Blepharoplasty

Generally speaking excess skin appears around the eyelids as we age. This is due to many factors. A major factor is the loss of collagen we experience as we age, combined with the loss of elasticity of our tissues.

The brows begin to droop. Here, fat beneath the brow, which is called ‘Sub-Brow fat’ falls down with the brows, pushing weight on the upper eyelids and the skin itself stretches.

Eyelid skin is the thinnest in the body and with time this stretching causes unwanted skin in the upper eyelid. This redundant skin is called Dermatochalasis, which often abuts on the eyelashes and pushes them down, obscuring the vision particularly superiorly and to the sides. The skin often is more lax towards the outside of the eyelids acting as a type of blinker as the skin droops down towards the outer side of the eyelids, diminishing side vision.

When upper lid Blepharoplasties are performed, skin is excised as well as some muscle and even some fat which can often prolapse, especially in the inner corner of the eyelid just outside the bridge of the nose causing a very lumpy appearance.

In addition to excess skin around the upper and lower lids, there are often crow’s feet at the outer angles of the eyes caused by elasticity of collagen and often associated with lifestyle factors and sun damage.

During a Blepharoplasty excess skin around the crow’s feet is excised, however, adjunctive treatments are best used in this area. Fraxel re:pair CO2 resurfacing laser, which is also used for the surgery itself, as well as collagen treatments such as Thermage and Platelet therapy can be done as part of the surgical procedure. These treatments reduce wrinkling associated with these crow’s feet, with a natural appearance.

Of course anti-wrinkle injections can be used. However these are only a temporising treatment and the ability to smile with your eyes is lost, which Dr Hollenbach thinks is a very unfortunate feature with using these anti-wrinkle injections.

Blepharoplasty should also not be done in isolation. Often it needs to be combined with a Brow Lift (if there is significant Brow Ptosis). There needs to be sculpting of the Sub-Brow fat if there is drooping of this area and similarly the lower lid can be augmented with a cheek lift or using fat transfer techniques.

These can all be combined in a single procedure.

It is important that a thorough knowledge of anatomy is undertaken and this is why an Oculoplastic surgeon is the right surgeon to undertake this type of procedure.

Unfortunately many plastic surgeons do not consider eye health as part of their workup when assessing patients for Blepharoplasty.

The advantage of having an Oculoplastic surgeon doing the procedure is that your eye health is checked before any procedure is undertaken. This includes checking your vision, looking at the health of your eyes and in particular testing for dry eye, which can be exacerbated after the procedure. This occurs because the blinking mechanism is interfered with during surgery and takes time to recover. If you have dry eye before the surgery, this can worsen after the surgery and this is therefore important to make sure this is assessed properly. Even if you don’t have dry eye prior to surgery you may feel some grittiness afterwards and need lubricants. Lagophathalmos or the inability to close the eyelids needs to be checked prior to surgery to avoid any postoperative disasters caused by the inability to keep the eyelids closed. This means not too much skin can be taken at the time of surgery and therefore the experience of an Oculoplastic surgeon is advantageous.

You can be sure that you are in safe hands when seeing an Oculoplastic surgeon such as Dr Hollenbach who will be go through the protocol for making sure your eyes stay comfortable after the procedure.

An Oculoplastic surgeon is again the ideal surgeon to do a lower lid Blepharoplasty as there have been too many instances where lower lid Blepharoplasties have led to pulling out of the lower lids referred to as Ectropion due to too much skin having been removed. This is often very difficult to correct and it is very important that an experienced surgeon does the procedure such as Dr Hollenbach, as they know how much skin is safe to take. Furthermore, paralysis of the lower lid eye muscles is not unknown. This unfortunate complication is again best dealt with by an Oculoplastic surgeon. There are of course other techniques, which can lessen the amount of skin to be taken, whilst achieving a natural look.

If eye bags are the primary concern, this surgery can be performed through the eyelids without the need to remove any skin at all.

