Explore Plastic Surgery

While the anatomy of the upper and lower eyelids is nearly identical, and the aging process which they undergo obviously similar, freshening up the eyelids is different whether you are north or south. Compared to the lower eyelid, the upper eyelid offers a ‘simpler’ procedure that, quite frankly, has fewer risks or complications.
In the lower eyelid, because it is suspended like a clothesline from one side of the eyebone to the other, too much skin removal or aggressive surgical handling, may make it pull down after surgery as it heals. This condition, known as ectropion, can cause a lot of eye irritation and tearing as the eyeball really wants the eyelid tucked up close against it. (this keeps it lubricated and allows the eyeball to be washed clean, so to speak, with each blink that we do) Even an infinitely small gap between the eyeball and the eyelid can cause this problem. In older patients, where the ‘clothesline’ is not as strong as in youth, the risk of ectropion is significant and some tightening of the tendon that attachs the eyelid to the bone is often done at the same time to prevent this potential complication.
The upper eyelid does not pose the same potential problems as the lower eyelid. There is no risk of the eyelid pulling away from the eyeball with skin removal and, as a result, much more skin can be taken. By comparison, it is usually possible to take three or four times as much skin from the upper eyelid as the lower eyelid. Difficulty with eyelid closure from too much skin removal on the upper eyelid, while possible, is rare. Since the movement of the upper eyelid is primarily responsible for most of eyelid closure (the lower eyelid is pretty passive), its continuous downward movement can also stretch out the eyelid fairly quickly should a tad too much skin be removed. The lower eyelid has no such capability.
The intricacies of upper eyelid surgery is all in the placement and design of the incisions and the cutout pattern of skin and muscle. Incisions on the upper eyelid which are placed too low may be visible, incisions placed too high may create an unnatural appearance after surgery. And, of equal importance, incision placements must be identical on both eyelids to make a good matched set.
The good news about upper blepharoplasty is that it is tremendously effective, fairly simple to undergo, and has few complications. But the real bonus is that it is virtually painless! Yes there will be some mild swelling and bruising, but with a week or two, you will have a result that will last for many years.

Dr, Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

 Like all aging processes, changes around the eyes are gradual with an onset and progression over many years. Aging changes often begin in the 30s with a little puffiness or bags on the lower eyelids and the beginning of some fine wrinkles in the crow’s feet. As it progresses into the 40s, excess skin is eventually evident in the upper and lower eyelids as well. Early eyelid aging is usually bothersome in the lower eyelids to most patients as they see the once smooth and pristine skin change. As more and more patients are interested in ‘early onset’ aging surgery so that more major surgery may not be needed later, concerns about the lower eyelids are usually voiced long before the upper eyelids.

In the younger patient who does not have a severe aging issue on the lower eyelids, a traditional more formal lower blepharoplasty (eyelid) procedure is usually not needed. A little removal of fat, tightening up a little bit of skin, and erasing some of the early wrinkles is often all that is need. This can be accomplished by a limited lower blepharoplasty or a ‘pinch and peel’ technique.

In the pinch and peel lower blepharoplasty, an extended skin-muscle flap is not raised as in the traditional lower blepharoplasty. A special instrument is used to pinch up a little excess skin underneath the eye lashes and then it is trimmed. Some lower eyelid fat can be removed from inside the lower eyelid at the same time. Finally the lower eyelid skin is peeled with a chemical solution, usually 25% or 35% TCA (trichloroacetic acid), which is perfectly safe as the skin which is being peeled has not been undermined. This combination of three ‘little’ procedures, when put together at the same time, produces a very noticeable change but without a lot of recovery. There usually is no bruising and minimal swelling. The ‘recovery’ from this procedure is more related to the pinkness from the chemical peel.

