Explore Plastic Surgery - Dr. Barry Eppley

 As everyone is aware, the internet is full of scams. The easy and no-cost use of  e-mail allows such illegal activities to appear in your inbox without any legal repercussions. You may ask yourself how could anyone fall for these but obviously some do or they wouldn’t keep doing it. The goal of each and everyone of them is to get access to your bank account and it is always in the guise of the need for some form of wire transfer of alleged funds.

Most people remember the ‘original’ e-mail scam…the one with government or family official from Nigeria. There have been many variations of this theme from different African countries and I still get one of these at least once a week.

In the spirit of marketing to niche areas, I just got one just for Plastic Surgeons. It’s the same old scam concept but with a new twist. Read and see if you can figure out the method that they will get access to your back account.

‘Greetings from Milan,

My name is Mr. ****** *******, I am a cosmetic dentist here in Italy. I do smile makeovers, preventive dentistry/maintenance, cosmetic dentistry, cosmetic dentures, etc. I have lots of happy clients here in Italy .

I have been looking for a plastic surgeon for over a week now till I met an old friend last week that referred you to me, She used to live in America before she relocated here with her family. So I decided to contact you to see if you are able to do an Upper and Lower Eyelid Surgery (Blepharoplasty) for this client of mine.

My clients name is Ms. ******** ******, she is a model here in Italy. She will be coming to the U.S in 3 weeks time for a modeling job and will be residing in Indiana  temporarily until the necessary arrangements for her job has been made. Before she leaves, she would be needing a Plastic Surgeon to help her out with her Upper and Lower Eyelids before her next photo shoot.

Please tell me a little more about yourself,  how long have you been a plastic surgeon? Would you be able to give her this surgery by the end of the month?
 
Please get back to me if you would be available to do the surgery and the amount that you will charge for the job. Let me know if she can pay you with a certified check drawn from a US bank so you can have her booked for the end of the month.

Till I hear from you may you remain blessed.’

Urgency to perform a plastic surgery procedure is not uncommon given the emotional nature of that type of decision. In a known patient where discourse has been established, this is not a concern. But in an unknown patient from afar, urgency is a sure sign of malevolence.

The catch here is when some unsuspecting plastic surgeon asks for payment in advance, which is standard. The switch will be made from sending a certified check to having to wire the money instead. At which point account numbers will be requested to do so.

Internet scams come at us in many ways. They all pray upon the inherent weakness in human nature to believe that money is easily obtained and without much effort. Occasionally that is true but most of the time it’s a recipe for being taken to the proverbial cleaners.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana  

One of the earliest and most recognizeable signs of facial aging is what occurs around the eyes. Because of the constant movement of the eyelids, the sphincteric action of the surrounding muscle units, and the thinness of the eyelid skin, the effects of time (and sun exposure…and lack of a good skin maintenance program) first become noticeable in this area. These aging effects  are recognized as lines, wrinkles, and bags.

Wrinkling of the skin is easy to understand because it occurs all over the face. It is the eye bags that are harder to figure out why they are there. Everyone knows eye bags occur in many people but why they are there is more of a mystery to the general public. I know it is a mystery because of all the eye creams and potions that are marketed to improve it. Once one understands the cause of eye bags, it is easy to appreciate why they are impossible to eliminate with any cream.

The development of fullness under the lower eyelids is the result of fat…fat that was originally under the eyeball. Our eyeball is encased in a surrounding sea of fat and muscle. The fat serves as a natural cushion to protect it from outer compressive forces. It allows the eyeball to be moved around without risk of injury. The fat under the eye is naturally held back by a thin film of tissue that runs between the lower eyelid (tarsus) and the rim of the lower eye socket. With age this tissue weakens, allowing the fat it constrains to protrude out. In some ways, it is like a hernia which is why it is referred to as lower eyelid fat herniation.

