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Posts Tagged ‘blepharoplasty’

Case Study – Double Hole Lateral Canthoplasty for Ectropion Repair

Saturday, October 3rd, 2015

 

Background: The position of the lower eyelid against the eyeball (globe) is of critical importance. To maintain good lubrication of the globe and to prevent the eye from drying out, the lower eyelid must be tight up against it. Like a clothesline spanning between two poles, the lower eyelid must have no slack in it and be relatively taut. Unlike the upper eyelid which opens and closes, the lower eyelid is fairly still.

The position of the lower eyelid is well known to be adversely affected by surgery due to the creation of scar and loss of lateral support. This can create a downward pulling of the lower eyelid known as ectropion. Lower eyelid ectropion deformities cause a downward and outward roll of the eyelid making it lose contact with the eyeball. When this happens the eye develops dryness ad irrigation due to exposure. Also the natural gutter effect of the eyelid position is ‘reversed’ and tears may run out the side of the eye as opposed to being directed towards the inner lacrimal drain. (punctum)

lateral canthoplastyCorrection of lower eyelid ectropion can be challenging and a variety of techniques exist to do it. All are based on using the lateral canthal tendon, or some remnant of it, to create outer support to the eyelid by attaching/resuspending it to the lateral orbital bony rim. Techniques differ based on whether it is attached to the inner or outer aspect of the lateral orbital rim. Accompanying techniques with the lateral canthoplasty are also often used including cheek lifts and in more extreme cases even skin and mucosal grafting.

Case Study: This 50 year old female developed ectropion of the right eye from prior lower blepharoplasty and other procedures. She has persistent dryness and itchiness of the eye and chronic tearing. She had failed two prior lower eyelid resuspension/elevation procedures.

Under general anesthesia she had a double hole lateral canthoplasty procedure. Above the desired point where the outer corner of the eye was desired to be, two transosseous burr holes were placed. A suture was passed from the outside in, attached to the lateral canthal tendon and then brought back out the other bone hole. The suture was then tied down pulling the outer corner of the eye upward and inside the lateral orbital rim.. Resuspension of the orbicularis muscle was done to complete her ectropion repair.

Lower Eyelid Ectropion Repair front view Dr Barry Eppley IndianapolisLower Ectropion Repair oblique view Dr Barry Eppley IndianapolisLower Eyelid Ectropion Repair side view Dr Barry Eppley IndianapolisAt six months after surgery, her ectropion remained repaired with complete resolution of all of her eye symptoms.

The double hole lateral canthoplasty procedure is as very effective procedure that solves the attachment problem. Besides a point of fixation one of its other best attributes is that it brings the attachment of the tendon inside the lateral orbital rim where it naturally is located. In moderate to severe ectropion this is my go to technique.

Highlights:

1) Lower eyelid retraction due to scar contracture is known as ectropion.

2) Manipulation of the lateral canthal tendon is a key element in lower eyelid ectropion repair.

3) Using bone holes place in the lateral orbital rim, a place of firm fixation for lateral canthal tendon repositioning is assured.

Dr. Barry Eppley

Indianapolis, Indiana

Cooling Gel Masks After Blepharoplasty (Eyelid) Surgery

Friday, January 30th, 2015

 

The eyelids are very thin tissues that are well known to swell and bruise easily. Because one’s eyes are so visible, every upper eyelid surgery patient would like their bruising and swelling to go away as soon as possible. For this reason, it is standard practice to do several after surgery strategies including cold compresses, head elevation and the oral intake of Arnica. While no one after surgery strategy is known to be universally effective, it is commonly believed that cooling or cold would be the most important.

Eye Masks for Blepharoplasty Surgery Dr Barry Eppley IndianapolisThe use of eye cooling has led to a wide variety of gel compresses for the eyes for blepharoplasty patients. Most are composed of a gel material that retains cold for a period of time after being removed from the refrigerator or freezer. The historic cooling regime was frozen vegetables (such as peas or corn) but gel pads are lighter and easier to use

In the February 2015 issue of the journal Plastic and Reconstructive Surgery, a paper entitled ‘The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty: A Randomized, Controlled, Observer-Blinded Evaluation Study’ was published. In 38 consecutive patients who had upper blepharoplasties performed, one side was cooled with an ice pack and the other eyelid was left uncooled. Evaluations were done on the degree of pain, edema, erythema, and occurrence of hematoma one hour, one day, one week, and two months after surgery. Light photography was used one week after surgery to determine the degree of bruising.

