When considering anti-aging improvements around the eye area, it is important to consider both the eyelids and the brows. Both can contribute to a tired look but they create that appearance differently. Eyelids become aged by having too much skin. In the upper eyelid, this can eventually become hooding with skin that can rest down on the lash line. In the lower eyelids, wrinkles and bags develop some of which is also the result of fat which begins to protrude out from under the eyelid. Conversely, eyebrows create an aged eye appearance by becoming positioned too low off of the forehead. The dropping of one’s brows also creates more excess skin in the upper eyelid which is really just skin that has been smushed together as the distance between the eyebrow and the lash line of the upper eyelid becomes closer together.
Depending upon the anatomy of the problem, some patients just need eyelid surgery alone, a fewpatients may just need a browlift alone, and some will need a combination of both to create the best result. Browlifts tend to be complementary to eyelid surgery.
2. What is the difference between an eyelid tuck and a blepharoplasty?
They are two different terms that describe the same thing. In 1818 Von Graefe coined the word ‘blepharoplasty’ (greek, blepharon = eyelid, plasty = to shape) to describe an eyelid reconstruction that he performed. Today, blepharoplasty denotes excision of excess skin, with or without the excision of orbital fat, for medical or cosmetic purposes. Blepharoplasty is the word we as plastic surgeons use. Patients commonly refer to it as an eyelid tuck.
3. Will eyelid surgery leave scars?
All surgery that involves incisions or the removal of skin will leave scars. But the eyelids are unique in that superb scars are almost always obtained. Good scarring on the eyelids is the result of two factors. The eyelid skin is one the thinnest on the entire body. Thin skin will always scar less than thicker skin because there is less dermis to react to the healing process. Blepharoplasty incisions are placed in natural horizontal skin folds in the eyelids. In the upper eyelid this natural crease can be seen as a horizontal crease the in the skin five to 8mms above the eyelashes. In the lower eyelids, the incision is put right under the eyelashes by 1 to 2mms. When these heal, they can be very difficult to see. (the upper eyelid scar can only be potentially seen when your eyelid is closed!)
4. How much swelling and bruising will occur after eyelid surgery? How long will I look bad?
There is no question that any surgery around the eyes will cause some temporary swelling and bruising. How much and for how long depends on a variety of factors including how many eyelids were done and your natural tendency to bruise. On average, lower eyelid surgery causes more swelling and bruising than uppers. When all four eyelids are done, most patients will start to look more normal in seven to ten days. It will takes fourteen to twenty-one days to look ‘non-surgical’. When browlifts are combined with eyelid surgery, these time frames may be longer.
There are several thins that a patient can do to help improve the rate of looking better sooner. In my Indianapolis plastic surgery practice, I emphasize three things. First, take the herbal medication Arnica Montana one week before and after surgery. This helps control the amount of bruising and speeds it resolution. It comes in multiple preparations. We prefer the spray delivery system. After surgery, keep your head elevated on ice on your eyes for the first twenty-four hours. You can stop the ice the next day but continue to rest and sleep with your head elevated for the first week after surgery.
5. How is browlift surgery done?
There are multiple methods of performing browlift surgery and the choice of which technique is used is based on each patient’s differing anatomy. There is no one single way to do browlift surgery that is right for everyone.
For women, the approach to lifting the brows is done ‘from above’. This means the incision is placed somewhere in or along the hairline and the brow and forehead are pulled back. Traditional browlifting is done from an incision way behind the hairline, removing scalp hair, to create the lifting effect. For women with long foreheads, this will lengthen the forehead in an unaesthetic manner and the incision is changed to right at the hairline. This keeps the forehead length the same (it cam also even be shortened) while lifting the brows. These open approaches have the advantage of being able to on the forehead and brow muscles to permanently weaken their effects of forehead wrinkling. …but at the expense of a long scar. When one has a scar concern and the forehead is not severe, the endoscopic approach can be used. Like laparoscopic abdominal surgery, several very small incision are made back in the scalp and the operation is done through a scope and a camera. This shifting technique will lengthen the forehead however so one has to determine beforehand of less scar or a longer forehead are more desireable.
Men do not have the browlift options that women do because of their hairline, or loss thereof, issues. It is rare to ever do any of these superior browlift approaches for that reason. Male browlifts are often done through the upper eyelid using a resorbable implant to push the brows up as they heal. This approach only produces a very mild browlift but the ‘less is more’ approach for men is always better anyway.
6. I would like a browlift but I am afraid I will have that startled look. How can this be avoided?
A browlift is an easy operation to overdo. Most potential patients are aware of this by looking at many Hollywood and famous people results. It can be a fine line between enough brow evelation to show a visible change and brows that are too high. Do not forget also about the shape of the brow. This is another factor that can make a browlift look unnatural. The best way to avoid this potential problem is to have a thorough discussion with your plastic surgeon beforehand, with a mirror and looking at issues of a new brow position and potential shape change. While browlift surgery is not like doing Photoshop on the computer, there is a surgical art to it that a plastic surgeon uses which is influenced by the browlift approach and other intraoperative techniques. Knowing what you want can help the plastic surgeon modify techniques to help meet your expectations.
7. Will insurance pay for eyelid and browlift surgery if I have trouble seeing?
In the past, insurance companies did regularly cover upper eyelid and browlift surgery if medical evidence existed that visual impairment existed from the excess eyelid skin and low hanging brows. Such routinue coverage is now increasingly uncommon and much harder to get approved. Whether the insurance option is an avenue to pursue can only be determined on an individual patient basis. Any such procedure on the lower eyelids, however, is never covered as there is no anatomic basis for excess skin getting in the way of seeing.
Dr. Barry Eppley