Since fat is largely composed of water, it can get bigger or smaller based on one’s water content. Eyebags are well known to be bigger in the morning (being horizontal all night) or if one has eaten a lot of salty foods the night before. (water retention) The size of a lower eyebag can be slightly improved by cold compresses (or cut pieces of cucumber) and some type of topical astringents. But no type of cream can get rid of the protruding fat in any significant amount.

Eyebag removal can be done through two types of  eyelid (blepharoplasty) techniques. If there is a lot of extra lower eyelid skin, then a more traditional open bkepharoplasty is done. By making a fine incision just beneath the eyelashes, the skin can be lifted away from the eyelid, the protruding fat removed, and the extra skin removed as the eyelid incision is closed. Most men and women over age 50 need this type of eyelid surgery to make a real difference.

If one is younger and excess skin is but a minor issue, an internal approach can be used. By going through the inside of the eyelid (no incision on the outside), the protruding fat is removed through this scarless route. The little bit of extra skin can then be safely tightened through a medium-depth chemical peel on the lower eyelid.

‘Debagging’ the aging lower eyelids is an important part of making the eye area look better for many patients. How much skin you have determines whether the incision to remove the fat is done from the inside or the outside.

Dr. Barry Eppley

Indianapolis, Indiana  

Aging around the eyes, as evidenced by wrinkles and dark circles, will occur to some degree in everyone. It is a perpetual process that starts to become evident after the age of 35. While formal eyelid surgery (blepharoplasty) may ultimately be needed, some may desire to consider non-surgical treatment options. While there are thousands of eye creams and potions, none can really make a significant periorbital rejuvenation change.

Laser resurfacing is the bridge between creams and blepharoplasty surgery. Traditionally, laser skin treatments have been avoided on the eyelids because the skin is very thin and the risk of causing a burn injury is very real. But laser resurfacing has changed over the past ten years with the use of more accurate depth control and fractional spacing of the laser pulses. Both approaches produce less skin damage and can virtually eliminate any risk of burns and scarring.

While there are advocates for every type of laser resurfacing device out there, there is not solid scientific evidence that fractional laser treatment produces a better or longer-lasting result than traditional non-fractional ablation. Fractional laser is certainly more popular currently but optimal laser energies and devices remain in a state of perpetual development and evolution.

Non-surgical eyelifts are currently done in my practice using the Sciton microlaser peel. Typical treatment time is done in less than 10 minutes for both upper and lower eyelids. The laser is used to treat the entire upper and lower eyelids, going right up to the lashline.The eyelid skin is first treated by a topical anesthetic for 15 minutes and the eye is protected with a metal shield. The eyelid skin can be treated from a 4 to 15 micron depth. This results in some mild redness and swelling for several days. Whether it is two days (4 micron) or four or five days (15 micron) is depth dependent. How much downtime a patient can tolerate determines the best depth. Ideally, a series of laser treatments are done to get the best skin tightening and some wrinkle reduction. Treating a patient every 6 to 8 weeks over  a 6 month period for a total of four treatment sessions is our current protocol.

Laser resurfacing of the eyelids is not new and has even been given branding names by certain practices. It has been touted that it achieves significant skin tightening with results that are comparable to a surgical eyelid lift…without any risks. The minimal to no risk part is true but comparing it to what can be accomplished with a blepharoplasty is an overstatement. It is a good compliment for the younger patient who does not yet need surgery and works well in conjunction with Botox injections. For the older patient with more skin excess, it provides some improvement but should clearly be viewed as a bridge to blepharoplasty and not a replacement for it.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Indianapolis, Indiana

Aging of the eyelids and periorbital area is one of the earliest signs of facial aging. This makes blepharoplasty (eyelid tuck), and an upper blepharoplasty in particular, a workhorse procedure in the arsenal of facial rejuvenation procedures. Many patients fear, however, that such an eyelid procedure will change their appearance somehow rather than making it more youthful or rejuvenated.

