Upper and lower eye lift. (photo)
Doctor Answers 9
Factors such as surgery dry eyes, possible ptosis, and potential laxity of lower eyelids do warrant an eyelid specialist
Thank you for your question. You submitted a photo of your eyes, asking about the best age to undergo upper and lower eyelid surgery. You state you are 45-years-old, with a history of dry eyes and glaucoma, so you see an ophthalmologist every 6 months to check your eye pressure. You also state you have a history of keloid scarring. I think that you are looking for some guidance about what to do, and when to do this.
I can give you my perspective as a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and dealing with ocular and cosmetic issues are the focus areas of my practice.
When assessing someone like yourself, we first start with asking about the key aesthetic issues you are concerned about. When I look at your eyes, I noticed a few things. First, looking at the upper eyelids, I noticed that the right upper lid is a little lower than the left upper eyelid. This may be just one angle of taking the photo, but if that’s the case, it is important to recognize you may have a concurrent issue called eyelid ptosis. Eyelid ptosis means the eyelid is drooping typically because of the levator muscle that lifts the eyelid. It doesn’t mean every time someone has a mild degree of ptosis it needs to be addressed, but I feel it is always important to recognize it and bring it to the patient’s attention.
When you look at your upper lids, do you feel like you have too much skin in the upper eyelids, or does it feel like the upper eyelid is a little too droopy in both eyes? I would lean towards the latter - it doesn’t look like you have a lot of skin over your eyes, but your upper eyelids look a little droopy, and that is something to consider for the best approach. Do you address the drooping of the eyelid from the muscle? Or do we address additionally some of the skin? It is very important when you consider eyelid surgery, especially when you have a history of dry eye, to prevent any risk or minimize the risk of ocular exposure. The procedure has to be done with eye health in mind - this is such an important issue that I can’t overstate it.
Moving onto your lower eyelids, I see some puffiness, and possibly some sagging of the lower eyelid. The puffiness can be dealt with typically with a lower eyelid transconjunctival blepharoplasty, which address the anatomic issue of the fat pockets under the eyes. Possibly a lower eyelid tightening procedure can maintain the proper tone of the lower eyelid to allow proper tear film distribution over the eyes.
Patients come to us from all over the world who have complications of eyelid surgery, such as eyelid retraction, or exposure, so they need some reconstruction to get the proper functional process of their eyelid back. It is something that I am very attuned to, so when you have other ocular conditions they need to factor in discussion of a surgical plan.
There are other procedures often done concurrently with eyelid surgery to help improve, and achieve the maximal benefit, which includes procedures such as platelet-rich plasma (PRP). PRP is derived from your own blood, and is a concentration of growth factors to help skin quality improve. We also do things like fractional CO2 laser and erbium laser to improve skin quality.
To address the concern about keloid scarring, people often think of keloids because they have other areas of the body such as a C-section scar, or an incision on their arm, or someone in their abdomen that got thick and they feel like they are a keloid former. Generally speaking, and with my experience in over 20 years of practice, and someone always attuned to the needs of different skin types and ethnicities, I would say that eyelid skin is remarkably forgiving, even in people who are in high risk of keloid forming. I think this is a matter of proper management technique, and minimizing the risk, but it is likely you won’t have an issue with keloid scarring.
As far as the question about the age to do a procedure, in my experience it’s kind of immaterial what the age is. My youngest patient for under eye bags surgery was 14-years-old, and so far my oldest patient is in their 90s, and we have one patient years ago who was over a hundred, so it is actually a question of the combination of aesthetics, functionality, and the need for these procedures, as long as you are physically healthy. It is important to factor in the relative importance of the procedure, and all the other ocular issues, and then do the procedure when you feel it will make an impact on your appearance. Clearly, this is something that’s bothering you, so by presenting this question to us, I think it is something important to you, but I think it is more important for you to understand all the variables needed to be factored in before you do any type of eyelid surgery.
I recommend you meet with qualified, experienced cosmetic surgeons, and I am more inclined to recommend an oculofacial plastic surgeon, and beyond that one who does a lot of cosmetic surgery. Even in a specialized field like oculofacial plastic surgery, there are colleagues who do a lot more reconstructive, and there are colleagues who do a lot more cosmetic. In my practice, for example, we do a lot more cosmetic surgery. I think there is a different frequency which people are attuned into when they do a lot of cosmetic surgery versus a lot of reconstructive surgery, excluding cosmetic. It is just a matter of being comfortable with the doctor you choose. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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No age is too young or too old - Treatment is individualized for each patient
I will start by saying that an in-person consultation would be the best way to fully evaluate your needs. From looking at your photo, I noticed a few details. First, your right brow is slightly higher than your left brow. This may be due to underlying asymmetry with the bony structure of your face, slight ptosis (drooping) of your right upper eyelid, or another factor. It does appear that your right upper eyelid is a little ptotic, and when that occurs, the brow often elevates in order to try to lift the droopy eyelid. I do not see much excess skin in your upper eyelids, so it is difficult to recommend a blepharoplasty procedure based on your photograph. In addition, with a history of dry eyes, you should be aware that eyelid surgery can make dryness worse, and your dry eyes should be very well-controlled prior to undergoing eyelid surgery.
With regards to your lower eyelids, I notice a small bulge in your left lower eyelid. Your right lower eyelid appears normal if not a bit hollow. Instead of surgery, I would think that fillers would be a good option to improve the appearance of the lower eyelids. However, please note that fillers in the lower eyelids are not FDA approved and would be an off-label use.
Again, the most important thing for you to do would be to get an in-person consultation with a surgeon who is experienced with cosmetic eyelid surgery.
Candidate for upper and lower eyelift
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