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Plastic surgeon or ophthalmologist for eyelid surgery?
Eyelid surgery is performed by several specialties and a question like this can have some controversy.
There are some financial interests which has created very unprofessional interspecialty
rivalry which occurs particularly when one group of surgeons claims superiority over
the other.
As a cosmetic oculofacial plastic surgeon for over 20 years, I have a unique perspective
as a specialist who has performed revision surgery for people coming to us from all over
the world.
A significant group of these patients needed extensive revision and were operated on by
board certified surgeons of several specialties.
Within every specialty performing eyelid surgery, there is going to be variability in every
individual surgeon’s technical skills, artistry, expertise and experience.
I would also state that communication with patients is critically important when you
are making a decision about finding a surgeon.
Someone who spends time with you and understands your personal aesthetic values and what you
want to see improve is absolutely necessary to achieve the goals you have.
My advice is to choose a specific surgeon rather than choosing a specific specialty
for your procedure.

What recovery like after eyelid surgery?
Eyelid surgery recovery is in clinical practice typically a process, which begins with a foundation
of proper diagnosis, meticulous execution of the surgical procedure and close attention
to the immediate postoperative recovery process.
Our patients are advised to apply cold compresses to the eyes 20 minutes on and 20 minutes off
while awake for the first 48 hours.
In addition, application of antibiotic ophthalmic ointment is part of the aftercare.
Our patients have minimal discomfort and often report having experienced no pain.
Most of our patients are able to go back to work in about 1 week.

What’s Best for Under Eye Wrinkles: Lasers, Radio Frequency, or Surgery?
Understanding the skin under the eyes is critical to the success of any treatment plan for under
eye wrinkles.
The skin under the eyes is less than half a mm in thickness so application of any heat
based therapy needs to be customized.
The goal of treatment is to increase the volume of collagen in the skin.
Collagen generation can be accomplished by careful thermal stimulation.
In our practice, we routinely use the fractional CO laser for lighter skin patients and Pellevé
radiofrequency for darker skin patients.
in addition to thermal collagen stimulation, we also employ regenerative medicine technology
through the application of platelet-rich plasma or PRP which is derived from your own blood
and is a concentration of the wound healing factors which stimulate collagen formation.
Understanding the basis for wrinkles under the eyes and developing the best strategy
for you is the key to getting the results you want.

Can Surgery Remove Wrinkles Around the Eyes?
Wrinkles around the eyes can be classified as dynamic which means the wrinkles appear
when the muscle is activated such as crow’s feet lines.
Wrinkles can also be defined as static which are present without muscle activity.
Blepharoplasty specifically does not address wrinkles unless the wrinkles are within the
skin that is being removed as part of the blepharoplasty. in our practice, we treat
dynamic wrinkles with medications such as Botox® and Dysport.
For static wrinkles, we employ regenerative methods such as platelet-rich plasma or PRP
to build collagen and improve skin quality as well as fractional CO2 laser and radio
frequency technology.

What’s the Best Cream for Under Eye Bags?
Creams do not directly address under eye bags caused by lower eyelid fat prolapse.
Although there are many creams which claim to address under eye bags don’t really work.
This is because fat which is prolapsed needs to be corrected surgically.
However, creams can be of benefit to enhance the texture and color of the fine skin under
the eyes.
In our practice, we developed skin products which have amongst them under eye creams for
the purpose of skin quality improvement.
Many people go to the popular retailers and buy everything for under eye dark circles
and puffy eyes they can find.
I would suggest meeting with a professional who understands the under eye area and simplify
the skin care products which are right for you.

Is Eyelid Surgery Safe if I have Dry Eyes?
As an Oculofacial Plastic Surgeon, I am first trained as an eye surgeon so dry eye conditions
are quite familiar to me.
Dry eyes can range from mild to severe.
Each person with dry eyes needs to be evaluated to optimize the lubrication of the eyes prior
to undergoing cosmetic eyelid surgery.
if you think of the eyelids in terms of their major function of protecting and lubricating
the eye then you understand my statement that “eyelids that look good, function well”.
This means that the upper eyelids need to close properly and move up and down without
resistance.
The lower eyelid position has to be stable and support the tear film appropriately so
the upper eyelid can function like a “windshield wiper” to distribute the tears over the
cornea.
This being said, I have performed eyelid surgery successfully on patients with severe dry eyes
including people with conditions such as Sjogrens syndrome, rheumatoid arthritis and Thyroid
eye disease.