When considering an upper eyelid procedure, one has to take into account the position of the eyebrow. A low or descended  eyebrow can make it appear that more extra skin is in the upper eyelid than really exists. But what defines if an eyebrow is too low or ptotic? That would depend on where one’s brow was in youth. I would submit that most people do not remember where it was in their youth in most cases. This leaves it up to the plastic surgeon to provide an assessment which often leads to an excessive amount of browlift procedures being performed. The benefits of a browlift should be looked at very carefully as they often do not achieve as much rejuvenation as one would think.

Traditional upper blepharoplasty procedures involve the removal of excessive skin and a strip of orbicularis muscle. Often times fat is also removed from the upper eyelid compartments. These eyelid maneuvers often leave the upper eyelid area hollowed with an eyelid crease that sits too high. As the new eyelid crease sits up too high, the upper eyelid sulci become too deep and creates an unyouthful volume-depleted appearance.

Today’s blepharoplasty techniques make several changes to avoid the aforementioned negative effects. First, the upper eyelid crease incision is made lower than a traditional approach. This keeps it from becoming retracted too high after surgery. Secondly, no orbicularis muscle is removed. There is no benefit to disrupting this muscle support system of the upper eyelid and introducing more scar. Skin only is removed . This also plicates or rolls the underlying muscle onto itself adding some fullness. Third, there is little if any need to remove fat from the upper eyelid. This will avoid the potential for creating a volume-depleted look. Last, the use of browlifts are used only when the brow has severe ptosis where it is positioned below the brow bone. When browlifts are done, there is more focus on lateral brow elevation rather than the inner part of the brow.

Patients fear undergoing eyelid surgery because it may make them look different. More likely with traditional upper eyelid methods, they may not look as rejuvenated or youthful as they would like. A more ‘conservative’ upper blepharoplasty with emphasis on fat and muscle preservation can lead to a more natural looking result that does not alter one’s appearance. Browlifting should be done with caution avoiding an overelevated result.    

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

1.      What is the difference between eyelid and browlift surgery? Which will make me look less tired?

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

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis 

Blepharoplasty (eyelid rejuvenation surgery) is one of the most common facial cosmetic surgeries. According to the American Society of Plastic Surgeons procedural statistics for 2008, nearly 200,000 such surgeries were performed. Lasik (corrective vision) surgery is done even more frequently with roughly one million done as of last year. It should be no surprise, then, that these two eye-related procedures can cross paths in the same patient. Either someone has had Lasik and presents sometime after for blepharoplasty or one has had blepharoplasty and is now interested in vision correction.

This raises the question of how one impacts the other and does it pose a problem? Blepharoplasty and Lasik are compatible procedures that can, and often are, done in the same patient. But they are never done together. They must be staged and timed so they do not create functional eye problems.

Blepharoplasty can interfere with eyelid closure with the potential for a temporary period of eye dryness as a result. The blink reflex is slowed and the loose amount of eyelid skin and laxity has been removed. In short, the safety net for competent eyelid closure has been reduced…even if it is only temporary. This can be revealed when one sleeps where only a small crack of opening between the eyelids can cause lack of adequate eyeball lubtication. This is evidenced by crusty eyelids in the morning and a feeling of dry or itchy eyes.

LASIK is an elective laser eye surgery that reshapes the cornea (front surface of the eye) to improve vision. It is the most popular vision correction procedure performed in the United States and worldwide. LASIK can correct a wide range of nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. Dry eye is not an uncommon problem after Lasik and an estimated 20% of patients having the procedure suffer some temporary period with it.

While Blepharoplasty and Lasik can be done before or after each other, there should be a sufficient time period between them. If blepharoplasty has been done first, one should wait until their eyelids are completely healed and that any symptoms of dry eye are completely resolved or do not exist. Usually this should be at least a three month waiting period. It will also depend on what type of blepharoplasty has been performed. The issue is really the lower blepharoplasty. ‘Low-risk’ blepharoplasties include those done through a transconjunctival approach (inside the eyelid with no external skin excision) and pinch and peel techniques where minimal lower eyelid skin is removed.