The results showed showed no difference in pain between the cooled and uncooled eyelids on the day of surgery. Pain in the cooled eyelids was significantly lower one day after surgery. No differences were seen in swelling, bruising or occurrence of hematoma between the cooled and uncooled eyelids at any time point in the study. The authors conclude that because the majority of patients had no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty is not necessary.

Upper Blepharoplasty Indianapolis Dr Barry EppleyThis study casts doubt on a very long-held and logical treatment after upper blepharoplasty surgery. It just seems so logical that cooling/cold therapy would be beneficial that it is hard to believe that it isn’t. Despite what this study shows I doubt few plastic surgeons will abandon it. Particularly since it is a very low cost treatment that at the least has psychological value for the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Natural Blepharoplasty Results

Saturday, September 13th, 2014

 

Background: Aging is an inevitable consequence of living and its most recognizable effects are on the face. The first place affected on the face by aging is around and on the eyes. The near constant motion of the eyelids and its thin overlying skin are a set up for wrinkles, loose skin and bags and puffiness caused by extruding fat from under the eye. Given that the eyes more than any other facial feature reveal one’s ‘character’ and are a reported ‘mirror of the soul’,  aging changes of them reflect what most would not want others to see.

Beginning in the late 30s and early 40s, the signs of periorbital (around the eye) aging begins. Botox and other neuromuscular modulator injections do a good job of slowing down this process by decreasing the formation of crow’s feet, but it can not prevent the development of loose skin on the eyelids and the herniation of fat on the lower eyelids. These aging eye effects can be quite variable with some people more genetically prone to developing them sooner and more extensively than others. But inevitably everyone will have more of these eye aging signs than they want.

Eyelid (blepharoplasty) surgery is well known and has been around for almost a century in various forms and techniques. Most patient’s biggest fear about blepharoplasty surgery is that they will look like a different person or will look unusual or very obvious that they have had plastic surgery. They can even point to numerous celebrity examples who show exactly what they fear. How is such a result avoided? Will everyone look like they have had surgery? After all, the eyes are seen by everyone and won’t all changes be seen?

Case Study: This 58 year-old female was tired of her tired looking eyes. She wanted to look less fatigued but was afraid that she might look ‘surgical’. She had a large amount of upper eyelid skin with significant hooding. (skin laying on or near the eyelashes) Her lower eyelids show multiple redundant skin rolls and bags. Here eyebrows were not especially ptotic or has any significant sagging.

Upper and Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, upper blepharoplasties was performed removing 12mms of skin centrally and sparing the underlying orbicularis muscle. Medial fat pockets were also removed.  Lower blepharoplasties were done using a skin-muscle flap technique. A three pocket fat removal, 5mms of tapered skin removal at the lateral canthus and a lateral orbicularis muscle suspension was done.

Upper and Lower Blepharoplasty result oblique view Dr Barry Eppley IndianapolisHer recovery took about ten days to look ‘non-surgical’ and three weeks to fairly normal. Many blepharoplasties will look a little tight for a period of time but by six weeks after surgery this has usually passed. Her results at six months show significant improvement but a result that retained her natural look.

An overdone or unnatural result from periorbital rejuvenation surgery is caused by numerous factors including aggressive tissue removal and an over elevated or exaggerated browlift. It is the browlift that is often at fault for a perceived abnormal eye look after plastic surgery. The effects of aggressive tissue removal, particularly that of fat, are often not seen until much later when the eye may look skeletonized or more hollow. The key to a natural blepharoplasty result is to not try and work out every excess bit of tissue or get rid of all wrinkles. While patients want the best result possible, they also d not want an over operated look either.

Case Highlights:

1) Aging of the eyes is the first facial area affected and is commonly treated by blepharoplasty surgery.

2) Four lid blepharoplasty (upper and lower eyelid surgery) is the most effective method of partially reversing the effects of aging on the eyes.

