Upper Eyelid Plastic Surgery Information Resource for Southern California including San Diego, Beverly Hills, Newport Beach, Los Angeles, and Orange County.
Upper Eyelid Surgery (Upper Blepharoplasty)
Consultation for Upper Eyelid Surgery
Outlined below is what you can expect from your upper eyelid consultation. Read carefully, as there are many suggestions that will save you time, answer questions, and help you to convey to your plastic surgeon what it is you want to accomplish.
Health History
All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used but also applies to local anesthesia. Prior to meeting with the plastic surgeon you will be given a health history questionnaire. There are five areas of your health you will be asked about. Be sure to answer questions in detail so that your surgery and anesthesia can be optimized for you.
General Health
General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.
If there are medical problems, Dr. Cruise will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.
If you have a health problem or are over 60 years of age, you can often save time by bringing a letter to your cosmetic consultation from your private physician stating what the problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.
If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.
If you are not able to tolerate general anesthesia, it may be possible for your procedure to be done under local anesthesia. This must be discussed with your plastic surgeon. Often, lower eyelid surgery can be done under local anesthesia.
Past Surgical History
The questionnaire asks about previous surgeries. Of particular concern are previous surgeries in the area that you wish to change. Be sure to identify any problems you may have had with anesthesia.
Medications
Be sure to list all medications, including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin- containing products at least 10 days before surgery. Tylenol is a good alternative.
Allergies to Medications
Information about medications that cause allergic reactions is very important so that these medications can be avoided. Of particular importance is the type of reaction you had, especially if you had trouble breathing. Be sure to include this information! Nausea is not an allergic reaction, but it is important to mention as well.
Smoking, Drinking and Drug Use
These will certainly affect your surgery and must be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift, smoking must be stopped at least 2 to 3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction, smoking will hurt the overall result but this may or may not be noticeable. In this case, smoking cessation is strongly advised but is not mandatory.
Specific Eye Issues
During your consultation you must be very accurate about your eye problems. These include glaucoma, lazy eye, retinal problems, and cataracts. Of particular concern is dry eye. Dry eye is characterized by frequent blinking, red eye, itching and burning. It can be made worse by eyelid surgery, especially if proper measures such as canthopexy or canthoplasty are not taken.
Patients with thyroid disease must be particularly careful with eyelid surgery as it can cause dry eye and/or persistent swelling if it is not controlled. Therefore, it is important to bring documentation of your last thyroid function test to your consultation if you have thyroid disease as this will be a requirement prior to surgery.
What Do You Want To Change?
It is important that you have a clear idea of what you want changed when you go for consultation. No plastic surgeon wants to hear, "What do you think I need done?"
Look in a mirror and identify what bothers you. Be specific. It may be helpful to look at pictures taken when you were younger to see if the problem always existed or if it is simply part of aging. Bring the picture to your consultation, as it may be helpful.
There are 4 things that you should look at regarding your upper eyelid that may need to be treated.
1. Sagging eye brow.
2. Excess skin and/or fat of upper eye lid.
3. Sagging lateral canthus.
4. Droopy upper eyelid.
Dr. Cruise will evaluate these four areas during your consultation. It is a good idea to look in a mirror and go over these areas yourself. It will help you identify what is causing the problem and, therefore, help you understand what needs to be done to correct it.
Physical Exam
Eyebrow Position
The upper eyelid exam starts with evaluating eyebrow position. The two main characteristics are demonstrated in the picture below. The first and the most important one is the relationship of the medial brow to the lateral brow. The lateral brow should be at the level of or higher than the medial brow.
The second consideration is that the brow should be at the level of the orbital rim in men and 1/4 inch above the orbital rim in woman.
Notice that the lateral portion of the eyebrow is well above the
level of the medial eyebrow.
Notice the dramatic effect
of elevating the lateral
brow.
Usually, a formal brow lift is not necessary. Dr. Cruise can often obtain lateral brow elevation by combining the upper blepharoplasty with a temporal brow lift. This requires a small incision right at the hairline of the temple.
Excess Skin and/or Fat of the Upper Eyelid
Skin.
Most patients complain about skin because it is so visible. With age, excess fat/skin will cause a loss of vertical height of the upper eyelid leaving an eyelid that is not capable of makeup application. Sometimes, the redundancy is so pronounced that the skin drapes over the eyelid to the point it impairs vision, especially when looking upward. Skin excess occurs in just about everyone with age.
Fat.
There are two types of fat that are routinely removed by plastic surgeons during an upper blepharoplasty. The most obvious fat is the fat that you can pinch between two fingers. This fat descends from the brow area with age. Usually it is quite thick and located just below the lateral eyebrow.The second fat is deeper. It normally lies along side the eyeball itself. With age, it tends to bulge outward. This is very common in Asians.
Proper evaluation can determine the two different types of fat. In any case, it is often necessary to remove both types in order to clean up the upper eyelid. Once again, there was a time when plastic surgeons routinely removed all this fat but this is no longer considered necessary. Complete removal can lead to a hollowed-out appearance, especially toward the nose. Fat is youthful and must be removed only as needed. If you look at an adolescent, you will see plenty of fat.
Asians typically require a more aggressive fat removal in order to achieve the desired result.
Sagging Lateral Canthus
This is one problem that many plastic surgeons fail to recognize and treat. Dr. Cruise began elevating the lateral canthus early is his career with such an elegant result that he began to perform it routinely. He found that it is especially useful on patients with lax lower eyelids or patients with a downward tilt of the eye. In youth, the lateral canthus is 2 to 3 mm higher than the medial canthus. This is exemplified in the picture of the ideal eyelid above. As we age, this elevation is lost resulting in what many call a "hound dog" appearance.
Below is an anatomic depiction of the descent of the lateral canthus.
 |
 |
| Youthful Eye Muscles. | Aged Eyes. Notice the drooping of the lateral canthus. |
Below is a excellent clinical example and treatment of a patient with descended lateral canthus creating a "hound dog" appearance. Notice how this is usually also associated with a descended lateral eyebrow.
38-year-old female with descended
lateral canthus and lateral eyebrow.
Eyelid Ptosis
This is another upper eyelid problem that many plastic surgeons fail to diagnose and treat. Eyelid ptosis simply means that the upper eyelid sags. In cosmetic patients, the most likely cause is the upper eyelid fat pushing it down. Here fat removal will take care of the problem. Another cause is tearing of a muscle attached to the upper eyelid. This is more complicated to treat, but still can easily be done at the same time as an upper blepharoplasty.
Normally, the upper eyelid is well above the pupil.
With eyelid ptosis, the upper eyelid falls to the level of the pupil. This gives a tired appearance and increases the vertical height of the eyelid on that side. The asymmetry is quite noticeable. If both sides have ptosis, the asymmetry is not as noticeable, but the eyes appear almost shut.
26-year-old female complains that her left eye
(right side of picture) was lower than her left.
Notice how the left upper eyelid touches the pupil,
whereas, the left eye is wide open and bright.
Also notice difference in eyelid height.
After shows both lids at the same level and
similar eyelid height.
Typical Incisions
The amount of skin removal depends on the amount of excess skin present. Here is a typical upper blepharoplasty excision. The end result is a straight line that becomes almost impossible to see after 3 to 4 months.
Upper Blepharoplasty Cosmetic Surgery Information Resource for Southern California including Orange County, Los Angeles, San Diego, Newport Beach, Orange County, and Beverly Hills.