Dr. Sherwyn performs eyelid surgery in his New York City (NYC) office. Cosmetic eyelid surgery, as a rule, addresses both the skin and fat of the upper and lower eyelid regions. Herein, blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes. Yet, by necessity, cosmetic eyelid surgery must be considered within the context of the overall aesthetics of the periorbital, or eyelid, region. Herein, precision is critical.
Typically, an upper blepharoplasty removes the excess fat and lax, drooping skin of the upper eyelids. Particular attention must be given to providing for clean, crisp, symmetric upper eyelid regions with an indiscernible resultant line of closure. However, a careful examination is required in order to determine an individual's need for a brow lift, upper blepharoplasty, or both. The majority of persons seeking rejuvenation of the upper eyelid region are candidates for both brow elevation as well as upper blepharoplasty. Whether one is a candidate for both procedures, however, does not mandate the need to do both at the same time. Indeed, the brow elevation may be performed prior to the upper blepharoplasty or vice versa. It is imperative, however, that should an upper blepharoplasty be performed first in a patient with brow descent provisions be made to provide for future brow lift by not removing excessive amounts of skin.
For those persons with brow descent who may or may not be candidates for upper blepharoplasty or who have had a previous upper blepharoplasty there exists a relatively new, little known technique called the transpalpebral, or eyelid, approach to the brow. Herein, either at the time of upper blepharoplasty, utilizing a prior blepharoplasty incision or simply utilizing the natural upper eyelid crease that all occidentals maintain, the muscles of the eyebrow region responsible for both folds and furrows as well as brow descent are approached via the upper eyelid and eliminated. Modification of these muscles will automatically effect passive elevation of the brow. When performed properly, this procedure eliminates the need for the use of Botox in this region. A true elevation may also be performed via the upper eyelid, termed browpexy, a procedure particularly useful in the male population or those with a receding hairline. The result is not only a more smooth resultant contour but brow elevation.
Rejuvenation of the lower eyelid may be approached through a variety of techniques and therapeutic options largely dictated by the individual’s specific needs. This is in contradistinction to the upper eyelid where the technique used is largely singular and consistent. Lower eyelid procedures include the transcutaneous, or external, approach to skin, muscle and fat pads, the transconjunctival, or internal, approach to fat pad reduction and/or reposition with/without resurfacing, and a relatively more recent technique referred to as pinch blepharoplasty. The external, or transcutaneous, approach entails the use of an incision just below the lower lashes. Through this incision, excess skin and  muscle may be removed and excess fat removed or re-positioned. However, once again, a careful evaluation is required in order to determine the individual's needs. For example, lax, loose, or malpositioned lower eyelids may require a canthopexy or canthoplasty to tighten or reposition them. Occasionally, the fat itself may be repositioned to simultaneously eliminate puffiness and soften the bony rims which often become evident with facial aging. If lower eyelid skin is not excessive, an internal, or transconjunctival, approach may be used whereby fat is removed or repositioned through an incision placed inside the lid on the conjunctival surface. Herein, there is no external incision and no need for sutures. This approach affords the opportunity to simultaneously use a laser, or chemical peel, to resurface the lower eyelid skin thereby eliminating fine lines and wrinkles while achieving a degree of skin tightening and lightening of dark or deeply pigmented skin, if so desired. The pinch blepharoplasty provides for the simultaneous elimination of excess skin while allowing the surgeon to snug or tighten the lower lid giving particular attention to softening the tear trough or orbital rim, that valley which demarcates and delineates the lower eyelid/cheek junction that so greatly contributes to facial aging. This technique is highly advantageous in this regard for it does not jeopardize lid position nor change the shape of the eye. Again, evaluation of each individual’s specific needs is critical.
To learn more about Eyelid Surgery (Blepharoplasty) offered by New York City (NYC) plastic surgeon, Dr. Sherwyn, contact us today.