What are the risks of cosmetic upper eyelid surgery? Cosmetic upper eyelid
surgery can be a highly effective way to improve the appearance of hooded eyes
and drooping eyelids specialized procedures such as Asian eyelid surgery
can be done so you appear as if you were born with a natural eyelid crease that
reveals the beautiful shape of your eyes successfully performed cosmetic upper
eyelid surgery doesn’t draw attention because it looks natural and fits with
the individuals facial characteristics what we do notice almost immediately are
the eyes of people who had either surgery and don’t look like themselves
typically they look tired tight and even surprised eye contact is the foundation
of social interaction so having eyes that don’t look natural can have a
significant impact on so many aspects of your life
cosmetic upper eyelid surgery is a complex art in order to achieve
attractive and natural-looking eyes it’s also a science requiring scientific
precision to the point that the difference between great results and
complications can be measured in millimeters I’ll discuss the risks
involved in cosmetic upper eyelid surgery and what I do to plan and
perform procedures with a high rate of successful outcomes
I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in Manhattan and Long Island for over 20 years I routinely perform
cosmetic eyelid procedures every day in my practice such as lower eyelid surgery
for under-eye bags upper eyelid blepharoplasty
for hooded eyelids double eyelid surgery to create an eyelid crease as well as
specialized oculoplastic procedures such as eyelid ptosis surgery I also
specialize in revision eyelid surgery to help people who’ve had complications
from surgery originally performed by other doctors a significant risk and
concern for patients I see in consultation for upper eyelid
blepharoplasty is excessive skin removal such that the person has difficulty with
eye closure one of the most common indications for upper eyelid surgery is
called dermatochalasis dermatochalasis is a condition where the upper eyelid
skin stretches and thins resulting in redundant folds over the eyes and
creating a hooded appearance I find that the shape created by this hooding
essentially defines the shape of the eyes and makes the eyes look like you’re
tired or angry to treat the hooded appearance eyelid skin needs to be
removed a first impression to how to address excess skin may be to just pinch
the skin and remove what’s being paged it’s actually not so straightforward the
upper eyelid needs to move with ease during blinking and in order to do
properly distribute the tear film over the eyes this means you need to leave
behind enough skin to allow for this action to take place in addition the
skin below the brow may have descended because of the eyebrows being in a lower
position what is referred to as eyebrow ptosis during the skin pinching process
there may be recruitment of skin below the eyebrow which can cause downward
displacement of the eyebrow and keep the eyes looking like they’re still hooded
further the extent of skin removal can actually drag
the eyebrow closer to the eyelid which is not a good look the skin elasticity
is critical when determining the amount of skin that’s needed to be removed for
eyelid surgery if the skin has limited stretch less concedes to removed if the
skin is very elastic more skin needs to be removed when too much skin is removed
the eyelid function can be compromised the patients with skin shortage after
upper eyelid blepharoplasty will often complain of their eye or eyes looking to
open and feeling discomfort with blinking they also report that their
eyes don’t close even when they’re sleeping it’s common for these patients
to need dry eye therapies such as the frequent application of artificial tears
and lubricating gel or ointment to be used at night for patients who come to
me in this situation I typically have to perform skin graft surgery in order to
restore the skin needed for proper eye function so what do I do to minimize the
risk of skin shortage after surgery well I factor in skin elasticity eyebrow
position and I help when I draw my design I spend a lot of time taking
measurements the art is also in the placement of the eyelid crease as well
as where the skin removal should begin and end relative to the inner and outer
corners of the eyes I also provide some estimation as to what the patient’s
upper eyelids will look like by using an instrument or a Q-tip to displace the
skin inward to reveal a more defined eyelid crease cosmetic upper eyelid
surgery is not just about redundant skin but also about fat located in two
distinct areas the first is called orbital fat
there are two fat compartments and the lacrimal gland within the space between
the bone and the muscle that lifts the eyelid called the levator muscle the
volume and position of the prolapsed fat as well as the lacrimal gland have
significant effects on the appearance of the upper eyelid this is why upper
eyelid blepharoplasty is not just a skin removal procedure as the surgeon you
have to be able to anticipate the appearance that will result when you are
sculpting the prolapsed fat in the upper eyelid if too much fat is removed during
surgery it can cause the upper eyelids to look hollow and even droopy the
second area which is relevant to the appearance of the upper eyelids is fat
and soft tissue located below the outer aspects of the eyebrow called the sub
bra fat I focus on this area particularly if the outer part of the
upper eyelids look very heavily hooded the result is a more open space on the
outer aspect of the upper eyelid revealing the true shape of the eyes I
often see patients who had surgery elsewhere and are concerned about having
had too much fat removed they’re looking for a solution to restore some fullness
over their eyes there are several surgical options which
I have performed throughout my career including fat grafting and dermis fat
graft surgery the challenge is that in this area particularly after surgery
there can be a limited blood supply limited blood supply could compromise
the viability of a tissue graft I have found that the placement of hyaluronic
acid filler to restore fullness has been highly reliable in cheating improvement
which can be appreciated immediately the technique I use allows me to place
volume with great precision and my patients don’t have to have a
recovery time as a would after surgery another common issue I see is not
addressing the presence of eyelid ptosis eyelid ptosis occurs when the margin of
the eyelid is lower than it should be the cause of eyelid ptosis is generally
related to the muscle which lifts the eyelid called the levator muscle like
the word elevator without the letter e in the beginning it’s been my
observation that general plastic surgeons choose not to address eyelid
ptosis and if essentially hope that removal of skin and fat will be enough
for a good result as a cosmetic oculofacial plastic surgeon I couldn’t
disagree more with this had in the sand approach when the upper eyelid is too
low you look tired or sleepy so when ptosis is not recognized and
addressed the eyelids will still look droopy after the surgeries performed a
basic fact and point of differentiation between the residency training of
general plastic surgeons in comparison to fellowship training of oculofacial
plastic surgeons is as follows a general plastic surgeon during a residency in a
typical Hospital will have limited exposure to eyelid surgery in comparison
to their exposure to breast hand and other body reconstructive procedures
since residency programs receive support from Medicare it’s unlikely for a
general plastic surgeon to have significant training in cosmetic eyelid
surgery or specialty training in cosmetic oculoplastic surgery otherwise
the taxpayer would be paying for elective cosmetic procedures which is
not supposed to happen cosmetic surgery in oculoplastic surgery training are
examples of fellowship training these are training programs for doctors
after completing a residency as an oculofacial plastic surgeon I first
trained in ophthalmology or eye surgery I then received specialized training
through fellowship in order to learn specialized procedures such as ptosis
surgery if a patient has ptosis and is going to have an upper eyelid
blepharoplasty I can operate on the levator muscle as well as the muscle
behind the upper eyelid called Mueller’s muscle these are not procedures
typically performed by general Plastic Surgeons brighter looking eyes after
ptosis surgery with blepharoplasty can be very gratifying for the patient there
are always risks to any surgery but risks can be reduced through the
experience and expertise of the operating surgeon eyelid surgery is one
of the procedures you don’t want to choose based on cost or by assuming that
all eyelid surgery procedures are the same as business and marketing and
elective healthcare services become increasingly commoditized for example
think about ads for discounted liposuction you as the patient have to
be your own advocate eyelid surgery is unique in that the results of a cosmetic
procedure not only affects your appearance but also affects your vision
I hope you found this information helpful thank you for your question