Louisville Eyelid Surgery doctors

The excess fatty tissue ("bags") and skin laxity of the lower lids can be well -managed using a variety of approaches. The transcutaneous (skin) incision has pros and cons: while a skin incision and small scar is created, visibility and manipulation of excess fat may increase and sometimes additional tissue tightening may be possible.  Likewise, the transconjunctival (behind lid) incision does not create a visible skin incision but access to fat manipulation and tissue tightening may be somewhat limited.  However, chemical peeling or laser resurfacing can usually here be done simultaneously if desired.        When there has been significant loss of skin elasticity, wrinkles are present, and  excess fat is prominent, it is sometimes wise to view lower eyelid rejuvenation as a 2-staged process. Once surgery is healed, a secondary "tweaking" procedure aimed at resurfacing (improving) the skin is often the "icing on the cake". And some lids will require more than the "routine" especially if the lateral part of the eyelid is loose or lax. This is why a careful preoperative evaluation by a well trained surgeon is so important! 

The eyebrows can be thought of as a kind of "curtain rod" and the upper lids as a "curtain". The brows are actually part of the lower forehead, and just below the brows we find the upper eyelid skin. The brows of some of us are somewhat high and in others quite low. When performing upper eyelid surgery (blepharoplasty) there must be adequate space between the lashes of the lids and the lower brows. So in eyelid rejuvenation surgery, we take into consideration both brows and lids. It is not always an easy decision, as some patients anatomy lies right on the borderline. We do not want to recommend a procedure (forehead lift) that is not necessary for the patient who requests eyelid surgery. But we also want to do what is necessary in order to obtain the best result for each individual patient.  So by raising the "curtain rod" (brows) this actually can actually improve  what we do with the "curtain" (eyelid skin). The pros and cons of both pathways should be fully discussed between surgeon and patient, so that the best decision for can be made on an individual basis. 

Depending on a person's age and inherited eye characteristics, sometimes eyes have a small appearance. If time and the aging process accentuate the "smallness" factor, then surgery sometimes can help "open up" the orbit and eyelid area. For example, when brows descend, combined with extra skin over the eyelids, the eyes appear "crowded" and brow elevation and/or upper eyelid blepharoplasty can help open this area. This can help the eyes appear bigger. Also, sometimes the lateral (outer) skin of the temple can descend, giving the eyes a hooded or even sad appearance. Elevating this with surgery can help "open the eyes". It is more difficult to achieve these improvements in a younger person with hereditary tendencies for small or deep set eyes. After evaluation by a qualified surgeon, options will be more clear!