Ptosis Blepharoplasty Procedure

Ptosis is a medical term used to express the excess of skin over the upper eyelid which results in decreasing the vision of person. Some time if it in sever condition then person lift their eyelid by his finger to see something.

who should perform the Surgery

Usually Ptosis Blepharoplasty procedure is performed by an ophthalmologist who is expert in eyelid surgery. Ptosis Blepharoplasty requires a very much experience so look for a surgeon who is experienced in orbit, eyelid and tear drain system. Selected surgeon must have a membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) showing he or she is not only a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, but also has had extensive experience in cosmetic surgery and ophthalmic plastic reconstructive.

Surgery Procedure

After selecting an experienced and suitable surgeon, main Ptosis blepharoplasty procedure will start. Normally the Ptosis Blepharoplasty can be completed the same day. In case of Ptosis blepharoplasty local anaesthesia is given in place of general anaesthesia so that patient is able to close or open the eyes to judge the position of eyelid because muscles is tightened or excess skin is removed from the upper eyelid. After giving anaesthesia, while it’s taking effect face is washed with an antiseptic normally Beta din (living person having iodine allergy) to come down the effect of infection. It must be taken care that no facial or eyelid makeup is worn on that day. In case of upper eyelid surgical incision is made in natural eyelid skin crease above the eyelashes. After healing time by time it will look like a natural crease. The incision is made by either CO₂ laser or radio frequency laser. This will help in minimal bleeding flow during Ptosis Blepharoplasty procedure.



After that again excess of skin is measured by opening or closing the eyelid. If required excess of skin is removed and incision will extend up to entire eyelid. After that wound is closed through fine sutures which will automatically dissolve in 7 to 10 days. Underlying skin is smooth in touch but outer surface is little rough in touch. Excessive rubbing of eyelid during this time period will harm and may be wound will reopen or may be result in skin puncturing, so care must be taken after Ptosis blepharoplasty procedure. After the wound is closed or dissolve it will look like a natural eyelid.

In lower eyelid blepharoplasty, some other factors must be taken in care. If excessive fat is present around the lower eyelid, it can be removed through inner surface without using skin incision. If excessive horizontal laxity of the eyelid present, the outer tendon is tightened to maintain or return the eyelid to its normal position. In the same way as in upper eyelid, wound will be given to lower eyelid to remove excessive fatty skin. This will give tighter, youthful and fine skin but some wrinkles still present in the skin which is not possible to completely remove with the help of Ptosis blepharoplasty.

Additional Testing and Medication of Ptosis Blepharoplasty

The Severity level of Ptosis is divided by determining the portion of upper limbus covered by the lid margin. Ptosis level is mild if its 2mm, moderate if its 3mm and severe if its 4+ mm. In second step we determine the peripheral vision affected by upper eyelid. An instrument known by Perimeter is used to measure the peripheral vision in upper half of eyelid vision. They check each eye independently. Lights are flashed on screen on different location for a short duration of time and person is instructed to see at a central target. If the person is able to see the light, he will push the buzzer. If no response is made by the person it means the droopy eyelid made him incapable to see the light. By following this procedure the extent of visual loss is determined. Photographs are also taken to determine the resting position of eyelid. Normally the photography session is instructed by Insurance company if surgery is insured to determine whether its medical reason or cosmetic reason of performing the Ptosis blepharoplasty.

                    Some of the patients take some type medicine which make the blood thinner ,this will increase the flow of blood during Ptosis surgery which may result in adverse effect .So some type of medicine must be avoided if you are thinking about performing surgery. Like Coumadin, Plavix, aspirin or any product containing anticoagulant (blood thinner) must be stopped 10 to 12 days  prior to surgery. Other things like Chinese black fungus or supplements containing vitamin E are must be discontinued one week prior the Ptosis blepharoplasty surgery. There may be other supplements which effect the blood clotting will be discussed at the time of consultation by the physician.

                 These are some of the testing which must be taken in care before performing the Ptosis blepharoplasty surgery.

