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Beverly Hills Blepharoplasty

What causes drooping eyelids?

Dermatochalasis is the medical term for excessive skin around the eyelids, and it is a common complaint among older men and women, although it can develop at any age. The primary cause of drooping eyelids is the aging process. The skin on your eyelids is very thin and delicate. As the years pass, the eyes are repeatedly being opened and closed.  Additionally, there is increasing relaxation of the tissues throughout the body, including the eyelid skin. Pockets of fat surrounding the eye can begin to bulge out, particularly in the lower eyelid. Excess fat may accumulate below or above your lids.

You may feel like you have a “tired” appearance and not know what is making that appearance. Frequently, drooping eyelids, excess skin around the eyelids, or bulging fat around the eyes is to blame.

What is the best treatment path for aging eyelids?

Surgery is generally the best way to address aging eyelids, but it’s important to work with a surgeon who is skilled in surgical techniques specific to eyelid surgery, or blepharoplasty. I have performed many of these procedures and have the training and expertise needed to create beautiful and functional results. A full facial analysis is incredibly important to understand each person’s own aging process. It is only with this understanding  that a plan can be created to address and reverse these changes. And while surgery is certainly the most powerful way of addressing upper and lower eyelid aging, there are also supplemental non-surgical means to address eyelid aging such as neurmodulators (like Botox), fillers (Juvederm, Restalyne, etc), chemical peels, and lasers.

Can you tell me how a blepharoplasty is performed?

Blepharoplasty refers to upper or lower eyelid surgical rejuvenation. For excess upper eyelid skin, I remove this tissue in a nearly scarless method.  This procedure is a relatively small procedure and can sometimes even be performed under local anesthesia although I do usually perform it under general anesthesia to completely alleviate patient anxiety.

I begin the procedure by injecting local anesthetic into the upper eyelid skin to be removed. This also helps to minimize any bleeding or bruising. Once the medication has taken effect, I begin the upper blepharoplasty by creating an incision along the natural fold in your eyelid. Placing the incision here helps to hide your scar.

I then carefully remove excess fat deposits and sagging skin. Because the skin is so thin in this area, the scar heals very well. I will then use an extremely fine suture to close the incision.

For a lower blepharoplasty, I usually access the fat bags under the eyes through a small incision on the inside of the eyelid.  While this may sound scary, the eyes are protected with special plastic shields and this approach actually prevents any scar on the outside of the eyelids and heals extremely well. Fat is removed as needed to create a smooth transition from the eyelid to the upper cheek. A special stitch is usually placed to help support the lower lid to protect it from pulling down and away from the eye.

At the end of the procedure, ointment is placed in the eyes to protect them from drying and a cooling pack is placed over the upper face to reduce swelling.  You will keep your head up for the first week to minimize swelling in the face.

What will my appointment be like to assess whether I’m a good blepharoplasty candidate?

Your appointment will be a full history and physical examination to assess your candidacy for blepharoplasty surgery. Most importantly, a full facial analysis will be performed to understand the aging process for you. With respect to your eyes, a comprehensive functional and aesthetic analysis will be performed to understand the different procedures to improve your eye appearance.

This complete exam is very important to minimize and eliminate risks associated with the procedure such as dry eyes and excessive bruising.

Can blepharoplasty be combined with other procedures?

Yes, blepharoplasty can definitely be combined with other procedures. To rejuvenate the eye region, surgery can certainly be a powerful way turn back the clock and reduce a tired appearance.  Surgery itself does not address the skin and therefore other modalities such as laser skin resurfacing and chemical peel can be used to thicken and improve thin and “crepe-like” skin that easily gets wrinkles.

Botox can be used to soften the muscles around the eyes that create an aged appearance.

Dermal fillers and fat injection can be used to re-volumize areas around the eye to reverse the changes of aging like sunken hollow eyes

These procedures can also be combined with other facial rejuvenation procedures such as facelift, rhinoplasty, neck lift, brow lift.  What procedures are best suited to you will largely depend on a thorough preoperative facial analysis.