The pinch and peel lower blepharoplasty is a procedure perfectly suited to the younger patient with limited aging issues of the lower eyelid. This procedure, combined with Botox treatments in the crow’s feet area, creates a nice rejuvenative effect with very minimal recovery. I have performed this procedure in the office under local anesthesia although it is more ideal if the patient is in the operating room under some form of anesthesia. The pinch and peel lower blepharoplasty truely fits my plastic surgery motto of….match the size of the oepration to the size of the problem.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As we age not only does extra skin and fat weight down our eyelids, but the overlying brows can often contribute to the problem. As the eyebrows fall below the bony rim of the forehead, ‘extra’ skin is created and the upper eyelids get heavier. Both the eyelids and the brow areas narrow the size of the eye making it look older and more tired. While many patients have eyelid surgery for improvement, some may benefit by a combination of eyelid and browlift surgery to create an overall better result.
In understanding browlift surgery, one has to appreciate not only the position of the eyebrow but the existing length of forehead skin (from hairline to brow) and the patient’s hairline pattern and density. These are key elements that help determine which type of browlift may be best for each individual patient. Fundamentally, there are really two main types of browlifts…open and closed. Closed or endoscopic browlifts are done from back in the scalp and uses two or four small incisions behind the hairline. Cameras are used under the skin to release the brow from underneath and entire scalp/forehead/brow unit is then shifted up and back. In the endoscopic browlift, the forehead usually gets longer and the frontal hairline moves back a bit. Also, if there is a lot of muscle action between the eyebrows, the endoscopic approach is more limited in how much can be removed. As a result, the endoscopic browlift in my hands is very good for those patients that have a short or average forehead length, do not have too much muscle action and deep forehead wrinkles, and whose brow only needs to be lifted a little. Open browlifts are done with an incision and resultant scar either at the frontal hairline or several inches behind it. When the open browlift is done with the scar back in the scalp, the patient with a high forehead has the same problem as the endoscopic browlift. When the incision is placed at the frontal hairline, this is a better choice as the hairline stays put or can even be moved forward or lower. Either scalp or hairline browlifts are better at removing overactive muscle as more muscle can be removed with wide open access under direct vision. (you can remove more when you can see it better)
While some browlifts are done alone, this is unusual as extra eyelid is often present if the brows are low in many patients. Conversely, it is much more common to have eyelid surgery (blepharoplasty) without browlifting. The combination of eyelid tucks and browlifting can make a dramatic difference in how one’s eyes look and the overall facial appearance and impression that it creates. The aesthetic key to browlifting is to not overdo it. No patient wants to have a ‘deer in the headlights’ look. For these reasons, it is important to carefully review beforehand with your plastic surgeon in front of a mirror what amount of browlifting you consider acceptabel and whether it adds enough to the results to justify the effort.
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 commonly performed facial aging procedures is that of the blepharoplasty or eyelid surgery. While it could be most common because there are four eyelids (and only one nose for example), it is frequently performed for reasons. It is the earliest sign of facial aging…and it often bothers patients the most because aging eyes are seen by all and make an impression (usually wrong) of being tired or worn out. Every conversation that you have ever had, you spend most of your time (or you should) looking into the other person’s eyes. Tired eyes are seen by all!
Of all the facial aging procedures, blepharoplasty (eyelid surgery or eyelid tucks) often makes the greatest difference in your appearance because of their social awareness. Removing a little excess skin and fat can really clean up your eyes and make you look less tired and more vibrant. This is why I always call blepharoplasty the best value of all the facial aging procedures. It causes the greatest positive change in your appearance.
The interesting thing about blepharoplasty is that is painless to go through for most patients. Yes, there is some noticeable swelling and bruising around the eyes but remarkably, there is usually no pain. You look bad but you don’t feel bad. Recovery from blepharoplasty is what I call social recovery. It is about when you will feel comfortable going back into public. Some patients don’t care what others think and they are back in circulation within 3 to 5 days. Most patients do care, however, so their full return to the public eye may be closer to 7 to 10 days.
Blepharoplasty is one plastic surgery where what you do before and after the procedure can make a big difference in the amount of bruising and swelling that occurs. Stopping any aspirin and non-steroidal medications 3 weeks before surgery is the first step. Taking arnica tablets beginning one week before and after surgery is the next step. For the first 24 hours after surgery, keeping your head up and ice on the eyes is tremendously beneficial. I also place an Actipatch Eye Recovery mask immediately after surgery and onto this is where you place the ice. ActiPatch emits pulsed electromagnetic waves which help reduce swelling on the traumatized eyelids. After the first 24 hours, keep your head elevated and only use a very light amount of eye antibiotic ointment on your eyelid incisions. (this keeps the sutures soft so that they are easier to remove)
In 10 - 14 days, you will look ‘non-operated’, even though there is still some small amount of swelling and perhaps some line of bruising along the lower eyelid. By 3 weeks after surgery, you will be able to enjoy the full benefits of your blepharoplasty surgery! Everyone will notice how much more refreshed you look…even though most will never figure that it was due to eyelid surgery. (unless you told them!)