If Lasik is initially performed, one should wait at least 6 months (if not longer) before undergoing a blepharoplasty. This time is need to ensure that the cornea has healed properly and to protect it from any stress from potential dryness. One’s ophthalmologist should be consulted  to get clearance for a blepharoplasty procedure.    

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from 12:00 - 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of periorbital rejuvenation was discussed. Blepharoplasty (eyelid tucks) now rate as the number one facial plastic surgery performed, exceeding facelifts, rhinoplasties, and chin augmentation. Becuase the eyes are of great social significance, most people feel that they are their most important facial feature. The eye area is the first region of the face which shows aging. Rejuvenation of the eyelids and brows can make a big difference on one’s appearance. Topics discussed with listener questions included blepharoplasty and its many variations for the upper and lower eyelids, browlifts, botox, injectable fillers, orbital implants, micropigmentation (permanent eyeliner), eyelash extensions, and Latisse eyelash growth stimulant.

Free plastic surgery consultation with Dr. Barry Eppley can be arranged by calling his Clarian North office in Carmel Indiana at 317-814-4100 or his Clarian West office in Avon Indiana at 317-217-2200.

Aging around the eye area is one of the first and often most significant signs of facial aging. The areas around the eye that change are the brow and both upper and lower eyelids. All the above sag due to not only loose skin but redundant (extra) skin as well. Most patients have a clear idea of these issues when it comes to the upper eyelid. They can clearly see skin hanging down onto their lashes and loss of the youthful supratarsal crease or fold that previously existed between the brows and the eyelashes.

Correction of the aging upper eyelid, known as upper blepharoplasty, is one of the simplest and most successful of all facial plastic surgery procedures. While it does cause some temporary bruising and swelling, the removal of a strip of the extra eyelid skin helps create an immediate change. The upper eyelid is tightened and the supratarsal fold is immediately restored.

 One of the potential concerns that some patients may have about the procedure is the risk of visible or poor scarring. The good news is that is one issue which is a rare problem. The scarring is so good in this area, and the scar is always hidden when you are awake (with the eye open, the upper eyelid crease rolls back inward), that this is really a non-issue most of the time.

 There are several reasons for the almost always good scarring which occurs on the upper eyelid. First, the upper eyelid has the thinnest skin on the entire body. The thinner the skin (with less dermis), the less tissue there is to produce scarring. Scar formation comes from the skin’s dermis which is paper-thin. Quite frankly, the excellent eyelid scars we see is as much the result of its thin skin as it is surgical technique. Secondly, the scar line is sufficiently above the lashline of the upper eyelid that it is completely covered when one’s eyes are open. To find an upper eyelid scar, you would have to ask the patient to close their eyes and then look carefully up close. Lastly, most poor scarring comes from wounds that are closed under significant tension. As the eyelids spent a significant part of their time being open, the incision closure or scar line is not under much stretch or tension.

In my Indianapolis plastic surgery practice, I have observed that the upper blepharoplasty is a very effective and simple procedure to go through. Most patients report virtually no pain, no matter how it looks to the viewer. Scarring is a very rare issue with blepharoplasty or eyelid surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

One of the most popular and successful facial plastic surgery procedures is blepharoplasty or eyelid tuck surgery. As it is for most the earliest sign of facial aging  is around the eyes.  And as the eyes are seen by all (every human conversation involves a fair amount of time looking into the other person’s eyes.), it is no wonder that how we look is highly influenced by the appearance of our eyes.  This is why I always blepharoplasty a great value based on how much it can change one’s appearance…and other people’s perception of you.

