Explore Plastic Surgery

 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

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