Case Studies Eyelid Contouring

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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a teacher in her early 50’s whose concerns was heavy upper eyelids and under eye hollowness. She wanted to improve these issues but did not want to have general anesthesia.

Pre-operative Assessment

Her upper eyelids had substantial skin excess. Her lid excursion was normal and there was no evidence of lid ptosis. Her under eye area (tear trough) was significantly de-volumized. She had moderately crepe lower eyelid skin as well. Her lower eyelid tone was excellent.

Procedures

She had Restylane® under her eyes to fill in the tear trough immediately followed by an upper eyelid blepharoplasty using local anesthesia in the office procedure room, which is our normal routine. This created a more alert, bright eyed appearance with a pleasing lid platform. Though it was recommended to perform CO2 laser resurfacing of the lower eyelids to tighten and smooth the skin, the patient was not interested. The patient is shown at 1 year following her procedures.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her mid 40’s whose concerns were heavy upper eyelids, puffiness under her eyes, hollowness at the lid-cheek junction and coarseness of her facial skin.

Pre-operative Assessment

Her upper eyelids had substantial skin excess. Her lid excursion was normal and there was no evidence of lid ptosis. Her under eye area had puffiness due to pseudo-herniation of the medial lower eyelid fat, compounded by a significantly de-volumized lid-cheek junction (tear trough). She had moderately crepe lower eyelid skin and generalized course facial skin. Her lower eyelid tone was excellent.

Procedures

Under general anesthesia in an outpatient surgical center, the patient had an upper eyelid blepharoplasty, lower eyelid transconjunctival (through the inside of the eyelid) blepharoplasty and a full face CO2 laser skin resurfacing procedure to improve her lower lid skin laxity and generalized skin texture while assuring a uniform skin color once finally healed. Note that the transconjuctival technique of lower lid fat contouring is preferred, compared to removing the fat from the outside of the lid, as it substantially reduces the risk of changing the position of the eyelid. General anesthesia was indicated in this patient for two reasons: she was having a transconjunctival blepharoplasty, which is uncomfortable when the fat is being removed if only local anesthesia is used and full face CO2 laser skin resurfacing, which is too much to undergo without full anesthesia.

After surgery, she had Restylane® under her eyes to re-inflate the tear trough. This created a more alert, bright-eyed appearance with a pleasing upper lid platform and a smooth transition from lower lid to cheek. The patient is shown at 5 months following her procedures.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her late 40’s whose concerns were heavy upper eyelids and lower eyelid crepe skin changes.

Pre-operative Assessment

Her upper eyelids had substantial skin excess. Her lid excursion was normal and there was no evidence of lid ptosis.  She had moderately crepe lower eyelid skin. Her lower eyelid tone was excellent. The remainder of her exam is unremarkable.

Procedures

Under local anesthesia in our office procedure room, the patient had an upper eyelid blepharoplasty (excess eyelid skin and muscle were removed and the lid contoured) and lower eyelid and crows feet CO2 laser skin resurfacing to improve her lower lid skin laxity and texture

After surgery, she had Restylane® under her eyes to re-inflate the tear trough. This created a more alert, bright-eyed appearance with a pleasing upper lid platform and a smooth transition from lower lid to cheek. The patient is shown at 3 months following her procedures. I chose this follow-up time frame to highlight what a patient typically looks like at this time. The upper lids are slightly swollen and the lower lids are slightly pink. Notice the amount of upper eyelid that can be seen. This is a youthful, flattering look. An overly deep upper eyelid platform, unless pre-existing in the patient’s younger years, is not a flattering look and is to be avoided. At 3 months, patients generally look quite good, however, in time, the eyes will look even more beautiful.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a man in his late 50’s whose concerns were heavy upper eyelids and lower eyelid puffiness.

Pre-operative Assessment

His upper eyelids had substantial skin excess. His lid excursion was normal and there was no evidence of lid ptosis. He had moderate pseudo-herniation (bulging) of his lower eyelid fat pads. His lower eyelid tone was excellent.

Procedures

Under general anesthesia, in a certified outpatient surgical center, the patient had an upper eyelid blepharoplasty (excess eyelid skin and muscle were removed and the lid contoured). To reduce the bulging of his lower eyelids, a transconjunctival blepharoplasty (through the inside of the eyelid)  was done to reduce the fat pads of the lower lid. This technique is preferred, compared to removing the fat from the outside of the lid, as it substantially reduces the risk of changing the position of the eyelid. To address the loose skin, skin was removed with a pinch technique and the incision closed just below the eyelashes.

The patient is shown at 3 months following his procedures. He now appears much more bright eyed and rested. With some additional healing, the mild swelling that remains will resolve.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her early 50’s whose concerns were heavy upper eyelids and lower eyelid puffiness.

Pre-operative Assessment

Her upper eyelids had substantial skin excess. Her lid excursion was normal and there was no evidence of lid ptosis. She had significant pseudo-herniation (bulging) of her lower eyelid fat pads. Her lower eyelid tone was excellent. There were moderate crepe skin changes of her lower lid skin.

Procedures

Under general anesthesia, in a certified outpatient surgical center, the patient had an upper eyelid blepharoplasty (excess eyelid skin and muscle were removed and the lid contoured). To reduce the bulging of her lower eyelids, a transconjunctival blepharoplasty (through the inside of the eyelid) was done to reduce the fat pads of the lower lid. This technique is preferred, compared to removing the fat from the outside of the lid, as it substantially reduces the risk of changing the position of the eyelid. To address the loose, crepe lower lid skin, CO2 laser skin resurfacing was performed. Note that the patient had pre-operative Botox® injected to her crows feet area (which is included when laser resurfacing the lower eyelid) pre-operatively, to keep the skin resting while healing progressed.

The patient is shown at 1 year following her procedures. She now looks much more bright eyed, rested and beautiful. In the future, she is a good candidate for Restylane® filler treatment to address the hollowness of the tear trough (lid-cheek junction).

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.