Tag Archives: blepharoplasty

Structural Changes in the Aging Face

3 Jan

Wrinkles and sun spots aren’t the only things we can expect to happen to our face as we age. There are many structural changes going on below the skins surface that contribute to an aging face that most people would never have noticed when they look in the mirror.

The young face on the left is round, contoured at the cheeks, and has a sharp jaw line (oh and hair and no wrinkles). The face on the right appears narrower, sunken, and droopy.

So besides the integrity of your skin, what else has changed?

Below the Skin

Bone Structure

Let’s start at the ground level. Your bones.

Your bones are always being built up and broken down. The rate at which the bone is broken down slowly starts to exceed the rate at which the bone is being built up as you age.

Bone changes cause:

  • a reduction in facial height
  • Increase in facial width and depth
  • The fat pad under the eye to bulge
  • A change in the shape and projection of the chin

Teeth

Injury and periodontal diseases result in loss of teeth, and it’s not like when you were young and the tooth fairy came and left you a dollar and a new tooth grew in (I hear with inflation it’s like $5 now!).

Loosing teeth affects the jaw bone and the muscles which attach to the jaw bone, which can result in make the face look narrower, hollow, and concave on profile.

Taking care of your teeth is super important, and not just for that pretty smile!

Fat Compartments

Collapsing fat compartments in the cheeks and temples reduce support to the overlying skin (side note: don’t worry! These fat cells go to other places… like your hips! j/k).

Splitting the face into thirds


Upper Third

Most people miss this when they look into the mirror at their aging face, but loss of fat in the temples results in the phenomenon I like to call “peanut head, ” which is also noticeable on super athletic people.

The presence of peanut head reflects a lack of support of the outer brow, which, along with loss of subcutaneous fat in the upper lid, causes the appearance of a droopy upper brow.

Blephroplasty anyone?  (Observing Surgery: Blepharoplasty.)

Middle Third

Eye sockets become wider and longer, resulting in a bulge of the cushiony fat pad that lies underneath the eye.

The cheeks start to flatten out, and the fat from the cheek descends to create a deep nasolabial fold.

The tear trough (area where eye skin and cheek skin meet) becomes noticeable. The middle third no longer has that fluid contour. This loss of fullness and form change causes shadowing in the trough, making a person appear to have dark circles, resulting in a tired appearance (just one of the things that causes dark circles).

Angles of the nose change, giving the appearance of increased length and the tip of the nose begins to droop.

Decrease of collagen and increase in tooth display at rest cause the upper lip to lengthen. Fun Fact: the upper lip can stretch by almost 4mm as you age.

(Stolen from another site…shhhh…) Image A shows a youthful face. Look at the contouring from the eye to the cheek. As you age, it can be convex like image B, which shows the fat pad bulging, or it can be concave like image C, making the eyes look hollow. Both B and C show a flat cheek when compared to Image A.

Lower Third

With all this stuff happening in the upper portions of the face, skin sags and starts to hang in the lower third. Adding insult to injury, the angle of the jaw changes, the jaw line, becomes less defined, and the chin shortens. Excess skin droops from the jaw line from gravity and loss of elasticity. Loss of ligament support in the jaw leads to the formation of jowls.

Even with droopy skin, the lower portion of the face starts to look smaller than the upper and middle third.

advancedskinwisdom.com a

(This image was also stolen).

What are your options?

Don’t worry. There are things you can do for volume loss! They do NOT include Oil of Olay, although the new commercial on tv claims it can (they lie).

Injections

For advanced volume loss, Sculptra is really the best injectable product. This product is a biostimulator; it works by stimulating your body’s own natural collagen. Results are the most natural of all the fillers, and the product lasts 2 years. I plan on writing a lot more about Sculptra, so stay tuned!

If you aren’t mentally or financially ready to jump into Sculptra, Radiesse is a wonderful thick, volumizing filler. It is usually my product of choice for cheek augmentation, naso-labial folds, and marionette lines.

For tear troughs, I LOVE Belotero (which is made by the same company as Radiesse). Filling this area literally takes ten years off your face, but remember, it is a very advanced procedure. Stick to a friend’s referral as to who to go to; I have seen a lot of over treated troughs!

For more help with fillers, check out What Goes Where?.

Surgical

Another option is fat transfer. I have assisted in several fat transfers; it is a very interesting procedure. If you are planning on liposuction, I highly suggest inquiring about fat transfer as well.