3) Natural blepharoplasty results occur when the amount of skin and fat removal is not overdone and lid function is not affected.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Eyelid Lifts (Blepharoplasty) in the Older Male

Monday, February 10th, 2014

 

Background: Aging begins around the eyes early in life and continues unabated up through one’s senior years. This periorbital aging is manifested by the creation of extra eyelid skin which is caused by the stretching of the thin eyelid skin due to frequent movement. As the redundant eyelid skin becomes excessive it weighs down the upper eyelid. Known as hooding it essentially creates folds of skin that lie on the eyelashes pushing the lid margin downward.

Older Male Eyelid hooding Dr Barry Eppley IndianapolisBetween of the weight of the eyelid skin and its folding over the lashline, an obstruction of the upper visual field results. This is often not even noticed by the individual because the visual field loss is so gradual. Getting lower and lower over the years, the loss of incoming light from a gradually smaller visual field is just credited to a naturally weakening vision with age.

With this upper eyelid hooding and visual field obstruction comes accompanying forehead wrinkles. While some of these horizontal forehead wrinkles are due to lifelong facial expressions, some of them are due to a constant holding of the eyebrows upward to lift some of the skin off of the eyelids, making one able to see better. Such browlifting is often inadvertent and unnoticed by the individual.

Case Study: This 76 year-old male wanted to improve the appearance of his eyes. He said he was frequently told he looked like he was squinting all the time. He felt he looked old and that some eyelid surgery may be beneficial. He wore glasses and had no symptoms of dry eyes.

Older Male Eyelid Lift Results front view Dr Barry Eppley IndianapolisUnder general anesthesia, a large excisional skin-only upper blepharoplasty was done. No orbicularis muscle was taken. The lower eyelids were treated by the raising of skin-muscle flaps, excision of protruding fat pockets, lateral canthopexies, conservative skin removal and orbicularis muscle suspension suturing.

Older Male Eyelid Lift results oblique view Dr Barry EppleyAfter surgery he had excellent improvement in appearance of both upper and lower eyelids. He felt he could ‘see’ better and that there was more light wherever he went. He did have a minor complication of some lower eyelid irritation and lower eyelid sag at the corners which took about two months after surgery to completely resolve.

Older Male Eyelid Lift results side view Dr Barry Eppley IndianapolisBlepharoplasty (eyelid lifts) in older patients can offer great improvement in appearance and even function. But the lower eyelid must be handled very carefully as it is at high risk for after surgery lid malpositioning. (ectropion) Even when handled well (limited skin removal, tendon tighening and muscle suspension), many older patients will experience  temporary period of lower eyelid lag symptoms.

Case Highlights:

1) Advanced aging around the eyes creates severe upper eyelid hooding, upper visual field obstruction and redundant lower eyelid skin with sagging.

2) When the amount of excessive eyelid skin is considerable, the eyes can look small and one can appear to be continuously ‘squinting’.

3) Upper and lower eyelid lifts (blepharoplasties) can create considerable improvement, opening up the eyes and making them feel less heavy.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonial: Upper Blepharoplasty (Eyelid Lift) Surgery

Tuesday, December 24th, 2013

 

Blepharoplasty (Upper Eyelid Lift)

Upper Blepharoplasty Eyelid Lift Dr Barry Eppley Indianapolis‘I never thought I would ever have plastic surgery for any cosmetic reason. I had worn glasses for many years but when I retired at age 65 I started to have more trouble seeing because of what was happening around my eyes. Everything just seemed a little more dim and I just can’t see as well. After seeing Dr. Eppley I realized that the skin on my forehead, brow and around the eyes had loosened and fallen to partially obstruct my vision. Trying to strain to see even gave me some issues with headaches. Having having my eyelid surgery by Dr. Eppley I could not only see better but I actually like the cosmetic improvements as well. I was not initially concerned with any cosmetic enhancement but I now see that as a pleasant bonus! Thank you Dr. Eppley for your surgical expertise and kind encouragement to go through the procedure. You were right, it was not as bad as I thought it would be.’

Bill

Carmel, Indiana

Commentary

There is probably no plastic surgery procedure that is more satisfying to a patient than an upper blepharoplasty procedure, also known as an eyelid tuck or an eyelid lift. This is so not only because of its aesthetic effect but because of the removal of the heavy feeling on the upper eyelid and an improvement in one’s visual field if the excessive skin is significant enough. It is its combined aesthetic and functional benefits that makes the upper blepharoplasty a winning procedure for those that undergo it. It is also a fairly ‘simple’ plastic surgery procedure to undergo with minimal pain afterwards albeit with some swelling and light bruising that takes about 10 days to go away completely.