An Overview of Ptosis Blepharoplasty

An excess of skin or fat in the upper or lower eyelid, is also known by Baggy eyes / Dermatochalasis, this type of condition may need surgical correction for their comfort, cosmetic and visual reason. This surgical treatment is known by blepharoplasty. The term Blepharoplasty is combined with a term ptosis when the edge of upper eyelid droops is closer to pupil in the combination or separation of baggy eyes then this combined known as Ptosis Blepharoplasty.

       The reasons of dermatochalasis are many but one and most important reason is increasing age. This comes into action when due to increasing age of a person the connecting tissues become weak and due to this weakness they start losing elasticity and which will create droops in upper/lower eyelid. Along with this the other reasons are tension, thyroid disorder, any type of medical injuries or fluid release and stretching of delicate skin of eyelid. When the cases of droops in upper eyelid, the actual margin of upper eyelid drop is nearly close or almost cover the pupil which create the condition of Ptosis Blepharoplasty. Due to fluid retention or a forward rupture in smooth muscle tissue will create puffiness in eyelid or a normal fat around the eyes. This fat around the eyes make the person helpless into raise the eyebrows due to which person experience tiredness mainly in forehead and muscular exhaustion. This overhanging skin in upper eyelid may cause intervention in vision either in side or above the eyebrows. More problem rise when we want to raise eyebrow to see more clearly or down to read something. The same factors are involved for the lower eyelid droops. The lower eyelid is hanging towards the nose and ear tendon, which looks like a hammock is hanging. If one or both the eyelid droops due to above mentioned reasons, this will create pulling of tears in eyes due to eyelid droops touching the cornea or sometime make the eyes dry due to exposure of delicate surface in air. The fat below or above the eyelids will create puffy and tired eyes. This puffiness or tiredness can be resolved by blepharoplasty or more specifically Ptosis Blepharoplasty.

Steps of Blepharoplasty Surgery

Step 1 – Anesthesia Medications are performed for your comfort during the bleharoplasty procedure. There are two choices one can select which include general anesthesia and intravenous sedation. After examin, your doctor will suggest you the best option.

Step 2 – The incision The incision lines for blepharoplasty surgery are marked in such a way that scars will concealed within the natural structures of your eyelid region. The upper eyelid’s droopy condition can be corrected through an incision in the natural crease of upper eyelid which allowing repositioning of fat deposits, tightening of tissue and muscles, and removal of excess skin if any.

The lower eyelid can be corrected through an incision just below the lower lash line. With this incision, excess skin of the lower eyelids can be removed.Transconjunctival incision is an alternate technique in which one hidden incision is made inside the lower eyelid to correct lower eyelid conditions and redistribute or remove excess fat.

Step 3 – Closing the incisions After Blepharoplasty, eyelid incisions typically closed with:
* Removable or absorbable sutures
* Skin adhesives
* Surgical tape
Laser chemical peel may be used by your surgeon to erase dark discoloration of the lower eyelids.

Step 4 – See the results The results of the Blepharoplasty surgery will appear gradually as swelling and bruising subside to reveal a smooth, better-defined eyelid and surrounding region, and an alert and rejuvenated appearance.

Get Rid of the Dark Circles Under the Eyes

Dark circles under the eyes make your appearance tired, stressed and aged. Some people have dark circles due to aging and others have from their young age. Dark circles in Caucasians can be seen more frequently as they have more dark pigments. Dark circles under eyes is not caused due to stress or tiredness, actually it is develop due to staining of thin eyelid skin from pigments that leaked through blood cells. Hemoglobin is the blood cell pigment that oxidizes close to the skin surface due to exposure to light and give a bluish red colour. When exposed to light hemoglobin change to hemosiderin, an iron-based pigment. Dark circles are become permanent as pigments deposit to the skin.

