Upper blepharoplasty CENTER FOR FACIAL PLASTIC SURGERY AT ENT SPECIALISTS
Upper blepharoplasty
Upper blepharoplasty, also known as “upper eyelid lift” or “eye lift”, is one of the most
complex facial rejuvenation procedures that, properly planned and executed, can have a
dramatic effect on one’s appearance. At the same time, a poorly performed upper
blepharoplasty can not only severely impact the appearance but also the patient’s
vision. The eyes are the windows to the soul and the eyelids are the curtains that protect
and keep the windows clean. A poorly planned blepharoplasty can impair the windshield
wiper role of the eyelids and lead to lagophthalmos (inability to close the eyes), dry and
painful eyes, decreased or even permanent loss of vision. From a cosmetic standpoint,
inappropriate removal of skin, muscle or fat from the upper eyelids can, in fact,
accentuate the age-related changes and make one look older and tired instead of
younger and rested.
The goal of modern upper blepharoplasty is to reverse the aging changes, to improve
the appearance and the functioning of the upper eyelids and make you look more
youthful, healthier and less tired. After an Eyelid-lift, your eyelids should not only look
younger but also function better, hence less dry eyes and blurry vision. Eyelid
rejuvenation depends primarily on restoring the convexity (the round shape) of the
eyelid-brow junction by removing the appropriate amount of skin, tightening the muscle
and redistributing the fat inside the brow and the eyelid.
Dr DAN’s Technique (#BelphbyDrDan)
Find Your Perfect Aesthetic
Dr Georgescu’s Technique: The upper eyelid lift is a highly customizable surgery, simply
because there are many different types of eyelid shapes and periocular aging has
different impact on different people. For this reason, I routinely perform over 10
different types of upper blepharoplast (eyelid lift) techniques. The art lies in knowing
which technique to choose for each individual patient in order to achieve the best
cosmetic and functional result. This comes with experience. However, in the majority of
patients, the excess skin is conservatively removed through an invisible incision placed in
the upper eyelid crease, the muscle is tightened and the fat is redistributed or
transposed.
Fat transposition blepharoplasty has become the most common technique I use in both
the upper and the lower eyelids because the majority of patients present with age-
related volume loss around the eyes. Fat transposition is a very effective way of
restoring volume loss at the eyelid-brow junction. Medial upper eyelid fat is frequently
bulging due to weakening of the orbital septum and orbicularis oculi muscle. It can be
moved laterally without damaging its blood supply and attached with deep sutures to
the central fat pad or the bone lining (periosteum). Similarly, the brow fat pad
responsible for the lateral hooding can be transferred medially and superiorly to restore
the convexity of the eyelid-brow junction in the lateral part of the brow. This gives the
upper eyelid the fulness or convexity that is typical for youth while permanently
eliminating the lateral hooding and the medial bulge. The skin sutures dissolve in less
than 10 days.
Adjuvant (Add-on) Procedures:
Brow-lift and Brow contouring.
If the brows are droopy (brow ptosis), a blepharoplasty alone cannot fully correct the upper eyelid aging changes. In my published research (Georgescu et al, 2009), I showed that brows typically drop even more when an upper blepharoplasty is performed alone, which further narrows the space between the eyelashes and the brow hairs. When brow ptosis is present, I perform a brow lift procedure at the same time and usually through the same upper eyelid incision as the blepharoplasty. When necessary, an endoscopic brow and forehead lift is performed using invisible incisions behind the hairline. In most patients, the brows are not droopy but have lost the natural convexity and shape, for which reason a brow contouring technique is more appropriate. This involves restoring the brow volume through either fat transposition or autologous fat transfer (fat injections). In addition, the natural, youthful shape of the brow and eyelid-brow junction are restored.
Corrugator muscle removal.
The Corrugator Removal technique eliminates the muscles that produce the frown lines (also called the “11 lines”) and pull the brows down and in. It is very effective at lifting the medial part of the brow, for which reason it is an excellent technique for women that have a very high lateral arch. This avoids the surprised look seen when the lateral part of the brow is too high compared to the medial brow. Corrugator removal is also ideal for men because it preserves the flat brow configuration that is typical in men. As opposed to Botox that lasts only a couple of months, the effect of the Corrugator muscle removal on the 11 lines is permanent, for which reason it is called a “Permanent Botox effect”.
Ptosis repair.
Eyelid ptosis also known as Blepharoptosis or Ptosis is characterized by the
drooping of the upper eyelid margin (not just the skin) and can affect one or both eyes.
It occurs when the muscles responsible for lifting the eyelid weaken or become
damaged, leading to the eyelid covering more of the eye than usual. This can obstruct
the upper field of vision and make it difficult to keep the eye fully open. In children, the
most common cause of ptosis is poor development of the muscle that lifts the upper
eyelid (levator muscle). In adults, the tendon of the muscle that lifts the eyelid stretches
and the eyelid falls, covering part of the eye. Ptosis can also be caused by disease or
injury to the nerve or the muscle.
Ptosis surgery usually involves tightening the levator muscle through the same
blepharoplasty incision, in order to elevate the eyelid to the desired position, a
procedure called External Levator Resection. For mild ptosis in adults, a procedure
called MMCR (Müller Muscle Conjunctiva Resection) can be done through the inside of
the upper eyelid without skin incision.
Micro and Nano-fat Transfer.
Sometimes, volume loss around the eyes is so advanced that there isn’t enough fat that can be used to restore the convexity of the eyelid-brow junction. In these cases, the patient’s own fat can be harvested from the areas where it is found in excess, processed into micro-fat and nano-fat, and reinjected in the brow area using small blunt needles (cannulas).
BEFORE THE SURGERY
From the time of your first consultation (whether on-line or in person) till the day of surgery you will have the opportunity to discuss with Dr Georgescu and his staff all your questions and concerns related to the surgical procedure, the preparation and the recovery. Make sure you fulfill all your financial obligations at least 2 weeks prior to surgery. Stop all anticoagulants (Eliquis, Pradaxa, Xarelto, Plavix, Coumadin, Warfarin), anti-inflammatory medication (Aspirin, Ibuprofen, Naproxen, Diclofenac, Indomethacin) and all vitamins and supplements (except for Calcium and Vit. D) two weeks prior to surgery, but only with the approval of your primary care doctor or cardiologist. Make sure you fill your prescriptions before surgery. You need to make arrangements for someone to bring you to the surgery center and take you back home, as you will not be able to drive the day of surgery. You also need someone to stay with you for at least the first night after surgery.
THE DAY OF SURGERY
If your surgery is scheduled in the office, you can have a light meal before coming in.
Take your regular medication as usual. Avoid drinking coffee or alcohol on the day of
surgery.
If the surgery is scheduled in the ambulatory surgery center, do not eat or drink anything
past 10:00 PM the night before! If you need to take your blood pressure or anxiety
medication, do so with a sip of water when you wake up. Make sure you arrive at the
office or the surgery center at the time indicated (our staff will call you the day prior
with the exact time you need to be there). Our surgery center staff will greet you and
make sure all the consent forms have been signed. Your companion can either wait in
our comfortable waiting area, where there is coffee, water and snacks, or can return
back home and we will call as soon as the surgery is over. You will be then taken to your
room where our nurses will place an IV and EKG electrodes. A urine pregnancy test is
performed on all pre-menopausal women. Then, you will meet in person our
anesthesiologist who will explain the anesthesia procedure. Most surgeries are done
under sedation. Dr Georgescu will come and read to you the consent form and answer
any last-minute questions you may have. He will then do the skin markings and may take
some additional photographs. The bed will then be wheeled into the operating room
where the time out will be performed before you go to sleep. The anesthesiologist will
then give you IV medication that will allow you to fall asleep. At the end of surgery, you
will be taken to the recovery room where you will wake up with no pain. We typically
use ice-packs in recovery for 20 minutes to decrease swelling. You and your companion
will be shown in detail how to apply the ointments and ice. After approximately 30
minutes you will be discharged to go home with your companion. We will bring you to
the car in a wheelchair. You will be given Dr Georgescu’s personal cell number to call at
any time if you have any questions or concerns.
RECOVERY & RESULTS
Most patients take between 7 and 10 days off after blepharoplasty surgery. Stitches
dissolve or are removed at 10 days. Bruising and swelling typically go away in about 2-3
weeks. Antibiotic and pain medication may be prescribed for a few days. You will need
to apply ice packs 20 min / hour while awake for 2 days. Starting on the 3 rd day, you
switch to warm compresses twice a day 10 min each till the bruising is completely gone.
You will need to apply antibiotic ophthalmic ointment on the incisions and inside the
eyes 4 times a day for 3 weeks. You will also apply Refresh Relieva PF artificial tears
every hour for 2 weeks followed by every 2 hours for 2 weeks and 6 times a day for 2
more weeks.
Starting on the 5 th day we will begin the INDIBA RF lymph massage that is performed in
our office and takes less than 30 minutes. The 3 complimentary sessions are scheduled 3
days apart and will speed-up your recovery by decreasing bruising and swelling.
Strenuous activity, such as golfing, swimming, tennis and weightlifting should be avoided
for 3 weeks. Walking is allowed the day after surgery. Light running and biking can be
resumed after 1 week. The hair can be dyed after one month. Makeup can be applied as
early as 2 weeks after surgery.
You will need to come back to the office the following day to ensure that your eyes are
not dry and that you are healing well. You will also be seen on days 7 and 14 followed
by 1 month, 3 months and 6 months. However, Dr Georgescu is available to see you at
any time if you have questions or concerns.
Although most patients look really good at 4-6 weeks, they are only 25% healed at this
time and may still experience dry eyes, tearing and blurry vision, especially when
working on the computer or phone extended periods of time. Full healing normally takes
4-6 months, at which time the numbness around the incisions is typically resolved.
Seek Dr DAN’s Advice
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2122 NW 62nd ST, Ste 229 Fort Lauderdale, FL 33309
