Raleigh-Durham Eyelid Surgery doctors

Michael Law, MD Michael Law, MD
Raleigh-Durham Plastic Surgeon
10941 Raven Ridge Rd Suite 103, Raleigh
27 answers
Edward J. Bednar, MD Edward J. Bednar, MD
Charlotte Plastic Surgeon
439 N. Wendover Rd., Charlotte
4 answers
J. Charles Finn, MD J. Charles Finn, MD
Raleigh-Durham Facial Plastic Surgeon
1390 Environ Way , Chapel Hill
4 answers
Glenn M. Davis, MD Glenn M. Davis, MD
Raleigh-Durham Plastic Surgeon
2304 Wesvill Court #360, Raleigh
1 answer
Adam D. Stein, MD Adam D. Stein, MD
Raleigh-Durham Facial Plastic Surgeon
4301 Lake Boone Trl # 309, Raleigh

Recent Answers

Lower Eyes: Should I Get Fat Removed?

some doctors say it is not wise to remove the fat pads unfer the eyes as it will give a person a hollow look.rather pull the excess skin and go with cheek implants. others support it and say it is better to remove it. how does a patient know which way to go?

A: Fat Pad Removal Under Eyes

I believe that the reduction of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads  can result in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.

In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.

Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
Filler or Lower Blepharoplasty for Lower Lids? (photo)

I am 40 and have genetic under-eye hollowness. It has become markedly worse over the past few years. I really want to do something more on the permanent side, but am now thoroughly confused: An oculoplastic doctor has said that I am not a candidate for a lower bleph/that it wouldn't make me look good. I have, however, seen that it gives amazing results on plenty of people with similar appearances. So - do I add or remove? Advice welcome! Thank you.

A: Lower eyelid surgery

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.

As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.

In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.

Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.

In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
It's Been Two Months and I Still Have Large Milia After Eye Lift- Normal? (photo)

Two months after eye lift and I still have several large milia and the incision line is very red.

A: two months after bleph

From the photo submitted I would advise getting in to see your surgeon.  Are both upper eyelid this way or only one?  Milia are not uncommon after bleph but the amount of redness and the size of these are not expected.  There may be more to this than simple milia and infection should be ruled out.

Glenn M. Davis, MD
Raleigh-Durham Plastic Surgeon
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