Some people prefer to have lower blepharoplasty to remove the dark circles. But this is not the solution. Lower blepharoplasty removes excess skin from lower eyelid and bulging fat. It is not meant for the pigment-staining problem under lower eyelid. Blepharoplasty may cause bruising and place blood products close to the skin surface, this may even look worse. But sometimes, lower blepharoplasty may help to fade-up dark circles under eyes. Lower eyelid is tightened in the surgery and removes the hollowness under eye for shadowing.

Chemical peel and laser resurfacing of lower eyelid skin does not help to remove dark circles. The peeling and exfoliation of the outer layer of skin does not treat the area where blood cell pigments lies. Laser skin resurfacing is performed to remove outer epithelium of lower eyelid skin. Resurfacing should not reach underside of the skin or the deeper dermis, it can cause lower eyelid scar. The process may cause the risk of hyperpigmentation which can make lower eyelid skin even darker.

Effective Approach to Dark Circles:
An approach of potential leaching of the skin with hydroquinone topical preparations is effectively safe and workable. But this approach is not specifically for pigment issue. Hydroquinone suppresses the melanin and colour production of lower eyelid skin, so it is effective over the hyperpigmentation or sun exposure brown spots. This process does not seem work well with hemosiderin pigment stains problem. Although bleaching chemical is an effective approach, it would be suggested otherwise.

There are many skin creams in the market that claim effective dark circles improvement. Some of them are even labelled as dark circle repair serums. These creams contain agents like arnica, haloxyl, and other enzymes that allegedly clear the pigments and help to get rid of the dark circles. This process is quite slow and may take months for noticeable change.

Another approach to the dark circles is the intense pulse therapy with vascular filters and topical dark circle serums. Light therapy is specifically target to the breakdown of pigments without injuring outer eyelid skin. This process does not even require any recovery for the patient.

Brow lifting for Men

Men are more concern about eyebrow dropping with the age. Generally men have heavy forehead than women and they look more tired with droopy eyebrows. Still, droopy brow is much tolerable for men than in women. The shape of men’s brow is different to women’s brow as it is in level with brow bone and less arched. When brow is drop down enough to combine with excess skin of upper eyelids, the facial looks become very tired and sad or angry too.

Brow lifting for men has some issue due to poor hairline on eyebrows. Lack of hair on brow eliminates many effective brow lift surgeries. The forehead skin and muscles of man are very thick and strong than women have. This reduces the prospect of the minimally-invasive brow lift procedures like thread lift or suture suspensions. The only option of surgery left is endoscopic brow lift procedure or direct brow operation. Endoscopic brow lift procedure is still less effective for many men having poor hairline on brow. Even if the surgery results in small visible scar, it will not be considered as a good deal. If the direct brow lift surgery is performed through upper eyelid incision, will give good results. Most men prefer to have upper blepharoplasty with no additional scars. Even if suturing the brow to a higher position from underneath or endotine resorbable forehead device that provides acceptable brow lift. This procedure can be performed with upper blepharoplasty surgery with a little addition of time. Procedure has restriction due to location of the supraorbital nerve inside of the brow. Nearly 1/3 of brow from inside not changes much. Few extra millimetre brow lift in supraorbital area of brow may cause injury to nerve. Slight removal of bulge is often visible after blepharoplasty above brow.

Endoscopic browlift or direct browlift procedure are provide more subtle change particularly in the brow area.

Blepharoplasty in Conjunction with Coleman Fat Injections

Lower blepharoplasty surgery can be performed in conjunction with Coleman fat injections. Cosmetic blepharoplasty can be combined together with Coleman fat injection. This procedure helps to camouflage the outer tear trough defects. Outer tear trough cannot be operated effectively with fat repositioning alone.

In this procedure, fat is reaped from outer area of thigh or buttock through a small incision. The incision can be closed with single fine suture. The fat is separated from blood cells by spun down in centrifuge and anaesthetic solution. After completion of blepharoplasty, fat cells are injected in outer area of eyelids with the help of a fine rounded cannula. This blepharoplasty procedure can be performed under local anesthesia for a single day.