Dr. Barry Eppley

Indianapolis, Indiana

Five Things You Didn’t Know About Eyelid Lift (Blepharoplasty) Surgery

Thursday, October 31st, 2013

 

Eyelid lifts or tucks are one of the most successful and commonly performed of all the anti-aging or facial rejuvenation procedures. While the number of eyelids outnumber any other facial structure, the number of eyelid surgeries performed is also due to the early onset of bothersome and visible aging which takes its earliest effect on the eyelids with the deveopment of extra skin, herniated fat and wrinkles.

While cosmetic eyelid surgery is common, there are numerous aspects of it that are not know or frequently misunderstood. Here are five things about blepharoplasty you may not know.

The Formal Name for Eyelid Surgery is Blepharoplasty. Coming from the Greek words, Blepheron (eyelid) and Plassein (to form), reshaping surgery of the eyelids is formally known as a blepharoplasty. Many times the procedure is simply known as having a ‘bleph’.

Upper and Lower Blepharoplasty Surgery Is Very Different. Upper eyelid surgery is the ‘simpler’ form of blepharoplasty with lower risks. It is largely a skin removal surgery and there are no concerns about the support or suspension of the eyelid which is largely responsible for the blink reflex and eyelid closure. Conversely, lower eyelid surgery involves removing tissue and tightening a structure that is suspended across the eyeball and largely does not move but must remain tight up against the eyeball. Thus risks of lower blepharoplasty with skin and fat removal are disruption of the lid position (pulling away from the eyeball) and prevention of this potential problem must be factored into the surgical technique used.

Laser Blepharoplasty Is Not Better. Laser blepharoplasty is simply using a laser beam to cut the eyelid skin or remove orbital fat instead of a ‘cold steel’ scalpel. Because of its high tech nature and the magical properties that have been given to anything associated with a laser, it is assumed that a laser blepharoplasty heals faster and gives a better result with less scarring than traditionally performed eyelid surgery. The reality, however, is exactly the opposite. The burn injury sustained by the skin edges from a laser actually increases the risk of visible scarring and heals slower…at the least it does not offer a better result.

Mini-Blepharoplasties Do Exist. Like all facial rejuvenation procedures, the scope of the operation should be based on the extent of the problem. For younger patients, the extent of the blepharoplasty surgery needs to be less. Such mini-blephs are known as pinch blepharoplasties where just a ‘pinch’ of skin is removed. This is often done using a special instrument to remove the smaller amount of eyelid skin. These pinch blepharoplasties are really helped by the concomitant use of skin resurfacing and Botox injections to improve the extent of their results.

Non-Surgical Blepharoplasty Can Offer Some Improvements. There are a variety of non-surgical treatment options for the periorbital region. Botox injections, laser resurfacing, chemical peels, injectable fillers and fat injections can be used to lessen wrinkles around the eyes, improve its skin texture as well as volume enhancement. While effective, such treatments are not technically a true blepharoplasty and certainly don’t create the same effect. While calling these treatments non-surgical is certainly appropriate, it is also important to realize they are adjunctive treatments that can benefit a surgical blepharoplasty or can be used alone.

Dr. Barry Eppley

Indianapolis, Indiana

Blepharoplasty with Fat Injections

Tuesday, July 2nd, 2013

 

The most common procedure for rejuvenation of the periorbital area is surgical blepharoplasty. Removing skin from the upper and lower eyelids as well as fat mainly from the lower eyelid can make the eyes appear refreshed and more open. But tissue excess is not the exclusive problem that occurs around the eyes as they age. Volume loss of the eyelids as well as in the adjoining cheeks is now known to be a significant part of the aging process that occurs around the eyes.

Changes such as the sinking in of the eyeball, the development of a prominent groove between the lower eyelid and the cheek and cheek sagging and flatness are the most common signs seen due to volume loss. No manuever in blepharoplasty surgery can effectively restore volume other than transposition of lower eyelid fat and this is merely a ‘robbing Peter to pay Paul’ approach.