What is the recovery like after blepharoplasty?

Blepharoplasty is usually an outpatient procedure, so you’ll be able to return home the same day. We provide comprehensive post-surgical care instructions, and following those guidelines can vastly improve your recovery process.  Usually you are swollen and sometimes mildly bruised for about a week. You may also experience blurred vision, light sensitivity, and double vision in the hours or days following your blepharoplasty, but these go away during the initial healing period. Periodic icing can relieve any discomfort, and you should also take care to keep the area clean and protected as the healing process moves forward.

About Nicholas Lahar, M.D. – Lahar Plastic Surgery

Nicholas Lahar, M.D. - Lahar Plastic Surgery

Lahar Plastic Surgery

Nicholas Lahar, MD

Plastic Surgeon located in Beverly Hills, CA

Droopy eyelids are not only an aesthetic concern, but they can also interfere with your vision. Blepharoplasty can help and is one of many treatments available from Nicholas Lahar, MD, of Lahar Plastic Surgery in Beverly Hills, California. If you’d like to explore this option in more detail, call Lahar Plastic Surgery today to book a visit. Online booking is also available and takes just moments to complete.

Blepharoplasty FAQS

In some cases, yes, upper eyelid surgery can be covered by insurance. This is particularly in cases where there is significant skin overhanging the eyelid and causing obstructions in vision. You will need to have documentation of these decreased visual fields and your Insurance provider can be contacted by us to assess whether your procedure will be covered. Unfortunately, insurance companies have been increasingly unreliable to cover these procedures.

While blepharoplasty is frequently the right answer for heavy upper eyelids, a heavy/low eyebrow may also be the culprit causing the upper lids to be droopy.  If the eyebrows have aged and dropped in position, there may be a cascade effect where the lower eyebrow now pushes down on the eyelid.  In these situations, it is very important to raise the brow and excise the appropriate amount of skin. If the situation is not recognized, an excess of upper eyelid skin can be removed but the brow will still remain heavy and low.

There are certain medical problems that may affect your eye rejuvenation. A diagnosis of thyroid problems, high blood pressure, or prior LASIK surgery are important history that will be important to tell your surgeon.  These conditions are not absolute contraindications for the surgery.

However, they may increase the risk of problems such as chronic dry eyes and bleeding and there may be some adjustments in the technique to minimize any complications.  Make sure you let your doctor know about any medical problems you may have so this can be a comfortable and safe procedure for you.

Lower lid filler has becoming increasingly popular for treating the lower lids, especially with the ease with which results and techniques are shown on social media. However, despite being “less invasive,” there are definitely nuances to lower lid filler and there is a significant risk for irregularities, blue tinting of the skin, and persistent swelling if not performed properly. While filler done properly can camouflage mild lower lid fat bags and address unsightly contours, it may actually be a better and safer choice to have a quick surgical procedure performed to address the lower lid.

Dry eyes are the most common complication after eyelid surgery. This can be made worse in someone who has had prior LASIK surgery, especially in the prior 6 months. In order to combat dry eyes, you will be given an eye ointment and possibly an eye steroid to help reduce inflammation and keep the eye lubricated.

Lower lid “pulldown” or retraction, also known as ectropion, is another complication that can occur with lower lid blepharoplasty.  The lower lid should sit nicely upon the lower eyeball, gently slanting upward.  After lower lid surgery, the lower lid can get pulled down by the scarring and healing process, particularly in patients with loose lower lids prior to surgery. If this complication occurs, typically we recommend lower lid massage and eye lubrication until the healing process begins to diminish. Usually this massage with help the lower lid find its way to the right place. I make sure to also support the lower lid with key sutures in the corner the eyelid that help to keep it in the right place. This maneuver will frequently be enough reduce the risk of ectropion.

If you have additional questions or concerns about blepharoplasty, call the office today to book a consultation. Online scheduling is also available and takes just moments to complete.

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