Frequently, I speak with patients who are interested in improving the contour of their upper eyelids.  They see excess skin and want it surgically removed (blepharoplasty). If one looks closely at their appearance it becomes clear that the problem does not lie in excess skin but rather it is due to drooping eyebrows (eyebrow ptosis).  While this may look good on Clint Eastwood (back in the day) it is not an appealing look on most of us.

Before

By raising the eyebrows, the skin of the upper eyelids is secondarily tightened and the issue is resolved.  There are several surgical techniques whereby the eyebrows can be raised; a direct browlift requires an incision at the level of the upper eyebrow hairs and is cosmetically unacceptable in my view, then there is the  coronal incision across the scalp above the hairline  used to pull the frontal region of the face up and thus raise the brows and lastly, the endoscopic browlift.  While all three procedures are effective, the first can leave noticeable scars and the last two may be more surgery and recovery time than one wants to undergo.

Utilizing Botox, it is possible to effect an appealing improvement of the eyebrow contour and secondarily the issue of the excess skin of the eyelid is mitigated.  When one considers the anatomy of the face and particularly the musculature controlling the eyebrows, one sees that there are muscles that depress the brow and those that elevate them.  With the judicious use of Botox, the depressor muscles can be weakened and the apposing elevators will then raise the brows.  The technique requires injection at seven sites.  While it is not effective in all cases of eyebrow ptosis, this approach when applicable is safe and easy with no down time.

Scientists are beginning to unlock the mystery of aging.  In 1900 average life expectancy was 47 years.  We are now pushing the average toward 80 years.  But there is far more to just racking up the years, in my view it is about quality of life; we want to live well for as long as we can.  I see myself as dying at 94 while standing on the bow of my fishing skiff wrestling a 110 pound tarpon. 

Part of feeling well is looking good.  As we age, it takes an extra effort to accomplish that goal.  Gravity is at work, body fat is relocating, collagen (the scaffold supporting our skin) is degenerating and our genetic predisposition begins to play out.  If you are in your forties, just look at the quality of the skin of your parents and get a glimpse into your future.  All of these factors  have an effect on the appearance of our face.   Perhaps the most important feature of the face is the eyelid area.  Upon meeting a person, this is the first region that is considered and we are programmed to make numerous decisions about that person at the instant of “the first encounter.”  By creating small alterations in the appearance of the eye area, one can send a whole new set of information at the moment of the encounter. 

62 year old prior to upper eyelid surgery

Following surgery

The only thing that was done in this case was to create a lid crease by removing skin.  You have a more youthful appearance and you notice the sparkle in the eye.  The key to surgical success is to do the minimum necessary to create the desired effect.

This procedure, known as blepharoplasty or cosmetic eyelid surgery is a 20 minute outpatient procedure which we do in our adjacent ambulatory surgery center.  It is done with local intravenous anesthesia from which the patient awakes immediately and leaves the operating room under their own power.  For reasons that remain unclear to me, there is no pain  following the surgery.  Folks can be up and about on the next day provided that they make an effort to apply ice to the surgical area.  The issue of bruising always comes up.  If you tend to bruise then expect that with the surgery, otherwise localized swelling is the norm.  The sutures are removed in one week. 

In many instances, health insurance companies including Medicare and Medicaid provide full coverage for this surgery.  When a patient meets the criteria, we take photographs preoperatively and submit them for review by the insurance companies.  Many people are surprised to learn that they are covered.

Age alone is not a factor; your state of health and your motivation to look as good as you can are the driving forces.  Call the office and I will meet personally with you and review your candidacy for blepharoplasty.