Eyelid Lift

There are two important reasons to spend time reviewing before-and-after pictures when considering plastic surgery. The first is to determine what procedure, if any, actually serves to improve your undesired appearance. The second is to distinguish which surgeon performs the best work.

There are many procedures discussed on the web and touted by the cosmetic surgery community and media as aesthetic dream-makers. Often, however, they are not. Be skeptical and use before-and-after pictures to determine which procedures will actually address your concerns. If an operation works well, there will be thousands of pictures demonstrating its success. If it's hard to find good before-and-after pictures of a procedure used for the problem you're trying to address, then it probably doesn't exist. Remember to be honest with yourself about your appearance when evaluating web pictures. The mirror lies. We recommend that you take pictures of yourself and set them in front of your computer while you do your research. Make sure that the "befores" look like you and then determine what procedures work. Just because the media or some web site states that fat injection to the buttocks will lift the butt, that doesn't make it so.

Second, once you've identified the best operation for you, it's easy to determine which surgeons achieve the most natural and attractive results. All people are hard-wired to appreciate natural attractiveness. Fortunately, it's easy for you to identify who can meet your highest expectations simply by reviewing before-and-after photo galleries.

Find a surgeon who specializes in cosmetic plastic surgery and performs numerous blepharoplasty procedures per month.

Seek a surgeon who upholds the proper credentials including certification by the American Board of Plastic Surgery (ABPS), membership in the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS).

Ask if the surgeon uses only an accredited, state-of-the-art surgical facility. Your blepharoplasty procedure will be performed in our AAAHC-certified Apex Surgical Facility in Golden, Colorado. Based on the latest recommendations from the Anesthesia Patient Safety Council, we prefer to use general anesthesia for our blepharoplasty procedures. General anesthesia minimizes the risk of airway problems, ensures a comfortable experience for the patient and surgeon, and makes for an efficient procedure. At Apex, we use only board certified anesthesiologists and a staff of nurses who specialize in caring for aesthetic patients. After your blepharoplasty procedure is complete, you will leave the facility by way of a private exit out of sight of other patients.

Decide, if upon meeting the surgeon, you make a connection with him or her and all of your questions are respectfully and sensibly answered.

In some patients, the appearance of aging in the upper lid is confined to the upper lid itself. These people require only a blepharoplasty to see significant improvement in this area. In many patients, however, the area around the upper eyelid looks aged because of the upper eyelid and the position and/or shape of the eyebrow. In these patients, an upper blepharoplasty may be performed in conjunction with a brow lift to more completely correct the aging process, as neither procedure alone would be optimally effective.

Twenty years ago, an upper blepharoplasty typically involved removing as much skin and fat as possible in a misguided effort to create a youthful appearance. In fact, these aggressive operations often left patients with a hollowed-out, skeletonized orbit that made them look even older and less robust. Modern techniques conservatively remove skin and fat from the upper and lower lids, and many adjuvant therapies (fillers, fat grafting, etc) actually add volume to replace that which was lost due to the aging process.

Surgical improvement of the upper eyelid is, for the most part, a matter of removing the excess skin. The lower border of the incision is placed in the fold of the upper lid, while the upper margin is determined by the degree of redundancy. In some cases, there is excess fat, as well, which presents as an area of puffiness in the central corner of the lid. This is easily removed through the same incision that removes the skin. Very fine sutures are used to close the incision precisely.

An aged appearance in the lower lid can be due to a number of factors, but there are three that are commonly addressed surgically

• 1. Fat in the lower lid may herniate or protrude unattractively. This excess fat is best removed via a transconjunctival approach, which utilizes a small incision inside the lower eyelid mucosa and avoids a skin incision.
• 2. There may be excess skin in the lower lid. This can be removed as a "pinch" procedure which preserves the structural integrity of the lower lid and reduces complications like prolonged swelling and lid malposition.
• 3. The quality of the lower lid skin may be compromised. Sun damage, smoking, and age can all lead to a loss of elasticity and tone in the lower lid skin. Removing skin will tighten the area, but won't change the skin itself. Laser resurfacing, chemical peels, and dermarolling are all useful techniques to improve the skin quality and can be used in conjunction with a blepharoplasty.

Any or all of these factors may be present, and combinations of these techniques are frequently used to give patients a harmonious, attractive result.

Perhaps the most important characteristic of an expertly performed blepharoplasty is that it leaves the patient with an unoperated appearance. Any aspect of the procedure that is over-done can alter the normal shape of the eye, and these distortions are noticeable even to the untrained eye. The lower lid, in particular, is an area that responds poorly to an overly aggressive procedure.

Rejuvenation of the upper face must include an assessment of the brow, upper lids, and lower lids. When indicated, all three areas should be addressed to maintain harmony and prevent a discordant appearance.