For sagging skin around the neck and jaw line, surgery is the only real option to date.

XOXO, old LK

(I found the ‘Age My Face’ Ap… yes… there’s an ap for that!)

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Why I Chose To Have an Eyelid Lift

28 Aug

A Note from Me:

The following is a note from a patient about their experience with blepharoplasty, or an eyelid lift. The patient has been a client and friend of mine for years, and had started doing Botox to lift her eyelids, although ultimately, she wanted surgery. I encouraged my client to talk to a plastic surgeon, just to get an idea of what the surgery was like, and when would be the best time for her to undergo this procedure. The patient decided to book surgery after her consultation.

I was able to assist in the procedure at the Newton Surgical Center location. Because the patient was also a friend of mine, we had previously arranged for me to take care of her post-op as well. The surgery itself was only about 2 hours start to finish. The patient stayed home for the next few days, but had very little pain or swelling. The best advice we can give: keep frozen peas in plastic baggies in the freezer and switch them out every 20-30 minutes. Ice decreases swelling, and the peas are light weight and mold to the shape of the eye. I knew there was some use for those things (I am not a fan of peas!).

I would like to thank this client for sharing her story!

(Do you like my shirt? I thought the eyes were appropriate for this post! Wow… I officially have started matching my outfits to my blog posts… maybe I’m becoming more like my mother (the kindergarten teacher) who has a festive turtleneck for every holiday of the year. I did match my diva weave to the Fourth of July this year…)

  • LK

Blepharoplasty (Eyelid Lift)


Blepharoplasty, or “Bleph,” is a surgical modification of the eyelid. Bleph’s are performed both for functional and cosmetic reasons. Cosmetically, the heavy, drooping eyelid gives the illusion of a tired appearance. The lower eyelid bleph is almost always done for cosmetic reasons, to improve the appearance of “bags” and puffiness. (In my experience, eyes are the most concerning feature for women in regards to aging.)

In severe cases, where vision is compromised, everyday tasks (such as driving) can be hazardous. An eyelid lift gives the patient a more awake, alert and youthful appearance and increases the field of vision.

Source: Center for Advanced Facial Plastic Surgery


Whether one is looking to treat their upper lid, lower lid, or both, this procedure is generally the same.  Blepharoplasty is usually performed under local anesthesia in an office or hospital setting.  I’ve assisted in many bleph’s (Observing Surgery: Blepharoplasty).

A crescent shaped incision is made either in the upper eyelid fold or next to the lash line on the lower lid.  Excess skin and fat are removed and small, inconspicuous sutures are left behind.

    


After surgery is complete the eye area can bruise and swell.  Cold compresses (or peas!) can be applied gently to minimize these effects. Antibiotic ointment also needs to be applied for the first couple of days to prevent infection.  Patients will return to for a follow up a week after surgery monitor the healing progress and most return to work soon after that.  The incision lines will fade after approximately two months, but are barely visible.

A Note from a Patient:

I can remember as far back as 6th grade having heavy eyelids. I am almost – and I say almost – 60 years old. For the past 10 years or so, I found myself constantly raising

my eyebrows in hopes that it would raise my eyelids. It became just so natural for me to do that – hence – wrinkles. Can’t win!!

Then I met Laura. Here I am – Miss Deathly Scared of Needles – and I had no qualms about getting shot up with Botox. Instantly there was an amazing difference. She was able to raise my brows so that it took an edge off of my drooping.

As a couple of years went by, I just got to the point where it just wasn’t enough for me. Hey, I am approaching 60, how long am I going to wait to become 40 again. Laura talked to me about seeing a doctor to get my eyes done. He was running a special time of the year sale and who doesn’t like a sale?? But seriously, I made the appointment and met the Dr. I felt so comfortable with his approach and what he had to say.

Originally, I had only wanted to get my top lids done. I had been so focused on them for so long that I didn’t even think about underneath the eyes. The doctor explained the full procedure to me (both top and bottom) and recommended I do both lids. He showed me the excess skin I had, and suggested once I did the tops, I would definitely want to do the bottoms (they were pretty saggy as well!). He said it didn’t make sense to do surgery twice. I was very happy with what he told me and made the appointment.