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

Eyelid surgery, known as blepharoplasty, is one of the most common aging facial surgeries. This is not only because every person has four eyelids (4 surgeries per patient) but because it is often the first plastic surgery procedure (not an office-based procedure such as Botox) one may go through to deal with the effects of aging. Because the eyes are seen by everyone (every human conversation is based on heavy eye contact), we are all too aware of when we appear tired even if we aren’t. The eyes may be the window to the soul but they are also the shades to the eyeball whbich do weather with age.
Aging of the eyelids is a result of three things; 1) The constant muscle movement around the eye causes the skin to wrinkle and create folds (lower eyelid) and hooding (upper eyelid), 2) eyelid skin starts to sag due to gravity, and 3) fat starts to protrude out from under the eye (lower eyelid bags) much like a hernia. All three aging conditions cause the eyelids to look heavy, saggy and swollen creating a very tired appearance. The eyelids can be made to look worse if one’s brow also starts to sag, making the skin on the upper eyelid look even worse.
Surgical correction of these aging eyelid problems is to remove the ‘extra’ skin’, remove or push back the herniated fat (lower eyelid), and sometimes even tighten the corners of the eye. On the upper eyelid, a large amount of skin can be removed leaving a very fine scar along the natural upper eyelid crease. Sometimes fat is removed in the upper eyelid but it is not as big of a problem as it is in the lower eyelid. A surprising large amount of skin can be removed in the upper eyelid without causing any problems with eyelid closure. In the lower eyelid, however, the reverse is true. Managing the herniated fat is a very important part of lower eyelid surgery. Whether the fat that protrudes is removed or, in a newer technique, tucked back up under the eye like a hernia repair, getting rid of excess lower eyelid fat is key to a good result for most patients. Removal of skin in the lower eyelid, however, must be done very carefully and much less can be removed than one would think. If just a little too much is removed, the risk of the lower eyelid pulling down after surgery is a real possibility. For this reason, particularly in the older patient, the lower eyelid which is often loose anyway is tightened like a clothesline at the side of the eyelid where it attaches to the bone.
When all four eyelids are done at the same time (which is most common), the overall effect can be quite dramatic. And since everyone looks at our eyes in conversation, the more youthful and refreshed appearance is appreciated by all even though most do not know it is from plastic 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

While men still make up a relatively small minority of patients having plastic surgery and office-bsed cosmetic procedures (< 20%), those numbers have been steadily increasing since 2000. The top male cosmetic procedures in my experience include liposuction, rhinoplasty, gynecomastia reduction, and blepharoplasty.
It is no surprise that liposuction remains the top procedure for men given the large potential for fat collections in any one individual and that it can be done in both yong and old alike. Unlike women, however, most male liposuction is relegated to the abdomen, flank, and neck areas. Even in relatively lean individuals, flank fat collections are common as one ages. Today’s liposuction techniques have been refined to include etching procedures for those leaner males who want an easy way to the ’six-pack’ look.
Male rhinoplasty has been a mainstay for many years and remains a popular procedure for the teenage and young adult male. It is far less commonly performed in the older male over 40 who have come to accept their nose, no matter how disproportionate it is to other facial features, and would feel very ‘abnormal’ if it were changed at this point in their life. Rhinoplasty may frequently be performed with chin augmentation if it will improve their facial profile over a rhinoplasty alone.
Gynecomastia reduction is, in my opinion, the one male plastic surgery procedure that is on the rise. Whether it be a small protrusion of the nipple in a teenager, to a more traditional gynecomastia in adolescents, to a droopy and deflated appearance in the middle-aged male, improvement in the mae chest is now quite common.Liposuction, nipple lifting and reduction, and pectoral implants are potential methods for male chest enhancement. Refined liposuction techniques, known as etching, provides better definition to the pectoral outlines which can be combined with any of the other chest contouring procedures.
Eyelid surgery (blepharoplasty) in the male remains a common procedure. Most men wait until their eyelid problems are more severe than many women as some aging around the eyes is more accepted in men. There still remains the senior male who only has his upper eyelids done due to visual field obstruction.
Men increasingly are joining the Botox and Lipodissolve injection therapy ranks as well as having other traditional (e.g., facelift) and more exotic forms (e.g., pectoral or calf implants) of plastic 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

EYELID SURGERY – Best Facial Rejuvenation Value for most Patients

Although eyelid surgery (blepharoplasty) treats only a small area of the face, it has a dramatic impact on facial appearance. Dollar for dollar, blepharoplasty surgery has the best value of almost any facial plastic surgery due to the way we humans interact, eye to eye contact. Everything about our eyes is seen by others. The eyes do create a perception of how we look and feel to others….and there is very little we can do to hide their appearance. The eyes show age more than any other body part due to smiling, squinting, frowning, sun damage , and heredity.

As we age, we lose the crisp upper eyelid crease that conveys an open, welcoming appearance. As the eyelid skin loses its elasticity, the eyelid begins to fall, eventually even resting on the lashes. With the excess droopy skin, some fat is also lost creating a deflated appearance in some. Upper eyelid surgery helps restore a natural, youthful appearance by removing skin through an incision in the eyelid crease. In some cases, fat may also be removed or redistributed. Since the incision is carefully placed, it is practically undetectable once healed.

The lower eyelids are one of the first areas of the face to show age-related changes. Loose skin and muscle create a droopy appearance and excess fat becomes more prominent. An incision is hidden either inside the eyelid (if fat only needs to be removed) or just below the lashline. (when all tissues need to be treated) The muscle, tendon, and skin are reshaped and resuspended and fat is either removed, tucked back in, or repositioned over the bone, dependent upon the patient’s needs. In some patients, chemical peels or laser resurfacing can be done at the same time (only when incisions on the inside of the eyelid) to improve wrinkles and loose skin on the lower eyelid and crow’s feet area.

Many patients say the most surprising thing about eyelid surgery is the lack of pain during recovery. Most eyelid recovery is ’social’, meaning you look swollen and bruised but feel fine.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis