Improve Your Appearance & Vision!
The eyes are the windows to the soul, but also one of the first areas to show signs of aging. Small wrinkles, droopy lids, excess skin, and bags under the eyes can make you appear tired or older than your age. Often, as the skin droops, your vision is affected. These changes can appear as early as your late 20s.
What is Blepharoplasty?
Blepharoplasty (eyelid surgery) can turn back these signs of aging and make your eyes appear brighter and refreshed. By removing excess skin and fatty deposits, your eyelid is restored to a more youthful appearance. In addition, if your field of vision is being affected, you may see better following the procedure.
Blepharoplasty can correct:
- Loose, droopy, and extra skin on your upper and lower eyelids
- Fat deposits on your upper and lower eyelids
- Bags under your eyes
What is a Brow Lift?
The natural aging process often causes our brow to droop. This may also be due to heredity, muscle activity, stress, or repeated facial expressions that create visible creases and deep furrows. The eyebrow may get a very flat appearance instead of a youthful arch. To improve this aging process, a brow lift may be performed alone or in combination with a blepharoplasty if there is excess skin on the upper eyelids.
A brow lift improves the appearance of the region between the upper eyelids and the scalp, extending to the temples. This procedure improves sagging brows and minimizes the appearance of lines and creases in the forehead.
A brow lift is most commonly performed in 40- to 60-year-olds with the goal of minimizing the visible signs of aging. People of all ages can benefit if you have deep furrows or frown lines due to muscle activity or stress.
A Brow Lift can:
- Reduce furrows
- Minimize creases across the forehead and high on the bridge of the nose
- Reposition sagging brows
- Raise eyebrows to improve field of vision
“I cannot believe I waited to have my eyelid surgery. In my early 30s, I noticed my eyelid skin was wrinkling when I put on makeup. At the end of the day, my eyes felt and looked “droopy” and I felt very tired from the skin resting on my eyelashes. Once I had my blepharoplasty, I immediately looked younger and felt great- even at the end of the day- I didn’t look or feel tired any longer! My advice to anyone considering eyelid surgery is¬ Don’t wait!”
At Grand Rapids Ophthalmology, we are fortunate to have Dr. Michael Boyle who specializes in cosmetic and reconstructive surgery of the eyelids. In addition to being a board certified ophthalmologist, he is fellowship trained and certified by The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Dr. Boyle performs both cosmetic eyelid surgery for patients interested in a more youthful appearance and reconstructive eyelid surgery for patients with medical problems that affect their eyes such as thyroid eye disease.
Oculoplastic surgeons are ophthalmologists (eye doctors) who have specialized in eyelid and facial plastic surgery. Oculoplastic surgeons are trained to do many different types of eyelid and facial surgery, ranging from simple eyelid malpositions to more complex reconstruction involving the eyelids and surrounding forehead, temporal and cheek areas. They understand the delicate anatomy and function of the eyelids and their surrounding structures. As well as the eyelids, they specialize in the lacrimal (tear) system, the orbit (bone cavity around the eye), adjacent periocular (around the eyes) and facial structures and the forehead and cheeks. Oculoplastic surgeons are also known as ophthalmic plastic and reconstructive surgeons and oculo-facial surgeons.
- Oculoplastic surgeons assess the surface health of the eyes and function of the eyelids prior to eyelid plastic surgery.
- As dedicated eyelid plastic surgeons, an oculoplastic surgeon routinely does surgeries in these areas, and recognizes potential problems.
- Oculoplastic surgeons are trained to manage the complications or eyelid and facial plastic surgery which can involve the eye itself.
Sun damage, smoking, stretching from swelling or obesity, and the wear and tear from blinking and rubbing all contribute to a gradual deterioration in the eyelid’s tissues and their support. By far, however, the most important variable is one’s heredity expressed over time.
No. Most semicircular rims of depression are the result of a relative deficiency of bone along the upper cheek with secondary sagging of the cheek’s fat pockets and muscles. Since the indentation (often called a “tear trough”) is not caused by an eyelid or orbital deficit, blepharoplasty does not correct. Injection with a commercial filler is the most common treatment.
Eyelid hollowness is not the same thing as cheek hollowness, a tear trough, or dark circles, all of which are much more common conditions. If the lids themselves have become hollowed due to insufficient fat volume following overdone blepharoplasty or aging changes, they can sometimes be re-inflated by grafting fat into the socket around the eye.
Yes, but not drastically. Conservatism is key.
Puffy eyelids look just as bad on a man as they do on a woman. In today’s competitive and youth-oriented world of business, both men and women have come to appreciate that while they may be well-qualified, their appearances matter.
Since eyelid skin is thinner than that on the rest of the face, the eyes are usually the first facial component to demonstrate a noticeable age-related loss of attractiveness. A person who is physically and psychologically healthy is ready to consider blepharoplasty whenever the effects of Mother Nature or Father Time bother him or her enough that an improvement is desired.
If you are shopping price, be aware that some offices quote only the surgeon’s fee by telephone, excluding such extras as operating room, anesthesia charges, etc. While cost is obviously important, the quality of your care and outcome are most crucial. To learn more about blepharoplasty costs contact our office for an appointment.
Dr. Boyle will perform a medical exam as well as a focused physical exam. He will need to know all your medical conditions, current medication regime including vitamins and herbal remedies. In addition, he will need to know your drug allergies as well as any reactions to medications you have had in the past.
You will need to let him know if you have uncontrolled high blood pressure, blood-clotting problems, or the tendency to develop large scars. Let Dr. Boyle know if you have had any prior facial surgery or if you are taking aspirin or other drugs that affect clotting. If you smoke, you will need to quit four weeks before your brow lift surgery and not to resume for at least four weeks after your surgery. Smoking decreases blood circulation to the skin and impedes healing.
Your height and weight will be recorded at each office visit. In addition, Dr. Boyle will evaluate you for the brow lift in the context of evaluating your facial aesthetics in their totality. This evaluation involves examining your upper and lower eyelids, your mid-facial aging, your neck, and your skin itself in addition to what is going on with your forehead. No one area of the face can reasonably be viewed in isolation, without consideration of the adjacent areas and the overall balance of your features.
Furthermore, Dr. Boyle will explain the anesthesia he will use during your brow lift procedure. He will address the risks involved in the surgery as well as your expectations of the overall outcome. You will be given a cost estimate for your procedure.
You will meet with Dr. Boyle approximately two weeks prior to your plastic surgery procedure, at which time any remaining questions you may have regarding the operation will be answered. You will have an opportunity to discuss and receive the following information:
You will receive a general physical examination to ensure that no new underlying medical problems exist that may interfere with the safety of the brow lift surgery. Any infections that you may have should be discussed with Dr. Boyle before your operative date.
You will receive specific instructions on how to prepare for brow lift surgery. The instructions will include guidelines on eating, drinking, smoking, and taking or avoiding certain vitamins, iron tablets and certain medications. A list of your medications will be reviewed, and certain medications should be discontinued at least 2 weeks prior to the brow lift operation.
You will be asked to refrain from taking any medications or other substances which could potentially be the cause of surgical complications such as aspirin, NSAIDs and vitamin E. These medications interfere with the blood clotting mechanism and can cause bleeding complications.
Patients with high blood pressure must have their condition well controlled prior to brow lift surgery and should plan to take their blood pressure medication right up to the time of their operation.
Pre-operative digital photographs are taken so that you can see the improvement from your brow lift surgery afterwards. You will be asked to sign a photographic consent prior to having any photographs taken. Pictures are usually taken 3 months after your procedure.
Dr. Boyle will write prescriptions for post-operative antibiotics to decrease your risk of infection and a pain medication for post-operative pain relief. Perms and bleaching should be avoided for two weeks prior to and two weeks after your brow lift.
You will receive specific instructions regarding the date and time of your brow lift procedure before leaving his office.
You will be instructed not to eat or drink anything after midnight the night before your surgery.
Do not shave your scalp prior to brow lift surgery; this may increase your risk of infection.
You will be asked to pay your surgical fee at your pre-operative visit. The fee is determined at the time of the consultation and is different for every scenario or combination of areas treated.
Scheduling brow lift surgery involves payment of a non-refundable deposit, as there are costs involved with preparing for the operation, and for holding operating room time.
You will be asked to sign a consent form for the surgical procedure and for board-certified anesthesia.
You will be asked to pre-arrange for somebody to drive you home from the surgery office after your brow lift surgery.
You cannot operate motor vehicles after surgery, and we will not place recently sedated patients in taxis for transport home. We can arrange for medical transport in the event you cannot find an escort.