In the March 2013 issue of the Aesthetic Surgery Journal, a paper was published on this topic entitled ‘Augmentation Blepharoplasty –  A Review of 500 Consecutive Patients’. In this report, the authors present their outcome experience in 500 patients that had fat injections around the eye at the time of blepharoplasty surgery over a three year period. Their fat injection technique was small droplet placement with small blunt cannula. Their evaluations show a natural-looking and long-lasting improvement of the treated areas by subjective evaluation. The reinflation of the midface, better blending of the lower eyelid into the cheek (orbitomalar groove effacement) and correction of hollowing of the eyelids were the major benefits of the fat injections. No complications were reported other than some expected bruising and swelling.

One of the great benefits to fat injections is their safety and lack of any significant complications as long as they are no overdone. (overfilled) This would be easy to do around the eyes because relatively small volumes are needed. Selectively adding fat injections during blepharoplasty surgery can help overcome some of the shortcomings of traditional tissue resection. They may have their greatest value in the cheek and lower-lid cheek transition as a much simpler and safer replacement to some of the midface lifting techniques which are well known to a significant incidence of lower lid malposition. (ectropion)

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Correction of Puffy Eyes in Women

Sunday, June 9th, 2013

Background:  The eyes are very good indicators of how the face is aging being the first to show its signs. Aging first starts around the eyes and continues to progress as one gets older. The frequent movement of the eyelids and the thinness of the skin makes for an often early onset of wrinkles. Eventually the thin eyelid skin develops excess skin or skin rolls that can hang down onto the upper eyelid lashes and below the lower eyelid lash line.

The one tissue component of eyelid aging that can be overlooked, literally, is the underlying fat. This is particularly relevant in the lower eyelid where various fat pockets can come forward as herniations through the orbital septum. This herniated eyeball fat presents as puffiness or bags of the lower eyelids which is often a bigger aging problem than that of excess skin. Lower eyelid fat herniation can become quite severe in the patient who has a natural proclivity for this anatomic derangement as evidenced by having puffy lower eyes even when they were young.

Correction of the puffy eyes requires blepharoplasty or eyelid surgery. The term blepharoplasty represents a spectrum of progressively invasive eyelid techniques from the skin down to the fat and canthal tendons. In its fullest expression, which is needed in the more advanced aging patient, blepharoplasty surgery must encompass skin and fat removal and orbicularis muscle suspension and lateral canthal tightening.

One of the concerns of women undergoing blepharoplasty is that they will have an overly tightened and unnatural look. They can point to numerous celebrities that have that ‘look’. Conversely plastic surgeons are focused on not removing too much tissue, particularly of the lower eyelid, and risk developing postoperative lower eyelid sag. (ectropion)

Case Study: This 62 year-old female wanted to improve her tired look that she had had much of her life. Even as a much younger woman she had always had lower eyelid ‘bags’. As she had gotten older the bags became bigger and the loose skin around the eyes became greater. She had put off blepharoplasty surgery until now because of a lifelong fear of anesthesia and not wanting to look like she had had ‘plastic surgery’.

Under general anesthesia, she underwent upper and lower blepharoplasties. A fair amount of skin was removed from the upper eyelids with a small strip of orbicularis muscle. More skin was removed from the outer aspect than from the central and inner aspect of the eyelid. The lower eyelids were treated by aggressive removal of the medial, central and lateral fat pockets which had significant protrusion. Only a few millimeters of lower eyelid skin was removed with suspension of the orbicularis muscle at the lateral canthal area. All dissolveable sutures were used with the exception of the lateral canthal extensions of the upper and lower eyelid incisions.

Like every blepharoplasty patient, she developed a significant amount of swelling and some bruising of the lower eyelids. It took about two weeks before she looked non-surgical and a full three weeks until she looked perfectly normal. The redness of the eyelid incisions took six weeks to become unnoticeable. It was a full two months until her eyelids looked really naturally relaxed, an observation that probably only a plastic surgeon would observe.

Removal of lower eyelid lid is a key component of the puffy eye patient. Large amounts of herniated lower eyelid fat seen during surgery usually represents a fat herniation problem that started long before significant aging began. While concerns abound about too much lower eyelid fat removal in contemporary blepharoplasty surgery, the extremely puffy lower eyelid requires a more aggressive approach to obtain a better contoured lower eyelid shape.

Case Highlights:

1) Aging of the face always affects the eyes initially and becomes progressively worse with time. Puffy eyes are the result of excessive and protruding fat of the eyelids, particularly that of the lower eyelid.

