How to judge a Blepharoplasty Surgeon?

Once you have decided for the blepharoplasty, the major issue is to judge the good blepharoplasty surgeon for treatment. You may hear about some people who got disappointed after blepharoplasty, because the surgery performed by non-specialty surgeon. You should go for a blepharoplasty surgeon who has good experience in blepharoplasty and performs the surgery on regular basis. Now the question is how to get such surgeon for blepharoplasty. One way to get information about blepharoplasty surgeon is the phone book. Pick the number of all surgeons and call for most specialized surgeon. But this may not be a fruitful way. The phone book will list you most practitioners having specialized in different surgery from face lift to liposuction with “blepharoplasty” among them. You need a specialized blepharoplasty surgeon who’s experience in blepharoplasty only and perform blepharoplasty surgery 3-4 times a day.

You can ask to your regular physician for a good blepharoplasty surgeon. Your family physician can give you the personal contacts of some reputed surgeons. Now you can contact them through phone and have a personal meeting with them. Don’t hesitate while asking questions to blepharoplasty surgeon, be direct with him. Don’t ask question which have answers in yes/no. Rather ask questions to blepharoplasty surgeon, how many blepharoplasty operations the surgeon does in a month on average basis. What percentage of his practice devoted to the blepharoplasty? How long the blepharoplasty takes? Ask cost of blepharoplasty and the preference for the type of blepharoplasty (lower and upper blepharoplasty). After a discussion with blepharoplasty surgeon, you can ask with some of his patients. It will give you a very good picture.

Benefits of Laser Blepharoplasty

Laser blepharoplasty is more efficient in soft tissue surgery and in some case use of laser is more effective than some standard techniques. The laser acts as three instruments when used properly, a cutting tool used for incision, cautery and a dissection device. Due to this the total operating time reduced. In laser blepharoplasty, the intraoperative is further increased near the absolute hemostasis which is often achieved when working in pre-orbital regions. Co2 laser has greatest incisional application in pre-orbital regions. The dissection with CO2 laser for eyelids in laser blepharoplasty performed on delicate vascular structures with a low risk of tissue distortion, functional impairment and hematoma formation. Laser blepharoplasty allows surgery in pre-orbital regions with low risk on vascular structures. Use of laser in some certain incisional procedures like blepharoplasty Ptosis repair and correction of eyelid retraction gives better precision.

There is an issue which is unclear whether incision procedure in laser blepharoplasty benefits the blepharoplasty surgeon, patient or both. Some study about laser blepharoplasty reported that benefit of CO2 laser over scalpel for incision includes quicker recovery time. The surgeons preferred blepharoplasty with laser due to improved intraoperative hemostasis. This has been noticed by the surgeons and patients that laser blepharoplasty reduce recovery time as well as operating time.

Laser Blepharoplasty

Laser is used by ophthalmologists for past thirty years for the treatment of diseases related to retina. Laser has been used frequently for medicine and surgery in recent years. In laser blepharoplasty, laser is used for incision and removal of skin, muscle, fat, tumors and almost any imaginable tissue. The laser incision tends to bleed less in laser blepharoplasty and thus the surgery takes less time as compare to general blepharoplasty. With laser blepharoplasty, extra fat from eyelid removed without first clamping and it also prevent bleeding. Laser blepharoplasty may eliminate slight discomfort.

The first laser used in laser blepharoplasty was neo-dymium- YAG (ND-YAG) laser in 1980. In this laser instrument, laser is transmitted through fiber optic coil with a power that can be directly applied to the skin. Laser power cuts the tissue and coagulates blood vessels. Laser blepharoplasty reduces the surgery time, but the saved time lost in the pre-surgery set-up. There was no demonstrable advantage from the laser blepharoplasty. Also there was an obvious scar on the operated side due to thermal injury.

The laser blepharoplasty then renewed in 1990s with some good features. Laser blepharoplasty was then introduced with high-energy pulsed CO2 laser. This laser devise is know by its trade name Ultra Pulse. The CO2 laser device produces pulse beam with high frequency that made skin incision with a smaller zone of thermal injury. The pulsed beam frequency and energy can be independently vary to achieve the ideal blend of cutting and coagulation of tissues. The CO2 laser in laser blepharoplasty also produces a small diameter beam approx 0.2mm which is also useful in pre-orbital region. When used properly, laser blepharoplasty could be performed quickly and thermal incision region reduced. After the healing from laser blepharoplasty, the scars become indistinguishable in appearance in very short period compare to steel wound blepharoplasty. After the satisfactory results from laser blepharoplasty, it become more popular in many clinical settings. In 1998, Er: YAG laser used to produce soft tissue incision. Unfortunately this laser was not able to produce enough hemostasis for soft tissue incision surgery.