It is mandatory to have someone stay with you for at least 24 hours after brow lift surgery for your comfort and safety.
- Wear loose fitting clothing that will wash easily in the event they are soiled.
- Leave all jewelry, contact lenses, or other valuables at home.
- Remove all body jewelry from pierced body parts the day of brow lift surgery.
- Your vital signs will be checked by Dr. Boyle’s nurse before your operation begins.
- Dr. Boyle will need to draw lines on your face and scalp to provide him with guidelines during your procedure.
- You will meet with the anesthesiologist to review your medical history.
- The brow lift procedure will take two to five hours, depending on the amount of work required.
Since the anatomy and health of the eyelids and surrounding face varies person to person, every operation must be custom tailored to fit the needs of the individual.
Since blepharoplasty is not a stock procedure, operating times will vary with the extent of changes and scope of the operation. As a general guideline, performing upper or lower blepharoplasty alone takes about 45-60 minutes, while having them both performed together takes about 90 minutes.
Blepharoplasty is routinely performed under local anesthesia with oral sedation. Most patients report little or no memory of the procedure. Compared to general anesthesia, local anesthesia is associated with less bleeding, increased safety, enhanced precision, and faster recovery.
Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed.
For most brow lift patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the head and down the other side of the head. The incision is usually made behind the hairline so that the scar will not be visible.
Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed, and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.
The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Dr. Boyle may choose to cover the incision with gauze padding and wrap your head in an elastic bandage.
The advantages of the traditional approach are that a more controlled contouring of the shape of the eyebrow can be obtained. The brow lift procedure has been in use for a long time, and the results are long-lived. Complications are few but include the possibility minimal hair loss along the incision line. Some may develop numbness in a small patch of scalp at the top of their head.
The Endoscopic Brow List
If your hairline is high or receding, the endoscopic brow lift may be your procedure of choice. This technique will avoid adding even more height to the forehead and allow for minimal scarring.
Typically, an endoscopic brow lift requires the same preparation steps as the traditional procedure: the hair is tied back and trimmed behind the hairline where the incisions will be made.
However, rather than making one long coronal incision, Dr. Boyle will make three, four or five short scalp incision, such less than an inch in length. An endoscope, which is a pencil-like camera device connected to a television monitor, is inserted through one of the incisions, allowing him to have a clear view of the muscles and tissues beneath the skin. Using another instrument inserted through a different incision, the forehead skin is lifted, and the muscles and underlying tissues are removed or altered to produce a smoother appearance. The eyebrows may also be lifted and secured into their higher position by sutures beneath the skin’s surface or by temporary fixation screw placed behind the hairline.
When the brow lift is complete, the scalp incisions will be closed with stitches or clips and the area will be washed. Gauze and an elastic bandage may also be used.
The advantages of the endo-brow lift are that the scars are less lengthy and therefore possibly less noticeable. There is less risk of numbness of the scalp.
The recovery may be slightly shorter without the need to heal a long incision line.
Through complications are few, they include inability to obtain significant shape change of the brow because of a mainly vertical vector or pull (as opposed to an upward and outward direction of lift with the open technique), and relapse. The procedure is fairly new and long-term results and longevity remains to be established.
Eyelid Surgery Post-Operative Instructions
- Begin wet washcloth and bag of ice compresses, to incision site, as soon as you get home. (Do NOT put ice on skin directly.) These compresses should be used as often as possible during the first 2-3 days after surgery. The more you use them, the less swelling and bruising you will experience.
- After 3 days, begin using warm, moist compresses 2-3 times daily for five minutes at a time. Continue the warm, moist compresses until all swelling and bruising has cleared.
- If any ointment or drops were prescribed to you before or after your surgery, use as directed. Use on the day of your suture removal also.
- Your sutures will be removed in approximately 7-10 days following surgery.
- Please refrain from using any make-up or contact lenses until directed by Dr. Boyle.
- Please refrain from swimming, jogging, or any activity that would increase your blood pressure for 2-3 days following surgery. Walking and LIGHT exercise is acceptable.
The following information is for Dacryocystorhinostomy and Orbit Repair patients only:
- Do NOT attempt to remove nasolacrimal duct tube that has been placed by Dr Boyle. Dr Boyle will remove the tube after necessary healing; this amount of time varies with each patient.
- No vigorous nose blowing for 1-2 weeks following surgery. (Gentle blowing is permitted.)
- Light blood loss through the nose is common.
