At our boutique practice in NYC, eyelid surgery is a very common procedure. The eyelids are the first physical attribute that we look at when we look at another face. They reveal our age, disease, state of rest, affect how we see and above all protect our eyes. Your eyes express more than any other feature of your face. If you suffer from eyes that are heavy, puffy, wrinkled, or pigmented, eyelid surgery may be the right choice for you.
Any treatment depends on whether the eyelid anatomy is normal or not.
The eyebrows are at rest at the level of the boney rim. The upper eyelids should have enough skin so when the lid is closed there is enough skin to cover the eyes.
The upper eyelid skin should not be puffy, should not drop to the level of the eyelashes, and should not be hanging on the outer aspect of the eyes. The crease of the upper eyelid is called the supratarsal fold. It should be a smooth curve of the upper eyelid and ideally not be covered by hanging skin. The upper eyelid level to the eyeball has a fixed distance. The upper lid should barely cover the dark area of the eyeball which is called the iris. The pupil, the dark circle in the middle of the eye, should be completely clear and not obstructed. The eyelids should be symmetrical. They should move equally.
The angle of the upper eyelids should be slightly elevated on the outer aspect so that there is an angle going towards the nose.
In 3-D the surgeon looks at the anatomy of the upper eyelid in plains or levels. The most superficial is the skin, with a thin muscle underneath that closes the eyelid, then fat that causes the bulges and finally a muscle called the levator that keeps the eyelid level.
The lower eyelids barely move and have a primary purpose of collecting our tears. The normal level is either at or slightly above the iris for colored part of the eye and should rest against the eyeball. Like the upper eyelids, they have a slight angle on the outer part of the orbit.
The planes of the lower eyelid are similar to the upper eyelid with skin superficial, a thin muscle underneath, and then three compartments of fat.
The skin should be smooth and wrinkle free. There should not be any bulges or any depressions.
HOW TO IMPROVE YOUR EYELIDS WHEN THEY ARE NOT NORMAL? WHAT ARE MY OPTIONS?
Low eyebrows, with the eyebrow below the rim can be the result of genetics, extensive squinting and ageing.
For mild dropping of the eyebrows, carefully placed BOTOX can elevate the eyebrow for a period of time. For a more permanent and accurate correction, small scar, endoscopic, elevation from the scalp is a better option to raise the eyebrows. This is done under light sedation and takes 1.5 hours. The recovery is 2-3 days.
UPPER EYELIDPLASTY, BLEPHAROPLASTY
Modern, advanced, eyelidplasty contours the skin, fat, and muscle. It contours the bulges, the creases and the overall appearance of the upper eyelid.
The most common procedure (we have done over 2,000) is a blepharoplasty that removes the excess skin, tightens the muscle underneath and removes the extra fat. By doing so, it also improves the supratarsal fold or eyelid crease. This is usually done under local anethesia, takes 1 hour and has a 3-4 day recovery. Variations on this include fat grafts to upper eyelid depressions , changing the direction of the upper eyelid fold, creams for hyperpigmentation and making Asian eyelids more western. The result is a younger, better functioning eyelid. Vision is improved because of the removal of the excess weight from the extra and hanging skin.
UPPER EYELID PTOSIS-DROOPY UPPER EYELIDS
Ptosis usually occurs when the levator muscle is either stretched from cataract surgery, weakens with age or becomes loosened from prolonged allergies. It can involve one or both eyelids.
Our technique does not cut the muscle but brings it down and folds it on itself, raising the eyelid to its normal position.
The surgery takes 1.5 hours, is done under light sedation or local anesthesia, and recovery is 2-3 days. It is normal, however, for the level to slightly adjust and become more symmetrical during the few weeks after the surgery.
LOWER EYELID SURGERY/BLEPHAROPLASTY/CANTHOPLASTY/CANTHOPEXY
LOWER EYELID BLEPHAROPLASTY
Lower eyelid blepharoplasty addresses the changes of skin, muscle and fat.
Mild wrinkles of the skin are treated with lasers and chemical peels. More extensive wrinkles, excess skin or even dropping of the lower eyelids are best treated by making a fine incision under the eyelashes, elevating the excess skin and muscle, contouring the fat and tightening the lower lids. If only fat and bulges are present a transconjunctival blepharoplasty or scarless blepharoplasty is performed. This removes the extra bulges and fat from inside the lower eyelid and does not leave a scar.
For an extreme excess of muscle and skin called festoons a more extensive but technically similar lower blepharoplasty is performed.
CANTHOPLASTY or Tightening the Lower Eyelids
A canthoplasty tightens the lower eyelid and changes the angle of the lower eyelid. Also called Cat’s Eyes , a narrow strip of excess muscle is elevated from under the lower eyelid and suturing it to the outer bone of the orbit. This is a very effective procedure in improving the look and function of the lower eyelid. The recovery is usually 1-2 days and it is performed under light sedation.
A canthopexy lifts the outer eyelids to give a better slant to the eyelids. The procedure detaches the tendons or fibrous tissue of the outer and lower eyelids and moves them to a higher level on the orbit. The recovery is 3-4 days and the surgery takes 1.5 to 2 hours. It is done under light sedation.
LOWER EYELID HOLLOWS, DEPRESSIONS and NASOJUGAL GROOVES
Lower eyelid depressions can be from aging, weight loss, and higher prominent fat bulges which cause a depression below them.
We prefer correction by one of three methods depending upon your age and the depth of the depression.
If there are prominent bulges the fat, can be brought down and used to fill the depression below the bulge. This is a very effective technique. For younger patients or those with only a little depression, injections of Restylane, Juvaderm, and more long-lasting, micro-fat transfers are the best options.
Thank You Dr Lesesne!
– Paula Miller
THE PROCESS OF CHANGING YOUR EYELIDS
We have developed a highly individualized methodical and experience-driven program to customize a treatment designed specifically for you.
It starts with an online or in-person consultation. Your history such as general health, eyelid problems, visual problems, allergies, dry eyes, will be discussed. Then, an examination of your anatomy and taking of photographs will occur. Your goals, along with some of our suggestions, will be noted. A treatment plan will then be developed and reviewed with you.
Westchester County New York and State of New York: Day of Recognition Award for Emergency Roadside Surgery
Recognition, Metropolitan Police, UK, For Emergency Surgery