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Blepharoplasty in males is almost always disappointing. A lot of males are really robbed of their aesthetics with blepharoplasty, and the reason is kind of simple. In plastic surgery, we're really trained how to do a blepharoplasty; not a male blepharoplasty, a female blepharoplasty. The changes that look great on a female face ruin a male face.

A female blepharoplasty, and I'm really referring to the lower eyelid when I say that, should be quite tight and the lateral canthus, the corner of the eye should be one to two millimeters higher than the medial canthus. We achieve all these things with a technique called canthopexy, tightening the muscle, removing some skin, and giving a very clean look here.

If you do that to a male, they will never look normal. The most easily identifiable reason for that is males have a little bulge of skin underneath the eyelid from some redundant orbicularis muscle and that's called the lower lid fold; something that's not really even discussed in plastic surgery literature. That fold needs to be maintained no matter what you do, and the intercanthal angle can not be raised. A man will look what we call "cat-eyed" very easily with raising the intercanthal angle.

Now the other caveat there is you're doing a surgery to a structure that's very delicate. Anytime we operate in the lower lid, we get some retracting from scarring, so we also need to stabilize the eye. In a female eye, we stabilize it when we lift up the lateral canthus, so that's pretty straightforward and you don't have to worry about it. In the male eye, you have to stabilize it and make it look male.

I was blessed to spend a long time traveling internationally with some of my mentors. In Brazil, Ruth Graf has a pretty cool blepharoplasty technique that she applies to everyone - male and female - making adjustments to get the right results. Instead of grabbing the lateral canthus, the cartilaginous structure of the corner of the eye, she grabs a pendant of muscle - the orbicularis - and puts it underneath the lateral canthus and secures that.

What I noticed when she was doing that is she had to work a little bit harder to get the clean lower lid. I did a "eureka" moment. I said, "This is my male blepharoplasty." I tweaked her blepharoplasty and made it so that I can really clean out the lid, get some nice support but have some redundancy right underneath the pupil on midgaze and a nice clean appearance here. I complement that with fat grafting to do the same thing that I do with fillers; I call it Aesthetic Facial Balancing. I kind of raise the cheekbone, highlight the soft tissue reflexes over the zygoma - the zygomatic arch which goes back here - raise the brow and I do a hidden . . . I call it a browpexy not a brow lift.

I go onto an upper lid blepharoplasty and secure the lateral brow just a little higher because everyone has what we call compensated brow ptosis. That means if I close my eyes, I massage down my frontalis muscle and I stabilize it there, my brow is really low but when I let go and I look up, my frontalis picks it back up. That's what causes these wrinkles up here.

By pexing the brow back up, not only do you look more refreshed and your brow doesn't drop when you get tired, your frontalis becomes more relaxed and you have less wrinkles.

All that together is kind of my male periorbital treatment for middle-aged men. I get really great results. I call it the Sexually Dimorphic Blepharoplasty because the form of the male eye and the form of the female eye are radically different so there should be sexual dimorphism in all our techniques really.

What Every Man Needs to Know About Eyelid Surgery

Dr. Rian Maercks discusses what every man needs to know about eyelid surgery.

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