If you have active bleeding that does not stop after continuous pressure applied for 20 minutes, please contact Dr Boyle.
The majority of patients report mild aching or burning, which is usually well controlled with Tylenol and cold compresses.
Most patients experience moderate discoloration that is gone within about ten days. Swelling peaks on the morning after surgery. While it mostly resolves over the next two weeks, a small amount may persist for several months or more.
While most normal tasks can be resumed within two days, too much activity during the first week will increase swelling. Strenuous activities should be avoided for two weeks or more. Most people prefer to lay low for several weeks.
In upper blepharoplasty, the incision is hidden in the crease. In lower blepharoplasty, the incision is placed along the back surface of the eyelid and/or just below the lashes. While full thinning and fading of any scar on the body can take a long time, keloids on the eyelids are rare.
A realistic expectation is that most patients will achieve about a 75-90% improvement after upper blepharoplasty and a 60-80% improvement after lower blepharoplasty. Some slight asymmetry is the rule rather than the exception. With Asian double eyelid surgery, requested crease shapes and heights can be approximated but not guaranteed.
Compared to procedures designed primarily to fight the effects of gravity (face lift, brow lift, etc.), blepharoplasty lasts a very long time. In the majority of patients, cosmetic eyelid surgery is performed only once. Everyone has heard about the unlucky patient who undergoes a face lift and experiences a wonderful result only to sag all the way back to his or her starting point within a couple of years. It is only natural, then, to wonder how long the improvement from another sort of lift — an “eyelid lift” — should be expected to last. In contrast to a face lift (in which surgery is directed primarily against the gravitational effects of aging by reinforcing and lifting sagging tissues), not much is truly “lifted” in a so-called “eyelid lift”. The term is unintentionally misleading and used only to draw an analogy between the well-known cosmetic operation used on an aging face and the primary cosmetic procedure used on the eyelids.
“Blepharoplasty” is the better term. Blepharoplasty differs from face and body lifts in several important ways: – Blepharoplasty is directed more against the influence of heredity on the eyelids than against the effects of gravity. The main determinant of eyelid “sagging” and “bulging” is not so much g-forces as it is a loss of tissue elasticity that comes hard-wired into your genes and then expresses itself during the late thirties and early forties.
The surgery to restore an eyelid to its normal contour is, therefore, not so much of a losing battle against the immutable laws of Newtonian physics. – Tissues placed under tension will invariably stretch, a trait that makes many reconstructive operations possible. While a face lift does indeed place tissues under some tension, a well-done blepharoplasty should not. One of the main determinants of “recurrence” is thus avoided. – Once hereditary deficiencies have been reversed, they show much less of a tendency to re-express themselves than do changes that are determined primarily by gravity (which disappears only in outer space). – Eyelid fat does not “grow back,” even with weight gain. While it is possible for additional socket fat to eventually work its way forward into the eyelid, it will almost never reaccumulate to the degree that predated the blepharoplasty.
Many people, in fact, experience the opposite effect with age– that is, a gradual loss of fat. What all of this means is that blepharoplasty yields a longer lasting result than most other cosmetic operations. The vast majority of patients will undergo blepharoplasty only once. While many articles on cosmetic eyelid surgery quote durations like “ten years” to describe longevity, we know of no data to support such statements. There is an old saying about plastic surgery: it can turn back the clock, but it can’t stop it. So, some of the luster of the original blepharoplasty should be expected to be lost with time. Rarely, however, does the full-blown operation ever need to be repeated (unless, of course, the first surgery was undertaken at a very early age). Any sort of later “touch-up” is usually quite conservative.
This brow lift procedure is most commonly performed in the 40- to 60-year-old age range to minimize the visible effects of aging. However, it can help people of any age who have developed furrows or frown lines due to stress or muscle activity.
Individuals with inherited conditions, such as a low, heavy brow or furrowed lines above the nose can achieve a more alert and refreshed look with this brow lift procedure. The brow lift procedure is often done with a facelift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a brow lift, especially if a patient has significant skin overhang in the upper eyelids.
Sometimes, patients who believe they need upper-eyelid surgery or blepharoplasty find that a brow lift better meets their surgical goals. Patients who are bald, who have a receding hairline, or who have had previous blepharoplasty upper-eyelid surgery may still be good candidates for brow lift. Dr. Boyle will simply alter the incision location or perform a more conservative operation.