Despite the success and relative simplicity of blepharoplasty surgery (compared to other facial procedures), there remain some basic misconceptions about it. Despite how one may look after eyelid surgery, there is a remarkable paucity of any significant pain.  The eyelids are very thin tissues with skin and a little muscle, but nothing that creates a lot of pain with surgical manipulation. In essence, you look bad but you don’t feel bad. As a result, recovery after blepharoplasty is mainly about how you look and not really about how you feel. It takes about a week or so until one really feels good again about going out in public.

 
Blepharoplasty will not necessarily make you look like you have had a beating. Recovery after eyelid surgery, in terms of the swelling and bruising that occurs, can be influenced by what one does before and after the procedure. Stop any medication that can promote bleeding, such as aspirin and non-steroidal anti-inflammatory drugs, two weeks before surgery. I highly endorse taking Arnica Montana tablets (a homeopathic supplement) beginning one week before and one week after surgery. This will help to prevent some of the bruising around the eyes that will occur as well as help what does appear clear faster. On the first postoperative night, keeping your head above your heart and ice the eye area (frozen vegetables are easiest) are really beneficial. All of these together can make it possible to be publically presentable and relatively ‘non-surgical’ in appearance a week after surgery.

Contrary to the perception of some, blepharoplasty will not usually change the way you look. We have seen photos of famous people who look different (and sometimes worse) after their procedures. This is a function of overdoing the operation which can definitely cause a change in the orbital and eye area. Too much skin removed or blepharoplasties combined with an aggressive browlift can make for an overdone or unnatural look. This is a result of how the procedures were performed, not just because they were performed. While everyone wants the best result and wants it to last a long time, no one wants to look unusual along the way.

Despite the really significant improvements that eyelid surgery can make, the results are not permanent. And as stated before, trying to make them last forever will only result in an undesired outcome. Like all anti-aging facial surgery, the operation treats the symptoms and not the underlying problem. Expect blepharoplasty results to last five to seven years, and sometimes longer. But  a tuck-up years later will eventually be needed to maintain that refreshed look.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

With aging, some people develop not only loose skin on the lower eyelids but ‘bags’ as well. These lower eyelid bags are well recognized and are often referred to as puffiness, bulges or festoons as well. Most do not realize that these lower eyelid bags are not just swollen tissue but is a ballooning out of fat from underneath the eye.

Anatomically, our eyeball is surrounded by cushions of fat so that it can be pushed around without breaking. This fat is held in place inside the eye socket by certain types of tissue that keep in back behind the rims of the eye socket. On the lower eyelid, a wall or partition between the lashline and the lower edge of the eye socket keeps fat back under the eye. With age, this tissue or ligament gets weak and the fat moves forward and bulges out. Simplistically, this represents a hernia of the lower eyelid. The bulge or bags you see on the lower eyelid is usually herniated fat.

The traditional lower blepharoplasty or eyelid tuck deals with this protruding fat as part of the operation. Removing or cutting it out is a mainstay of this eyelid rejuvenation procedure. This is a good approach for many patients but not for all. Removing too much fat or taking fat in someone with a tendency towards a more skeletonized face can create a sunken in look later, which is not ideally helpful in making a more youthful and attractive appearance.

Recent trends in lower blepharoplasty has been towards saving, rather than removing, this protruding fat. This does make sense in that, at one time, one did look youthful with this same fat. Repositioning it back into the eye where it came from seems logical. The fat can be put back by doing a ‘hernia repair’. Push the fat back and secure it by sewing the herniated membrane down to the edge of the eye socket, recreating an effective retaining wall again.

Having performed both approaches to the lower eyelid bag repair, I find both of them effective. Sometimes the quality of the lower eyelid membrane is not very good, so I will simply do removal of the protruding fat. But when it is good, I prefer the hernia repair approach as it always seems better to preserve tissue as one ages.

An unanswered question about lower eyelid hernia repair is how it holds up long-term. Does the fat end up coming out again years later…or does the hernia repair hold up for a long time? This answer will become clearer in the next decade as many more of these are done and followed.  

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis