Dr. Michael MacDonald Shares His Expertise On Eyelid Surgery

Dr. MacDonald, Would you please explain eyelid surgery or Blepharoplasty?

Blepharoplasty is the technical term used for surgical rejuvenation for either the upper and/or lower eyelids.

In your practice, what are the most common reasons patients are considering Blepharoplasty surgery?

The most common reason for lower eyelid blepharoplasty, typically done in younger patients, is a puffy tired looking eyelid. The most common reason for an upper eyelid blepharoplasty, typically in slightly older patients, is for a hooded, and tired looking appearance around the eyes. Opening the eyes as little as 3-4 millimeters more than their natural appearance will make a patient appear to be more rested, as though they have been on vacation for a month!

Do you typically perform Blepharoplasty in conjunction with a face-lift?

Blepharoplasty may well be performed in conjunction with a facelift and often a patient waits to have surgery until a facelift is warranted. However, because the eyes are the center of where we look in each other’s faces patients often are interested in having blepharoplasty surgery long before they are candidates for facelift surgery.

What is the average age in your practice for Blepharoplasty surgery? Do you see a growing trend of younger patients seeking surgery for an eye “lift”? What is the youngest patient you have treated? What is the oldest? Is the surgery more difficult in patients over 50 years old?

Average age for lower Blepharoplasty is mid-thirties. Average age for upper blepharoplasty is in the 40’s for women and 50’s for men. The youngest patient that I have performed a lower lid blepharoplasty on was 29 years old. The oldest patient was 77. The surgery is not more difficult in older patients. However, as patients age, healing and recovery time is typically slower. Having said that, recovery from blepharoplasty surgery is generally very rapid and without complication.

If a patient is concerned about both the lower and upper lids, do you suggest having the surgical procedures preformed separately?

If both the upper and lower eyelids are contributing to the tired, aged appearance, I would certainly prefer to perform both procedures simultaneously. In this way, there is only one recovery period and the overall rejuvenation of the eye area is completed at once.

What are some of the major causes of droopy eyelids and eye bags?

Genetics, lack of sleep, and poor skin elasticity are all contributors to the aging look around the eyes.

As we age our eyes naturally start to droop, what are some other ways to create a “lift” other than surgery?

I do not agree with the expression “lift”, as it applies to the eyelids. Certainly, good hydration of the skin with good under eye moisturizers is very important to maintain a youthful appearance.

Is photo aging a factor for creped skin around the eyes?

Photoaging is definitely a factor in the development of creped skin around the eyes. Sun damage contributes to loss of skin elasticity and adequate hydration with sun exposure is particularly important.

What are some solutions that you would recommend for creped skin around the lower eye area?

Hydration of the eyelid skin with excellent skin moisturizers is the best way to minimize wrinkles. Of course, wearing a good sun block at all times is important to prevent the progression of damage.

What is the difference between laser blepharoplasty and surgical blepharoplasty? Are there any advantages in one over the other?

Laser blepharoplasty often refers to the tool that is used to make an incision in the eyelid skin. Surgical blepharoplasty uses a scalpel to make incisions, while in laser blepharoplasty a C02 laser is used to incise the skin. There is a disadvantage to using laser blepharoplasty. We believe the healing process is slower with this type of procedure since there is thermal damage from the laser energy to the skin adjacent to the incision line. Conversely, making incisions with a scalpel blade heal more quickly. A different laser procedure around the eyes involves laser resurfacing of the eyelid skin. This is generally not considered a laser blepharoplasty; instead it is included in the range of options available for resurfacing of the skin around the lower eyelid to address wrinkles or texture irregularities.

What is the recovery time? How soon after surgery can you resume your normal activities?

Recovery times tend to be quite quick. Normal daily activities can begin again within 3-4 days. There will often be some bruising for up to 7-10 days. The bruising will be prolonged if patients begin exercising or bending and heavy lifting prematurely. Resuming normal exercise routines is best delayed for at least 3-4 weeks following eyelid surgery.

How long does it take for the scars to heal?

I generally remove the stitches in the upper eyelids 5-7 days following surgery. Because the incisions in the upper eyelids are placed in the natural skin crease, these scars are very difficult to see. This makes the healing appear to be very speedy; however, wound healing takes anywhere from 6-18 months. It is all about where the incisions are placed for minimal noticeability. With lower eyelid surgery, I am often able to perform this procedure with no visible scars whatsoever. In fact, the incision is made on the inside of the eyelid so there are no stitches to remove and consequently no scar line to heal. What’s more important than how long it takes the scar to heal is where the scars are placed. This is particularly applicable in eyelid surgery.

If someone is considering Blepharoplasty what are the most important questions they should ask their surgeon?

Especially with lower eyelid surgery, there are a number of different approaches to be considered. Should the incision be made on the inside or on the outside to incorporate removal of some skin at the same time as recontouring of the fat in the lower eyelid? Is it necessary to remove some skin and muscle, or is fat recontouring more important? Can the fat from the cheeks be elevated and suspended in order to fill in the depression that gives the appearance of dark circles under the eyes? Often by suspending the fat in this region, any depression in this area can be completely eliminated. Are there any contour irregularities in the cheeks or farther out in the lower eyelids? Do any changes need to be made at the cores of the eyes?

With the upper eyelids, pre-op consideration involves thinking about removing any fat particularly in the area close to the lid line, as well as skin and/or muscle. As mentioned above, all of these considerations should take into account any incisions and the resulting scars that may be acquired. Can these scars be avoided or placed in such a way so they are not noticeable?

What is the average cost for Blepharoplasty surgery?

For upper eyelid surgery, including anesthesia and operating room fees is approximately $4000. For lower eyelid surgery is in the same range. For upper and lower eyelid surgery performed together, the total cost including anesthesia and operating room fees, is approximately $6000.

Dr. Macdonald is director of Aesthetic Surgery Center of San Francisco, located at 490 Post Street, San Francisco, CA. He is a specialist in cosmetic and facial plastic surgery. For further information please visit www.drmmacdonald.com.
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