Blepharoplasty–A good Facial Rejuvenation for Patients

Blepharoplasty is performed over a small area of face, but it has a remarkable impact on facial appearance. Blepharoplasty surgery gives the best facial rejuvenation among all facial plastic surgeries. Eye is the most seen part of the face by others. Eyes express more age compare to other body parts because of squinting, smiling and frowning.

With aging we lose freshness of upper eyelid crease that shows appearance of eyes. As we age more, eyelid skin begins to fall by losing its elasticity and eventually resting on eyelashes. Eyelid skin becomes droopy and excess fat makes it baggy. Droopy skin of eyelid gives a tired and old age appearance. Upper blepharoplasty gives a natural looks and youthful appearance by removing excess skin from upper eyelid crease. Some patients have baggy eyelids, excess fat from upper eyelids may be restructured or removed. Incision in the upper eyelid crease is made carefully, practically it is disappear and unnoticeable once recovered.

Lower eyelid is the primary area of face that shows age-related changes first. The lower eyelid skin and muscles start losing and make a droopy appearance. The excess fat on droopy eyelids becomes more prominent. In lower blepharoplasty, the incision is made inside of the lower eyelid crease if only fat is to be removed. When all tissues need to be checked, incision is made under the lash line. The muscle and tendon over the bone are reshaped and resuspended depending upon patient’s requirement. Fat may be repositioned or removed or even tucked back in to the lower eyelid. Some patients may require chemical peels or laser resurfacing in conjunction with lower blepharoplasty to reduce wrinkles and crow’s feet.

Main thing about blepharoplasty is the painless healing and less recovery time over other facial surgeries. Most patients say about blepharoplasty is the best facial rejuvenation value.

Pinch and Peel Lower Blepharoplasty

Changes around the eyes are gradual over many years like all other aging processes. Generally, aging effects starts in the age of 30s with small bags and puffiness on the lower eyelid. Aging also begins with some bright wrinkles in the crow's feet. In the age of 40s, excess skin begins apparent in the lower and upper eyelids. More patients prefer early onset aging blepharoplasty to avoid any major surgery that may require later.
In the early age when young patient does not have any severe issue with lower eyelids, then traditional lower blepharoplasty is not recommended. A limited lower blepharoplasty with small removal of fat, tightening of little skin and little skin resurfacing to erase wrinkles is often required. This technique of limited lower blepharoplasty is called as "Pinch and Peel Blepharoplasty".
Pinch and peel lower blepharoplasty is performed with a special instrument to pinch up small excess skin under eyelashes and then trimmed. Extended skin flap is not lifted just like in traditional blepharoplasty. Little lower eyelid fat may be removed from inside of the lower eyelid. After pinch on lower eyelid, it is peeled with chemical solution. Generally this solution includes 25% or 35% TCA (trichloroacetic acid) and it is perfectly safe for the skin. Pinch and peel lower blepharoplasty is a little procedure and gives a good visible result. The recovery from blepharoplasty operation doesn’t take much time and recover with comforts. After this blepharoplasty, there will be little pinkness on eyelids from chemical peel without any bruising and less swelling.
The pinch and peel lower blepharoplasty is mainly recommended to younger patients those have minimal aging issues on lower eyelid. This procedure produces a good rejuvenative change when combined with Botox treatment for crow’s feet. The operation can be performed under anaesthesia. The pinch and peel lower blepharoplasty perfectly matches the small aging issues with lower eyelids.

