Detroit Oculoplastic Surgeons

Could the Squeezing Ability of Meibomian Glands Get Directly Impacted by the Removal of Muscle & Fat After Blepharoplasty?

Could the squeezing ability of the meibomian glands get directly impacted by the removal of muscles & fat attached to the under eye fatty tissue during a blepharoplasty?

I'll assume you already know something about eyelid anatomy because I have not had a single patient (in tens of thousands) ever specifically ask about the Meibomian glands! But it is a good question. The majority of the "pump function" of the eyelid muscles relates to the tear outflow system and eyelid closure. Thus, aggressive blepharoplasty with removal of too much orbicularis muscle can cause tearing, hanging out or down of the eyelid (ectropion) or problems with closing the eyes. Most experienced oculoplastic surgeons do not aggressively remove orbicularis muscle.

Blinking of the eyes does indeed help with the secretion of oil from the many small meibomian gland located in the tarsal plates of the eyelids. This oil is excreted from small openings along the eyelid margins and provides a coating to decrease tear evaporation. So one could imagine that in addition to the myriad of other problems you'd have with an overzealous blepharoplasty, decreased meibomian gland secretion might occur as well.

In summary: Choose a surgeon experienced in eyelid anatomy and surgery!

Evan Black, MD

Detroit Oculoplastic Surgeon

Pulsating Feeling After Endo Brow Lift, Will it Go Away?

I had an endo brow lift 3 wks ago. My forehead feels like it is pulsating (and is driving me crazy). Sometimes I realize it is not doing it but thinking about it gets it started again. Will it go away?

Nearly all of my endo brow lift patients enjoy the wonderful, refreshed and youthful look provided by this procedure. BUT It does come with a price (and we're not just talking money)! Small nerve ending are cut and other nerves and muscles are stretched by the procedure. This can result in unusual sensations of numbness, tingling, or even occasional true muscle spasms as Dr. Garcia mentions here as well. If you can feel the pulsations, but neither you nor anyone else sees any movement of the forehead muscles, then it is probably a nerve sensation but not a true spasm. If you actually see the muscle twitching, then of course it is a spasm. Either way, these strange feelings resolve completely in almost all cases, usually within a few weeks, but sometimes it takes as long as 4-6 months. There are medications that can help with nerve discomfort as well.

Evan Black, MD

Detroit Oculoplastic Surgeon

Hollowness Under Brows 1 Year After Brow Pexy. Could This Have Been Prevented? How To Correct? (photo)

I had a brow pexy over a year ago. I now have very hollow areas directly under my brows. What could have been done to prevent this. How can it be permanently fixed? I am a 52 year old female.

It looks like some fat may have been removed or the "brow pexy" technique caused some atrophy (shrinkage) of the sub brow fat. Your best options would be a long lasting filler or a fat injection. Neither of these is likely to be permanent, but should offer significant improvement with minimal downtime or hassle.

Evan Black, MD

Detroit Oculoplastic Surgeon