When can I Go Back to Work after Eyelid Surgery?
In the modern world quick recovery is critically important to our patients.
In order to help our patients return to work as soon as possible we’ve developed a system
where we perform our procedures in our own certified operating facilities with a dedicated
team.
We perform blepharoplasty typically with local anesthesia with LITE intravenous sedation
and have a process for immediate aftercare to allow our patients to recover as quickly
as possible.
In our practice, we explain to our patients that most people are able to return to work
within 1 week.
There may be a benefit from using tinted eyewear or camouflage cover up during the 1st week
after your return to work.

I have Dark Skin.
Is Upper Eyelid Surgery Safe for Me?
I Don’t want Keloids.
People with dark skin have unique issue which are important to factor in when planning cosmetic
upper eyelid blepharoplasty.
I actually wrote an article many years ago entitled “Ethnic Consideration in Eyelid
Surgery” to help a growing group of darker skinned people who were previously not being
acknowledged or served by plastic surgeons.
In our practice, I look at the skin type, the relative prominence of the eyes and the
facial structure.
In most situations, planning based on a deep understanding of the skin, facial anatomy
and design of the incisions with meticulous skin closure can result in very nice outcomes.
Choosing to have your blepharoplasty with a particular surgeon should be based on the
surgeon’s experience with dark skin and the style of their results which you can review.
From my perspective, even people with a history of keloid formation in other areas of the
body can safely have upper eyelid blepharoplasty.
Proper evaluation, well executed surgery and compliance with aftercare with close monitoring
by your surgeon over the year after your procedure can help you get best results.

What Type of Anesthesia is Best for Blepharoplasty?
Blepharoplasty or cosmetic eyelid surgery can be performed under local anesthesia, local
anesthesia with intravenous sedation and general anesthesia.
With local anesthesia, the area to be operated on is made numb with a local anesthetic injection.
You are fully awake and aware of the procedure.
With local anesthesia with intravenous sedation, you are given intravenous or “through the
vein” medication which creates a relaxing effect so you are in a twilight or sleepy
state and you’re less aware of your surroundings.
In general anesthesia, you are placed in a very deep state where you are placed on a
respirator with a tube in your throat because you’re unable to breathe on your own.
So which anesthesia is best?
As a practicing Oculofacial Plastic Surgeon for over 20 years, I’ve performed eyelid
surgery with all these anesthesia methods.
In my opinion, the best kind of anesthesia is local anesthesia with intravenous or through
the vein sedation.
We use this method every day in our practice and our patients benefit from a comfortable
procedure with a quick recovery.
This is in contrast to the awareness of pure local anesthesia which can cause many people
to be anxious and the risks and longer recovery associated with general anesthesia.

My under eye bags don’t go away no matter how much I sleep. Why?
Under eye bags which are not affected by rest, allergies
or sinus conditions is typically caused by “lower eyelid fat prolapse”.
Lower eyelid fat prolapse is also referred to as “herniated fat” which means that
fat that was located in a space around the eye called the orbit has prolapsed or herniated
forward resulting in puffy under eye bags.
Many people try to use creams and non surgical solutions however if your eyes are significantly
puffy, the only practical solution is a procedure called lower eyelid blepharoplasty.
Lower eyelid blepharoplasty is a procedure which addresses the puffy under eye bags through
either an external also called a “transcutaneous” approach or from the inside of the eyelid
called the “transconjunctival” approach.
In our practice we routinely perform lower eyelid blepharoplasty through the transconjunctival
approach so we’re able to avoid any external scars.
We perform these procedures under local anesthesia with LITE intravenous sedation so we’re
able to avoid general anesthesia which results in a more comfortable experience as well as
a quicker recovery.