Upper Blepharoplasty-No Ectropion Risk

The anatomy of both upper and lower eyelids is almost similar and also the aging process for both is similar, but refreshing the eyelids is dissimilar whether you from north or south. The upper blepharoplasty procedure is quite simpler as compared to the lower blepharoplasty procedure.
Lower eyelid is suspended from one side to other of the eyebone, excessive skin removal or aggressive surgical behavior, may result in pull down after blepharoplasty as it heals. This condition is called “Ectropion”. Ectropion may cause eye irritation and tearing because eyelid should be tucked up close to eyeball. Eyelid provides lubrication to the eyeball when we blink it. So, a very small gap between the eyelid and eyeball can cause this Ectropion. In old age people, the lower eyelid is not that much strong as in the youth age, the Ectropion condition may be significant. To avoid this problem in lower blepharoplasty tendon is tightened that attach the eyelid to the eyebone.
The upper blepharoplasty does not cause Ectropion condition as in lower blepharoplasty. In upper blepharoplasty, no risk of the eyelid pulls down from eyeball in excess skin removal and excessive skin can be removed. Much more skin removal from upper eyelid in upper blepharoplasty rarely causes any problem. The details of upper blepharoplasty are all in the design and placement of the incisions and the removal pattern of skin and muscle. Incisions placement on the upper eyelid has too much importance. Incisions made too much low may be noticeable and incisions made too much high may results in unnatural appearance after blepharoplasty. Also incision placement on both the eyelids must be similar to make a good looking matched set.
The advantage of upper blepharoplasty is that it is extremely effective, very simple to get performed and has less risk of complications. The good thing about this surgery is almost painless. After upper blepharoplasty, there will be little swelling and bruising for a week or max two, but good results will remains for many years.

Top Ten Instructions after Blepharoplasty (Eyelid Surgery)

Blepharoplasty or eyelid surgery can make a remarkable impact on your looks as eyes are a major part of every social discussion. Blepharoplasty also relieves the excess skin from upper eyelid and gets clear bulges on the lower eyes. Eyelid surgery will cause bruising and swelling around eye and its looks bad and socially noticeable for a short time. Here is a list of top ten instructions that blepharoplasty surgeon generally provide to patients after blepharoplasty:
1. Swelling and bruising around the eyes generally most severe on the 2nd day after blepharoplasty. Keep your head in elevated position on 2 to 3 pillows or sleep in a recliner. This will help limit the bruising and swelling.
2. Using cold compresses on the eyes in the first 24 hours after blepharoplasty is helpful in keeping down swelling. Put some ice cubes in a ziplock bag. Keeping cold compresses for first 48 hours make you feel even better.
3. Apply antibiotic ointment on eyelid suture lines twice a day. Keep suture lines lightly lubricated. The antibiotic ointment is ophthalmic and its safe even if it reaches in your eyes.
4. In browlift surgery, the incision is made in scalp or at the hairline. No need to apply antibiotic ointment at hairline. This unnecessarily makes your hair greasy.
5. In browlift surgery, a circumferential head dressing is made to keep pressure on the forehead. This dressing may be removed in the first morning after browlift.
6. Eyelid sutures will be removed after one week of blepharoplasty.
7. You may resume the wearing contact lens one week after blepharoplasty.
8. You may wash hairs on hairline after 48 hours of browlift surgery.
9. Do not use any eye makeup such as eyeliner or eyeshadow for 2 weeks after blepharoplasty. You can use cover-up on bruised areas after eyelid sutures removed.
10. Exercise or any strenuous physical activities should be avoided for at least 3 weeks after blepharoplasty.

Transconjunctival Lower Blepharoplasty has no chance of Lower Eyelid Retraction

Lower eyelid retraction is an unusual expose of “white” of the eyeball by pulling down the lid. Scar-related retraction in internal lower eyelid is a complication in usual blepharoplasty. The risk of this internal complication can be eliminated with transconjunctival lower blepharoplasty by trimming bagging orbital fat. This operation doesn’t harm the delicate and important middle layer of eyelid, so the deep scarring by contracture does not produce after a years of operation.
If transconjunctival blepharoplasty procedure is used for fat repositioning in cheek hollow, cheek implant or tear trough placement then extended dissection is required. In such case, there would be a little risk of internal scar-related retraction. There can be other reason also for lower eyelid retraction other than lid scarring. If excess orbital fat is removed from lower eyelid, the support to lower eyelid may lose and crumple downward into hollow.