Generally speaking surgical wounds heal up after a week. Sutures are removed at that time or are often left to dissolve naturally, which may take up to 8 weeks.

It may take up to 3 months for everything to settle down and swelling can persist over this period.

At Preface Cosmetic we have various measures to try reduce post-operative bruising and swelling including the use of LED lights, laser treatments to absorb blood from bruising and using various cosmeceuticals designed to aid with wound healing. We also use silicon scar gels to reduce scarring and platelet therapy can also aid with healing and reduce persistent swelling, as well as dealing with the crows feet and improving the texture and tone of the overlying skin.

Of course general measures immediately after surgery such as elevation, posturing and the use of ice packs are paramount.

Swimming, exercise and heaving lifts is to be avoided for two weeks. Mineral makeups can commence a few days after surgery if you so desire.

The most important aspect of any surgery is to make sure that the proper surgery is done in the first place. There is no point in doing a Blepharoplasty on someone who has Brow Ptosis and even though this is a much more expensive procedure, often times it is in fact the Brow Ptosis which gives a heaviness of the upper lids, rather than excess skin which is called Dermatochalasis. This needs to be properly assessed at the time of the initial consultation. Often the Brow Lift is combined with a Blepharoplasty and sometimes a Brow Lift alone is more appropriate. Again a Oculoplastic surgeon is the one with the most experience to help you make this decision.

Similarly if there is Midface Ptosis, it may be appropriate to do a Mid-Face Lift or a Cheek Lift at the time of doing a lower lid Blepharoplasty. It may also be prudent to do a fat transfer to volumise the cheeks. At the same time, Cheek Lifting can be done with absorbable threads or can be done with more formal techniques of Mid-Face Lifting. Mid-face lifting includes the use of Endotine, which is an absorbable anchoring device designed to hold the cheek up. Cheek implants may also be considered.

Many potential candidates who see me for Blepharoplasty are young or middle aged. This is driven through media, both social media and more formal advertising media. Dr Hollenbach thinks that one should be circumspect. He would not consider doing Blepharoplasties on anyone under the age of 30, unless it was absolutely necessary in terms of vision being compromised by excess skin. He actually can not remember any such case.

Dr Hollenbach believes Blepharoplasty can be done if needed after the age of 30 and of course the older one gets, the more skin is present and so there is no upper age limit for the procedure.

It should be noted that if the upper eyelid skin abuts the lashes, then the term functional Blepharoplasty is used where it becomes a medical procedure and not a cosmetic procedure. This can be partly covered under Medicare.

Dr Hollenbach has been doing Oculoplastic surgery for in excess of 20 years and has done many hundreds, if not over a thousand Blepharoplasties. He has also done many types of brow lifts, both Endoscopic and Transblepharoplasty brow lifts, using anchors, attaching the eye brows to desired level to the bone. Thread lifting is also in his armamentarium for brow lifting.

There are always risks with any operations. Dr Hollenbach has a very low rate of complication during the procedure and very rarely has to do any repeat surgery due to any adverse results after initial surgery. This of course is very important. It goes without saying that you will be looked after post surgery and will be nursed through the healing period using any of the healing aids we have at our disposal at Preface Cosmetic. Post-operative care is paramount and we pride ourselves in this area. Dr Hollenbach will see you frequently after the surgery to help you with any questions or concerns.

Dr Hollenbach frequently gets referred patients who have had Blepharoplasties done elsewhere where there have been problems.

An Oculoplastic surgeon such as Dr. Hollenbach will assess your eye function fully before and after surgery. He will make sure that there is minimal scarring both in the skin but more importantly in underlying tissues, which can lead to eyelid problems down the track.

The costs of Blepharoplasty vary depending on whether it is upper lid or lower lid and whether any adjunctive procedures are performed. These costs will be given to you at the time of your initial consultation and should be discussed further with Dr. Hollenbach.