I was more excited than I was nervous on the day of my surgery AND lucky. I had my own private nurse. Laura picked me up and brought me in for the surgery. She actually stayed and watched the surgery for more of that unstoppable knowledge that she craves. I wasn’t totally knocked out, so I have very faint bits of hearing some things. Apparently, I wanted to get up and help. How thoughtful of me!! When I was done, Laura took me home and took care of me (as much as I can remember). Thank goodness for peas, the best home remedy in the world.

My recovery was so fast. I didn’t have any problems at all. It was amazing. I chose to stay in the house for almost a week just because I am so vain and it forced me to stay home and work. From being so healthy and constant peas on my eyes, my lids started healing over the stitches so they took them out early. Four of my friends came over to see me one day to bring lunch. I think I was in the very purple stage. No one wanted to say anything. My cousin told me later that she was scared to death looking at me. I knew how bad I looked. Now they all can’t believe how amazing my eyes look. I absolutely love them. AND the funny thing is that with all the focus on the lids, the best thing I did was underneath the eye. I would do it all over again in a heartbeat.

Other patient experiences:

Why I Chose to Have a Tummy Tuck.

Observing Surgery: Blepharoplasty

24 Feb

Case Study:

Today I assisted in a blepharoplasty on both the upper and lower lids of a man in his late 50’s. Interesting right? This stuff is not just for women. And before you have any thoughts about it being a gay man you are completely mistaken. This man was a blue-collar, married man.

This patient’s wife, mother, and other relatives had undergone the same procedure. His upper lid was so saggy it impeded his vision tremendously. Genetics plays a large role in how we age, and considering this man had a number of family members who had undergone the procedure, saggy lids clearly ran in his family tree. The women in his family had such great results; the patient was ready to go under the knife. In 3 hours time, he looked about 20 years younger than when he walked in the door, but the most important part for this patient: his vision was improved! He couldn’t believe what a difference it made!


Time:

10:00 am : Patient is given oral sedation and pain medicine. The procedure is done under conscious sedation (patient is awake but comfortable).

11:30 am : Patient has reached adequate level of sedation. Patient is marked on the lids, where the surgeon will be cutting, and local anesthesia is injected into the area.

12:30 pm : The right eye is finished. Top and Bottom lids have been cut and stitched. The patient already states his vision is improved! AND he looks 20 years younger!

1:30 pm : The left eye is finished. Top and Bottom lids have been cut and stitched. The patient is shown his results. The eye is then taped at the sides to kept tension off the sutures.

Stats:

Total time of procedure start to finish: 3 ½ hours

Total time taken off patients face: 20 years

Total cost to patient: $5,250 (Upper only is $3,250 and Lower only is $3,250)

Follow up: The patient will return in 1 week to have the “tension tape” taken off and the non-dissolvable stitches removed (both dissolvable and non-dissolvable are used).

Downtime: About a week of being black and blue, and having the tape on your face. Tape is in though… Tape is the new black! (Just kidding).


(From the ASPS website)

Also known as a “Bleph.” The technical term for eyelid surgery. It improves the appearance of the upper eyelids, lower eyelids, or both by giving a rejuvenated appearance to the surrounding area of the eyes by removing skin and fat. The result gives a more rested and alert appearance.

Almost 200,000 Bleph procedures were performed in 2011, and it remains in the top 5 most popular cosmetic surgery procedures.


Treatable conditions:

  • Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids.
  • Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision (like in the case study!), can be treated by eyelid lift surgery.
  • Lower eyelid blepharoplasty can remove excess skin and fine wrinkles of the lower eyelid.
  • Bags under the eyes can be corrected by blepharoplasty.
  • Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris (colored portion of the eye).

Is it right for me?

A blepharoplasty procedure is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

You should undergo blepharoplasty surgery for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Good candidates for cosmetic eyelid surgery are:

  • Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
  • Non-smokers
  • Individuals with a positive outlook and specific goals in mind for blepharoplasty
  • Individuals without serious eye conditions

You must tell your doctor if you have any of these medical conditions:

  • Eye disease such as glaucoma, dry eye or a detached retina
  • Thyroid disorders such as Graves’ disease and under or overactive thyroid
  • Cardiovascular disease, high blood pressure or other circulatory disorders or diabetes

Prevention

If sagging lids run in your family, there are things you can do to prevent going under the knife. Botox is used to lift the lid (but it can only lift so much). Ulthera is also being used as an alternative to surgery. But remember, non-invasive and minimally invasive treatments won’t give you the extent of the result surgery will. If you start doing this alternative procedures at a younger age (say mid 30’s) you are more likely to prevent the need for surgery.

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