Transconjunctival Blepharoplasty to Avoid Hound Dog Eyes

Earlier people prefer to undergo traditional scalpel blepharoplasty. The usual problem with this surgery is when blepharoplasty surgeon cuts through the supportive muscle of the lower eyelid, the eyelid support is often lost. Also, the scarring created by the blepharoplasty surgery tends to pull down the eyelid. If a patient already has a loose lower eyelid, the condition becomes even worse. The outcome of surgery may be a sad eyed look which surgeons called as hound dog eyes.
Fortunately, a newer blepharoplasty technique can be used to avoid the hound dog eyes. This procedure is called transconjunctival blepharoplasty.

The transconjunctival blepharoplasty is performed in a different manner from the old scalpel blepharoplasty and prevents injury to the supporting eyelid muscles. The inner pink part of eyelid is called conjunctiva. In transconjunctival blepharoplasty, a small incision is made with a laser inside of the lower eyelid through conjunctiva. This procedure avoids injury to the supporting muscle of eyelid. After that, fat is repositioned or removed from the inside of lower eyelid and tightened the lid. Dark circles corrected by performing an arcus marginalis release. Laser transconjunctival blepharoplasty is becoming more popular nowadays.

Following are the advantages of the transconjunctival laser blepharoplasty:

1. Eyelid shape not change after surgery.
2. No visible scar on the lower eyelid.
3. Transconjunctival technique avoids the hound dog eyes or sad eyed look.
4. Healing and recovery after surgery is generally quicker.
5. Bruising over eyelid is less.

If your lower eyelid loose or turns down, the old style scalpel blepharoplasty may results in serious sad eyed look or hound dog eyes. Very few blepharoplasty surgeons perform the transconjunctival laser blepharoplasty.

Selective Tissue Sparing Blepharoplasty

As in traditional blepharoplasty, the intrinsic weakness associated with excess tissue subtraction and tucking has progressively understood by surgeons. Now efforts to develop more soothing approaches to eyelid rejuvenation have yielded a lot of advance blepharoplasty techniques that seek better short and long-term outcomes.
Basically traditional blepharoplasty is a removal technique in which unstable skin, orbital fat or muscles are subtracted with an objective of debulging the upper and lower eyelids. Once orbital fat has been removed or moved out of the orbit, standard volume associations are changed. Once muscle has been incise or subtracted, its final power is everlastingly weakened. The most general problem resulting from traditional blepharoplasty is excessive tissue removal weakens the eyelid’s support and an aesthetic problem is eyelid hollowing.
These outcomes after traditional blepharoplasty are generally analyzed as unavoidable limitations. They are undesirable results and do nothing to appear eyes more attractive or youthful.
"Tissue sparing blepharoplasty" should not be misinterpreted to simply signify performance of the usual blepharoplasty in a more conventional manner. Mostly denotes "selective tissue sparing blepharoplasty" in terms of both subtraction and tissue injury. Some patients may be most benefited from leaving assured tissues completely alone while carefully removing other tissues. Some patients may be considered for newer and very special approaches that remove little or nothing.
Upper eyelid tissue sparing blepharoplasty is a well-developed secure and efficient operation. Lower eyelid tissue-sparing is not in extensive use and still under development.

Blepharoplasty for Inborn Crease Imbalance

The natural asymmetry in the crease shape, height and depth is not at all uncommon. As well as imbalance in the height and width of eyelid opening is known as “palpebral fissure”. During a study, eyebrow, eyelid and orbital measurement comparing in models with the average population and observed that moderate asymmetry around the eyes were common even with good looking faces.
Natural asymmetry is more common in Asian descent and may be influenced by some anatomic variables. Most of the patients believe their imbalance is due to difference in amount of skin and fat in the two lids, but this problem is quite related to weak natural crease fixation instead of tissue excess or deficiency.
It is advisable for exceptionable asymmetry to have blepharoplasty on both eyelids simultaneously, even if one eyelid already has acceptable natural crease. By undergoing blepharoplasty to both eyelids at the same time, surgeon has better chances to achieve balanced final match. When blepharoplasty performed only on one eyelid, it is more difficult for the surgeon during the operation to judge exactly how much to evaluate developing symmetry between the two eyelids.
In some rare cases, the presence of considerable ptosis affecting only one eyelid and the deficient eyelid may show no crease formation. For such cases, patient must undergo ptosis surgery along with double blepharoplasty for better improvement.
If asymmetry in crease shape is the cause of earlier double eyelid blepharoplasty surgery rather than inborn preexisting imbalance, surgical treatment can be especially challenging. Crease reformation for marked natural asymmetry or unacceptable surgery relies on advanced blepharoplasty techniques that are far more complicated and less expected than those used in normal double blepharoplasty surgery.