Variations in Eyelid Ptosis Surgery

Eyelid Ptosis can also be repaired with several different procedures like muller’s muscle-conjunctival resection and Fasanella servat procedure. These procedures are less common and rarely used by surgeon. The operation is performed by the surgeon from back side of eyelid in conjunction with blepharoplasty from normal skin. These posterior procedures work well for eyelid Ptosis repair performed as an isolated approach. These less precise operations have advantage instead of direct levator tuck because once the eyelid is open it is hard to operate.
Advantage: Repair of eyelid Ptosis may give expected results of blepharoplasty surgery. If a patient suffering from both baggy eyelids and eyelid Ptosis (drooping eyelids) and only the baggy eyelids are operated then final result will not be appreciable. For expected results from blepharoplasty you have to go through with both the operations.
Disadvantage: Eyelid Ptosis surgery does not interfere with the blepharoplasty surgery, but recovery can take long time. The operation is performed on defective tissues and this is the cause for long time recovery. Re-operation rate of eyelid Ptosis surgery is higher than cosmetic blepharoplasty.

Repair of Droopy Eyelid-Eyelid Ptosis Surgery

Eyelid Ptosis is the drooping of the upper eyelid caused by muscle paralysis and weakness. Eyelid Ptosis surgery includes the elevation of drooping upper eyelid. This surgery is not related to the baggy eyelids. This surgery may be performed with blepharoplasty. The levator muscle starts in the back of eye and as it enters the eyelid turns into the aponeurosis (tendon). The thinning and tearing of the levator aponeurosis are the cause of adult-onset Ptosis. Very rare muscle diseases like myasthenia gravis cause the muscle paralysis which requires major operation.

During the eyelid Ptosis surgery, patient cooperation is required. So, local anesthesia is allowed with minimal sedation. The Ptosis surgery can be performed through upper blepharoplasty with a skin incision in the upper eyelid. During the upper blepharoplasty the levator aponeurosis is inspected by the blepharoplasty surgeon. After examination, the levator aponeurosis is tucked by the non-dissolving sutures. The blepharoplasty surgeon must be careful for smooth lift of droopy eyelid. The surgeon should have in mind to restore the normal curve of eyelid margin which becomes flattened with eyelid Ptosis. After the blepharoplasty your one upper eyelid should match with other upper eyelid with a smooth curve to the lid margin.

Instructions After Asian Blepharoplasty

# After several days of Asian blepharoplasty, some of sutures may untie or break but it is normal. There is no cause of harm until or unless your incision remains closed.

# Excess salt intake may increase swelling over eyelids, so limit the amount of salt in your food.

# Stitches from eyelids are removed in 5 to 6 days after Asian blepharoplasty surgery.

# When your surgeon remove your sutures, use antibiotic on that evening only. You should use warm compresses at least once a day after sutures are removed. Do this thing for 3 or 4 days.

# After Asian blepharoplasty you may not be able to open your eyelids fully for first three weeks. You can use artificial tear preparation during the day. It may feel comfortable with that.

# You can apply light concealer make-up on upper cheek area after 5 days. This may help you to camouflage any bruising. You can use regular eyelid cosmetics after 10 days. Application of Vitamin E oil can harm you, so do not apply it. In Asian blepharoplasty, special scar reducing creams or gels are of no use. Instead of this you can use eyelid moisturizing cream.

# After three day of Asian blepharoplasty, the improvement in your eyelids begin slowly. Most of swelling and bruising gone after 2 to 3 weeks. Although 20% of swelling remains for long period. You have to be more patient because your crease will improve day by day and may take 4 months to reach at final position.

# You can reuse your contact lens after 8- 10 days of Asian blepharoplasty.

# Initially your incision turns to red and becomes slightly bumpy and elevated. Its scar will continue to fade by the time.

# Do not expect success of Asian blepharoplasty with early recovery. There may be some imbalance between the two eyelids due their healing rate and variation in swelling. Final healing may be expected in 12 to 14 months and your eyelids will look alike.

Asian Blepharoplasty Procedure

Asian blepharoplasty is also known as double eyelid operation. The goal of Asian blepharoplasty surgery is the creation of upper eyelid crease and removal of excess skin. Sedation is kept normal during the surgery so that blepharoplasty surgeon can examine position of new crease through patient.

