Advanced Eyelid Lift Procedures

The eyelids and adjacent facial regions arguably are the most delicate facial structures. The lids have the thinnest skin of the face and are commonly affected by family traits and aging-related changes. Small changes can make a big difference in either direction of attractiveness. The anatomy of the area around the eyes is extremely complex allowing sometimes access to adjacent structures through eyelid incisions used for blepharoplasty. These advanced lid procedures can enhance the overall aesthetic outcome after cosmetic eyelid surgery.

Lower Blepharoplasty with Fat Repositioning – State of the Art Eyelid Lift?

Most people who consider cosmetic eyelid enhancement have a combination of three issues: puffiness of the under-eye area, “dark circles” and skin creases. Conventional blepharoplasty reduces the puffiness through fat removal. If a trans-conjunctival blepharoplasty is performed, no skin change will happen. When an incision under the lash line is used, the skin will also be tightened. This leaves the depressions under the eyelid “bags” untreated although they may appear somewhat lessened. For the most natural look, these “tear troughs” (a.k.a. naso-jugal grooves) would be enhanced and filled in. Cosmetic eyelid experts nationwide commonly discuss best ways to correct this problem area. Most commonly, blepharoplasty with repositioning of orbital fat is considered one modern way of creating a youthful and soft under-eyelid region. Other options include injection of dermal fillers (“non-surgical eyelid lift”) or fat transfer (facial fat grafting). For regular tear-trough correction, implants are rarely recommended but may become a consideration in very severe deficiencies.

The eyelid lift with fat repositioning (fat-sparing blepharoplasty) is performed through routine incisions. The fat that is normally removed and discarded is mobilized in a way that it maintains its blood supply and integrity. It is then repositioned downwards to fill in the hollow underneath the eyelid “bags”. This hollow corresponds with the lower bony eye socket border (a.k.a. orbital rim). The fat is draped over the bony edge hereby softening the lid-cheek junction. Eyelid surgeons who routinely perform this advanced procedure are very enthusiastic about the aesthetic benefits. Many surgeons do not perform this procedure and therefore, they may not recommend it.

Upper Blepharoplasty with Myoplasty – Permanent Botox?

Frowning of the forehead is usually a subconscious animation of the forehead and brow region. Although it makes us look angry and unapproachable, it is virtually impossible for us to stop us from activating the muscles that are responsible for the frown. One of the reasons for the success of Botox is its benefit in relaxing the muscles responsible for frowning. Advanced upper eyelid lifts can incorporate a procedure to relax these muscles, namely the corrugator, procerus and depressor supercili muscles. An upper blepharoplasty represents a perfect opportunity to treat these muscles through the already existing lid incision which is hidden within the lid crease. The muscles are approached, identified and permanently weakened leading to softening of the natural frown. Because the muscles are not completely paralyzed, some animation remains for a natural look. Although this treatment may even lead to a gentle brow elevation, most patients recognize the benefit in the improvement of the scowl region between the eyebrows. Because these muscles are closely intertwined with important nerves and vessels, a thorough understanding of the rich anatomy by the eyelid surgeon is important for a safe procedure.

Upper Blepharoplasty with Brow Release

As we age, the brows may start become droopy. We may recognize this as droopy lids although the eyebrows may play an integral part in the upper eyelid region and therefore, always need to be assessed. Aside from aging related changes, brow position is also determined by muscle actions: there are muscles that pull down the eyebrows and others that raise the brows. When one changes the balance between these two groups of muscles, the height and position of the brows can be altered. For instance, if the brow depressors (muscles that push down) are weakened, the elevating brow muscles (i.e., frontalis muscle) will raise the eyebrows. In addition, the brows are held down by an attachment to the bone (a.k.a. orbital ligament). Release of this attachment will free up the brows leading to a gentle elevation. It is important to recognize that the brow elevation achievable with a trans-blepharoplasty brow release cannot be as extensive as after a comprehensive browlift (LINK). This advanced procedure does represent significant value for patients who are looking for a gentle brow release.

Upper Blepharoplasty with Browlift

A procedure also commonly called “browpexy” , it uses a variation of techniques where the tissues above the brow are freed and the brows sutured to the forehead in a higher position. Advantages include that the procedure can be performed through the pre-existing upper lid incision. Most specialists who embrace this approach would agree that elevation will be a gentle only, therefore some surgeon refer to it as a “brow stabilization” rather than a true brow lift. Unfortunately, because the brows are pushed up increased horizontal forehead creases just above the brows are common. Some patients report an unusual or limited ability to raise the brows after a browpexy procedure. Talk to your cosmetic surgeon about his experience with a trans-blepharoplasty browlift to decide if this is right for you.

For more information, please contact Dr. Fechner.

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