Information on Blepharoplasty in Los Angeles

Blepharoplasty in Los Angeles is growing continously. If you are a resident in Los Angeles, then you have convenience of selecting the best blepharoplasty surgeons in the country. You will find the best surgeons at Beverly Hills. If you're planning to have blepharoplasty in Los Angeles, surgeons at Beverly Hills can give you good suggestions for the type of eyelid surgery that will suit you best and give effective results.
The experts in Los Angeles can give you a complete makeover with new advanced technologies. Your relatives and friends won't believe the transformation in you after blepharoplasty in Los angeles. If you want to find out more about eyelid surgery in Los Angeles, here is the information about some of the best surgeons in Los Angeles.


Dr. Keyes, M.D.
Keyes Surgicenter
9201 Sunset Boulevard, Suite 611
Los Angeles, California 90069
Phone: 310 859 9388


Steven C. Dresner, M.D.
1127 Wilshire Blvd., Suite 1618
Los Angeles, California
90017-4007
Tel.: 213 482-3467


Dr. Warren Lent, M.D.
150 N. Robertson Blvd, Suite 140
Beverly Hills, Los Angeles
California 90211
(310) 652-6500


Mary A. Powers, MD, FACS
9201 West Sunset Blvd
Los Angeles, California 90069

Asian Blepharoplasty (Double Eyelid Surgery) is different from Occidental Blepharoplasty

"Asian blepharoplasty" or double eyelid surgery are common terms used for blepharoplasty but this not exactly a blepharoplasty. Both surgeries are certainly done on the upper eyelid but there are so fundamental differences that both Asian blepharoplasty and occidental blepharoplasty are thought as unique operations rather than related procedures.
Basically "Blepharoplasty" surgery is developed for European and Occidental descent patients which is now old, while "Asian Blepharoplasty" surgery is developed recently for patients of Asian lineage. Many blepharoplasty surgeons who can very well perform occidental blepharoplasty may have little or nearly no experience with double eyelid surgery.
The differences between Asian Blepharoplasty and Occidental Blepharoplasty related to anticipated goals, age of the patient, and surgical procedure are:
• Most European patients want blepharoplasty surgery in their forties, fifties and sixties, while the immense mass of Asian patients demanding surgery in their twenties and thirties.
• In the Occidental blepharoplasty, the major concern is rejuvenation of the aging upper lid. The surgery is considered as subtractive for most part. The stretched and weakly positioned skin or fat are removed from upper lid. Small attention given to reshaping the present crease.
• In the Asian Blepharoplasty, the major concern is the enhancement of the asymmetrical or unbalanced crease or creation of a new crease in upper lid. Minimal attention is given to the skin and fat removal and in some cases, no fat is removed from lid.
• The "suture techniques" for crease formation in occidental blepharoplasty becomes more fragile.
• If a young Asian patient is operated with procedure similar to that is used in Occidental blepharoplasty, the result can be unnatural or surgical.

