Eyelid Surgery
Blepharoplasty (also known as eyelid lift) is a procedure which eliminates excess hanging skin and fat of the upper eyelids (upper eyelid blepharoplasty), and excess skin adding with fat contouring of the lower eyelid (lower lid blepharoplasty). These procedures may be done separately or together in a single surgery.
In upper lid blepharoplasty, I tend to remove only medial fat along with skin. I choose to keep most eyelid volume to avoid the overdone lid appearance.
I’ve decided to explain my lower lid approach in a Q and A form:
What is the lid cheek junction?
The lid cheek junction is the area of the face where the lower eyelid and cheek meet. It is a very important anatomic area in aesthetics of the face because this area tends to show dramatic age related changes as we progress through out 40’s and 50’s.
What happens to this area in the aging process?
Several events occur in the lid cheek junction during the aging process. One is that the fat around the eyeball within the eye socket becomes more pronounced (prolapsed forward as the fat bag lining attenuates), creating the typical eye bags. Another occurrence is the cheek tissues loosen from the upper cheek and tend to fall downward revealing a hollowness below the eyelid bags. Additionally, as we age, fat volume diminishes in the face further accentuating this hollow. And finally the skin in this area tends to thin out or attenuate becoming lose, crepe, and wrinkled.
How do you address these problems with surgery?
Several things are done during the lower eyelid blepharoplasty to improve the youthful appearances of the eyes and face. Excess skin is removed (modest amount) through a small subcilliary (below lash line) incision. The fat bags are released from their attenuated membrane (bags) and spread out to fill the hollow area below the bags and above the cheek. Much of the fat is preserved in this maneuver known as fat transposition. Then the released upper cheek is lifted over the top of this newly draped fat and secured internally. Finally, for those patients who have severe cheek volume loss, I add small amounts of filler (or fat harvested from other locations known as fat grafting) to co-mingle between the other transposed fat. In the end, the results are smoother, more youthful, natural appearing eyes and upper cheeks!
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Once I called for the appointment for a consultation, one of the first things the nurse asked me was if I smoked. I admitted that I had just quit (for the hundredth time). She told me that Dr. Spiro would not perform surgery unless the patient is “smoke free” for at least six weeks. And, don’t try to get away with cheating because he will perform random nicotine tests. That’s how strongly he is against it. He said smoking can really affect a positive outcome. I knew right away I was in good hands. And wanting to have the surgery performed by this innovative, extremely talented and caring doctor only reinforced my desire to quit smoking. It is now five weeks after my upper/lower eyelid surgery, fat transposition and lateral cheek lift. I am thrilled with the results. My eyes are so big and open and the bags are GONE. I look and feel great. I had no pain at all. Dr. Spiro has the nicest bedside manner. He is gentle, sweet, attentive, caring. He explained everything in detail from beginning to end. He always made me feel special and cared for. His office staff, the nurses, everyone is professional, and caring. Besides having a new refreshed face, I am no longer a smoker. I thank you Dr. Spiro from the bottom of my heart. You are an amazing surgeon and a beautiful caring person. I selected Dr. Spiro for his subtle artistry as much as his professional surgical technique. I wanted to look like me – but more refreshed. From my first appointment, where Dr. Spiro explained his approach exactly, I felt I was in good hands. His support staff is equally amazing making this a comfortable process through a bit longer than expected recovery (as is often the case in eyelid revision surgery). I have no doubt, however, that I am being well cared for at every step – and I can see that the results will be exactly what I wanted. Dr. Spiro was able to precisely revise an earlier eye surgery (30 years prior) that did not age well – a very difficult technique he performed skillfully. I highly recommend this practice.
It was a very big decision to go see Dr Spiro and I am beyond pleased that I did. He is an expert in his field, an artist and a perfectionist! What a perfect blend for a plastic surgeon. He and his staff took such good care of me before, during and after the surgery. I knew I was in the best of hands going into this surgery and my results exceeded my expectations. I feel amazing. I highly recommend Dr. Spiro!