Oculoplastics or Oculoplastic Surgery
PTOSIS (Droopy Upper Eyelids)
Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision. For before and after photos of Ptosis, Click Here.
There are many causes of ptosis including age related weakening of the muscle, congenital weakness, trauma, or sometimes neurologic disease. As we age, the tendon that attaches the levator muscle, the major muscle that lifts the eyelid, can stretch and cause the eyelid to fall. This represents the most common cause of a droopy eyelid. Ptosis may also occur following routine lasik or cataract surgery due to stretching of the muscle or tendon. Children may be born with ptosis or may acquire it due to trauma or neurologic reasons.
Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. In severe ptosis, when the levator muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s). Other types of repair may include surgery on the muscle on the inside of the lid in cases of small amounts of ptosis. The surgeon will perform testing determine the best form of correction for the individual patient. The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid.
Your eyes are often the first thing people notice about you and are an important aspect of your overall appearance. As we age, the tone and shape of our eyelids can loosen and sag. Heredity and sun exposure also contribute to this process. This excess, puffy or lax skin can make you appear more tired or older than you are. Eyelid surgery or blepharoplasty (pronounced “blef-a-ro-plasty”) can give the eyes a more youthful look by removing excess skin, bulging fat, and lax muscle from the upper or lower eyelids. If the sagging upper eyelid skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand the visual field. For before and after photos of Blepharoplasty, Click Here.
For the upper eyelids, excess skin and fat are removed through an incision hidden in the natural eyelid crease. If the lid is droopy, the muscle that raises the upper lid can be tightened. The incision is then closed with fine sutures.
Fat in the lower eyelids can be removed or repositioned through an incision hidden on the inner surface of the eyelid. Laser resurfacing or a chemical peel can be performed at the same time if desired, to smooth and tighten the lower lid skin. If there is excessive skin in the lower lid, the incision is made just below the lashes. Fat can be removed or repositioned through this incision, and the excess skin removed. The incision is then closed with fine sutures.
Upper and lower blepharoplasty can be performed together and also can be combined with other procedures such as eyebrow or forehead lift, midface lift, face lift, neck lift, or laser skin resurfacing.
Eyebrow and Forehead Lifting addresses eyebrow position and loose or wrinkled forehead skin and underlying tissue. To fully understand the benefits of eyebrow and forehead lifting, one must be aware of the importance of the position of the eyebrows. Eyebrow position changes as we age.
Our natural eyebrow position, the effects of gravity and fat deflation, how active our eyebrow and forehead muscles are, and previous eyelid, eyebrow or forehead surgeries (if applicable), all contribute to the position our eyebrows are in today. The face sends a message, and the position of the eyebrows is a significant part of that message. That message could be, “I feel worried,” “I feel angry,” or “I feel stressed.” The message could also be, “I feel calm, rested, and relaxed.” There are several types of eyebrow and forehead lifts. The type you and your surgeon choose will depend on your current eyebrow position, facial structure, and on what is possible to maximize your appearance. The main types of forehead lifting are as follows:
Endoscopic Forehead Lift
The Endoscopic Eyebrow/ Forehead Lift is very popular. It requires 5 small incisions hidden in the hair and leaves no visible scar. This procedure can lift everything from the hairline to the eyebrows. It tightens and smoothes the entire forehead while lifting the eyebrow area which “opens up” the entire upper face. Eyebrow shape and asymmetry can be addressed with this type of lift. Following the procedure there will be some bruising and swelling. Patients are usually comfortable returning to their normal routine activities in about 2 weeks. For before and after photos of Endoscopic Forehead Lifts, Click Here.
The Pretrichial Eyebrow/ Forehead
The Pretrichial Eyebrow/ Forehead Lift requires a long incision. This procedure is ideal for patients who want to both lift the eyebrows and raise and shorten the forehead by removing a strip of skin and underlying tissue along the incision. Because the forehead is shortened, the hairline is lowered which is ideal for those with a high forehead. This procedure lifts everything from the hairline down to the eyebrows and can address eyebrow shape and asymmetry. The scar from the incision, once healed, is virtually undetectable. Following the procedure there will be some bruising and swelling. Patients usually return to their normal daily routine in 2 – 3 weeks. For before and after photos of The Pretrichial Eyebrow/ Forehead, Click Here.
The “Gull Wing” or Direct Brow Lift
The “Gull Wing” or Direct Brow Lift requires removing a section of skin and underlying tissue above and following the length of the eyebrows. This procedure is ideal for those who do not want to involve the hairline. The “Gull Wing” beautifully lifts a sagging brow while tightening and smoothing the forehead by pulling the skin and tissue of the forehead down rather than up. It therefore lowers the hairline which is ideal for a receding hairline and/ or a high forehead. This procedure also addresses eyebrow shape and asymmetry. Care is taken to position the scar just along the eyebrows so that it is maximally camouflaged. Patients will experience some bruising and swelling following the procedure. They are usually comfortable returning to their normal routine activities in about 2 weeks.