid surgery is about looking better and natural.  This can only occur with an appropriate preoperative evaluation which identifies all aspects of the eyelids and adjacent structures which must be addressed during surgery.  This approach will prevent patients from being unhappy after surgery.  Patients don't always know what about their eyelids make them look tired, worn or older.  They just know they want an improvement.  It is incumbent upon the cosmetic surgeon to inform and educate the patient regarding these issues so that the best outcome can be...

Facial fillers are injectable materials, used to plump up areas of the face (add volume), such as the lips, or treat facial wrinkles.  They are different than Botox in that they do not reduce wrinkles by weakening the movement of facial muscles. They do so by filling in lines or depressions (like the dark circles under the lower lids).  Sometimes they are used together with Botox as the combination may work better than each individual treatment. Facial fillers today Historically Collagen was used to fill lines for years.  Today other products are used more...

Asian upper lid blepharoplasty is a specialized form of surgery, common to all Asian people (Chinese, Japanese, Korean, Filipino, etc), whose aim is to improve the aesthetics of the upper eyelids without changing the ethnic appearance of the patient. The anatomy of the Asian upper eyelid is distinctly different than that of the Caucasian eyelid. A thorough familiarity with Asian lid anatomy is crucial to attaining successful surgical outcomes. An aesthetic Asian upper eyelid should have natural fullness and usually a distinct crease. These are typical patient...

For years when patients came to see cosmetic surgeons for eyelid surgery (blepharoplasty, canthoplasty, ptosis repair, fat grafting, fat repositioning, etc) they were counseled on how surgery could remove the excess skin and bags and get rid of wrinkles.  The thinking was that gravity made the eyelids and face sag and that cutting out eyelid skin and fat and lifting tissue (traditional blepharoplasty) was the answer.  Well we have found that often times this kind of blepharoplasty surgery makes patients look funny, gaunt, pulled and “done.”  It just doesn't look...

Webbing of the lateral canthus (where outer upper and lower lids meet) is called a canthal web.  Normally the lateral canthus consists of an almond shaped angle.  When webbing occurs, skin obscures the angle and the canthal angle resembles a duck's foot which is normally webbed.  This causes both aesthetic disfigurement (it is not attractive), and a functional deficit (the web blocks vision on side gaze). The best way to treat a canthal web is to avoid allowing it to develop.  These webs occur in a variety of situations.  I have had them sent to me form...

Lower eyelid rejuvenation has undergone a tremendous evolution in the last decade.  There has been a paradigm shift from fat excision to fat preservation.  This has recreated youth rather than advancing the aging process which typically involves fat loss from the eyes and face. There are two ways to augment volume (filling depressions with fat) in the lower lids. One technique is called fat repositioning. This involves translocating eyelid fat which is prominent to areas where it is deficient (depressions, grooves and hollow areas).  This is an incisional...

One of the major complications of lower eyelid blepharoplasty is a retracted (pulled down) lower eyelid.  This leads to a change in the shape of the eye, a rounded outer corner to the eye, and sometimes a “wide-eyed appearance.” The goal of any cosmetic blepharoplasty is to improve appearance in a natural way – “NOT” to change ones look. How can this be accomplished.  Firstly, performing surgery from the inside of the lid, “a transconjunctival blepharoplasty,”reduces the chance of an altered shape to the eye.  The surgeon must be well versed in this procedure to...