Advanced Upper Blepharoplasty with Myoplasty

Wrinkles on the forehead is generally a unconscious simulation of the forehead and eyebrow area. Even though it makes our looks like annoyed person and unfriendly, it is almost unfeasible for us to prevent us from activating the muscles that are dependable for the frown on the forehead. The main reason behind the success of Botox is its advantage in relaxing the muscles which are responsible for wrinkles and frowning. Advanced upper blepharoplasty for upper eyelid lifts can include a treatment to relax frowning muscles, specifically the procerus, corrugator and depressor supercili muscles. An advanced upper blepharoplasty gives a wonderful opportunity to treat these muscles by the previously existing eyelid incision which is unseen within the lid crease. The muscles are approached in upper blepharoplasty, recognized and permanently destabilized which leads to permanent softening of the natural frown. Because the muscles are not entirely paralyzed, some simulation remains for a natural look. Although this upper blepharoplasty treatment may even direct to a mild brow elevation, most patients identify the benefit in the improvement of the frown region between the eyebrows. These muscles are strongly intertwined with significant nerves and vessels, so a methodical understanding of the rich anatomy of eyelids by the blepharoplasty surgeon is essential for a safe and secure procedure.

Asian Double Eyelid Surgery- Blepharoplasty also popular in Men

Asian blepharoplasty surgery is now popular for men also. It is not strictly meant for women. In the past years, Asian blepharoplasty was performed over 95% of women, but in the last decade, there was a steep rise in the number of men undergone double eyelid surgery.
As per current stats, Occidental blepharoplasty is performed on less than 20% of male patients, while Asian male accountability for double eyelid surgery is over 30%. This rise in interest of men is indicating the fundamental change in objective of blepharoplasty in Asian and non-Asian people. The nature of the blepharoplasty procedure for Asian eyelid is a structural repositioning of tissues intended to create a natural-occurring crease while in the non-Asian eyelid, the objective is to remove away the changes occurred with the aging.
A conservative approach is highly recommended for both Asian and Occidental men. Normally, a low tapered crease in eyelid appears the most natural and also the best option. Some women desire a high crease with medium height and parallel contour in blepharoplasty; this procedure normally chosen to create a definite platform to apply cosmetics. A dramatic crease is never a recommended idea in blepharoplasty, mainly for the men faces.
Some men are concern about having the low creases as they think that they may require additional blepharoplasty later on for age-related bagginess. While this is a rare case, such later blepharoplasty surgery is subtractive in nature because the incision surgery builds a long-lasting crease and depends fully on how that patient finally ages. Still, it is highly recommend against try to have preempt changes that may or may not happen in middle age.

Upper Blepharoplasty- Eyelid Surgery Without Crease Formation

The upper eyelids may emerge baggy in Asian people. Bagginess is usually due to the occurrence of excess fat and skin. Some people may wish to reduce their upper eyelid bagginess through blepharoplasty while conserve the current eyelids creaseless. Asian people have a special anatomical feature in their eyelids, so, "standard" Asian double-eyelid blepharoplasty surgery can run a specific risk of varying the current state of the crease and noticeable scar.
There are certain new techniques developed in Blepharoplasty for such cases:
• In this upper blepharoplasty, the skin generally incised a few millimeter above lashes. The incision is external and does not tend to the orbicularis muscle. A plane then established between skin and orbicularis muscle expanding upward. After this a flap having skin only is elevated without unsettling the eyelid structure.
• For upper eyelid bagginess, the excess fat needs to be removed to decrease a marked convexity in the eyelid. The orbicularis muscle is incised slightly a highed level in blepharoplasty. The orbital septum is then opened at little higher level. After that in blepharoplasty, a small amount of fat is trimmed out and removed. The orbicularis muscle and orbital septum left to close naturally without any suturing. However this step is not required, unless excess fat is offensive.
• If fat pocket nearby to the nose, bulging enough to visible, the transconjunctival approached is considered for blepharoplasty i.e. the area closet to nose approached from the backward of the eyelid. After this a small incision created to remove any excess fat. In this way, No noticeable external scar is created.
• Lastly, the skin flap is wrapped over the original incision marked in eyelid and extra skin trimmed conservatively. Now the skin edges will be closed with few sutures without useing any kind of deep fixation.
This upper blepharoplasty procedure is performed by not removing any orbicularis muscle or orbital septum and creation of a noticeable crease is avoided and the healing exterior scar is convincingly well camouflaged.