In Asian blepharoplasty surgery, incision is made across the upper eyelid. Skin of Asians is more reactive, for best incision scalpel is used instead of laser. A small strip of skin is excised using scissors just above the initial incision. Small strips of orbital septum and orbicularis muscle are excised. Height, shape and depth of new crease depend upon the amount of orbital fat removed. Skin and fat are removed from eyelids in a similar manner as in the normal upper blepharoplasty. Amount of tissues removed from eyelids are more conservative. Deep fixation is done for Asian blepharoplasty to create an attachment between the aponeurosis and the dermal layer of skin. Selective tissue removal and precise internal tissue rearrangement result in height and shape of the final crease. The Asian blepharoplasty is done to correct incomplete or multiple creases.

Asian Blepharoplasty/ Double Eyelid Surgery

Asian blepharoplasty is also known as double eyelid surgery and double blepharoplasty. Man and woman of Asian ethnicity seek blepharoplasty to feel better about their appearance. The enhancing of eyelid structure through Asian blepharoplasty, its better conforms aesthetics and feel happier and more confident. Nearly half of the Asians have upper eyelid crease, which makes a difference with occidental crease in its way. The Asian upper eyelid crease notably differs in height, shape and depth as compare to the occidental crease. Some Asian people are born with low/weak crease or without crease, later seek double blepharoplasty. Through Asian blepharoplasty some patients want only defined and stable platform for their upper eyelashes. Besides this some patients want removal of excess skin and fat rather than full Asian blepharoplasty.

The first Asian blepharoplasty description was published in 1800s in Japan and it is widely appreciated by Asian people. The Asian blepharoplasty has become popular in the last fifty years. Asian blepharoplasty is the most requested cosmetic surgery and reason behind this is the population on Asian people in both Asia and United States. Although Asian people undergo Asian Blepharoplasty at a younger age compare to occidentals.

Functional Blepharoplasty

Functional blepharoplasty is related to the vision of eyesight. The primary goal of functional blepharoplasty is to improve the vision of eyesight. At an older age, the eyelid skin becomes overhanging and narrows the field of eyesight vision. So, in functional blepharoplasty only the overhanging eyelid skin in removed. During functional blepharoplasty, surgeon will not remove fat pockets and deep fixation. Because this results in hollow space in eyelids and give ugly looks.

Results of functional blepharoplasty are not comparable with the full blepharoplasty surgery. Your insurance company will pay for functional blepharoplasty if it is really necessary and recommended by your blepharoplasty surgeon. Otherwise it is considered as a cosmetic surgery and no insurance company pay for that.

Advantages and Disadvantages of Upper Blepharoplasty

Advantage: Upper blepharoplasty is a proven and safe procedure to improve your appearance. Upper blepharoplasty may give a dramatic improvement depending upon the preferences of the patient. Eyes are the attractive and most focal part of the face. Such operation can be performed at a modest cost with quicker recovery. Most of the people preferred blepharoplasty than the full face lift. At a very modest cost, you can get 75-90% improvement in your looks. Upper blepharoplasty gives you expected results as compare to full face lift.
Disadvantage: If eyebrows are already droopy and weak, then you should require brow stabilization to prevent the further ancestry. For eyebrow stabilization browpexy is the only suitable procedure that can be performed with the same incision of upper blepharoplasty. Wrinkles at the lateral canthus also known as “Crow’s Feet” are minimally removed. Blepharoplasty alone is not the sufficient procedure to remove the droopiness of the eyelid due to defective aponeurosis or levator muscle “True Ptosis”. None of the patient have perfect eye anatomy. Every patient have some pre-existing anatomical limitations and why healing is not perfect. There may be some slight asymmetry after upper blepharoplasty.

Variations in Upper Blepharoplasty

1- “Tissue Sparing Upper Blepharoplasty” is used to avoid high creases and eyelid hollowing. In this surgery orbicularis muscles are not thinned and orbital spectrum are left integral. Very little orbital fat is removed if necessary.
2- In recent years, Laser Blepharoplasty has received much attention. During upper blepharoplasty a laser is used with traditional scalpel and scissors. Laser blepharoplasty reduces the operating time and has benefits for the surgeon. There are other techniques which used for incising and excising like electrocautery, heated scalpels, heat cautery and radiofrequency energy.
3- “Deep Fixation” in upper blepharoplasty may be used for some selected patients to deepen the eyelid creases. This will give a better support for drooping eyelashes and stable platform of skin to apply cosmetics.
4- To close the upper eyelids incision, “Tissue Adhesive” may be used resembling super-glue. In this process few sutures are placed. This technique is seldom used in upper blepharoplasty.
5- If tear gland dropped down inside orbital rim of the bone from its normal position. This may creates a bulge at the lateral side of upper eyelid that mimics eyelid fats. The tear gland may need resuspension, if severe.
6- In upper blepharoplasty, “Transconjunctival Incision” may be considered. If there is no excess skin and only nasal fat pocket bulging. Fat removal may be undertaken from the inside surface of upper eyelid without making any external scar.