2) The puffy lower eyelid becomes very significant when the patient naturally as a congenital herniation of lower eyelid fat since they were young.

3) Successful correction of the puffy eyes requires substantial lower eyelid fat removal and skin from both the upper and lower eyelids.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Lower Eyelid Bags

Saturday, June 8th, 2013

 

Undereye bags are a well recognized facial entity. Everybody has seen lots of people who have them and eventually many people will see them on themselves as they age. For some few people they will have them even when they are quite young before they have any significant aging. Lower eyelid bags in the aging face are made up of several tissue components including loose skin and muscle as well as protruding fat. In the younger patient who just has bags or puffy lower eyelids the issue is one just of protruding fat. But in either the young or old, where does the fat in lower eyelid bags come from and why is it there? This is known as herniated lower eyelid fat that wss originally under the eyeball. Fat under the eye acts as a cushion, which is why you can push back on your eye and it gives in a little. The fat around and under the eye cushions it from impact. This fat is normally contained to the under the eyeball due to a ligament in the lower eyelid known as the septum. But as we age this ligament weakens, allowing the fat to come spilling out creating the puffiness or bags.  In the younger patient with bags, this ligament is naturally or congenitally weak allowing the fat to prematurely bulge out. In essence bulging lower eyelid fat is the result of a weakness or hernia in the lower eyelid ligaments. This heriated lower eyelid fat has three distinct pockets of fat known as temporal,central and medial or nasal fat pockets. Interestingly, while fat is well known to have a yellow color the nasal fat pocket is white and no one knows why.  Herniated lower eyelid fat can be removed exclusively in a transconjunctival lower blepharoplasty or as part of a more complete open lower blepharoplasty.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Rejuvenative Effects of Blepharoplasty (Eyelid) Surgery

Tuesday, February 5th, 2013

Background: The constant movement of the eyelids and their thin skin makes for early and inevitable signs of aging. The eyelids almost always shows the signs of age first. It is also easily observed since the eyes are the fundamental focal point of human conversation. The signs of periorbital aging are always associated with such patient complaints as ‘I look tired’, ‘I look older than I feel’ and ‘My eyes feel heavy’.

Despite the relatively small amount of upper eyelid skin that naturally exists, it is incredible how much excessive and loose skin can be created. Often it appears that there is at least twice as much skin present than would normally exist in the upper eyelid as one ages. The amount of fat that comes sticking out (herniated) from below the eyeball to make up the lower eyelid bags can be equally impressive.

Case Study: This 55 year-old female wanted to improve the appearance of her tired and aging eyes. She had so much upper eyelid skin that it had fallen down onto her lashlines, partially obscuring her vision. Her lower eyelids had large bulging bags and wrinkled skin with numerous brown spots.

Under general anesthesia, a large amount of upper eyelid skin was removed. More skin was removed laterally (near the outer corner of the eye) than medially. (near the inner corner of the eye) On the lower eyelids, a skin-muscle flap was raised and the protruding medial, central and lateral fat pads were removed. The lower eyelid skin was conservatively trimmed of excess skin and the orbicularis muscle and skin resuspended out laterally.

Her postoperative course was typical for eyelid surgery with substantial swelling and mild bruising for the first ten days after surgery. Sutures were removed at one week after. By two weeks she looked nearly normal and by three weeks after the procedure she looked completely normal and non-surgical in appearance. Her last follow-up at three months after surgery showed a refreshed and rejuvenated periorbital appearance.

Blepharoplasty surgery has one of the highest patient satisfactions of all the rejuvenative facial plastic surgery procedures. Despite the small size of the eyelids, comparatively small amounts of skin and fat removal can make for a dramatic change in appearance. Every blepharoplasty patient’s goal is to look refreshed, maintain a natural appearance and avoid complications. This is done by not removing too much eyelid skin, particularly on the lower eyelid.

Case Highlights:

1) Aging of the eyes occurs by hooding of the upper eyelid skin and bulging of lower eyelid fat. Both eyelids develop increased wrinkles and skin rolls.

2) An upper blepharoplasty removes excess skin and recreates an upper eyelid crease and sulcus

3) A lower blepharoplasty removes or relocates herniated fat and removes a conservative amount of skin with corner of the eye tightening.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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