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upper blepharoplasty -Upper
blepharoplasty is a general term used to describe the
most popular eyelid surgery through an incision in the
crease of the upper eyelid to remove skin, protruding
fat, and/or muscle. The amount of skin to be removed
is carefully determined before surgery by pinching the
skin to demonstrate and measure how much excess can
be removed and still allow the eyelid to close. Upper
blepharoplasty could also technically include asian
eyelid surgery since this is surgery on the upper lids.
(see asian blepharoplasty below)
lower blepharoplasty -Lower
blepharoplasty is also a general term to describe any
surgery on the lower eyelids. This can be done through
the skin just under the eyelashes (see transcutaneous
blepharoplasty below) or through the inside of the eyelid
(see transconjuntival below). Lower eyelid surgery using
either technique can improve the contour of the under
eye area, but it does not treat fine skin texture problems.
A chemical peel or
laser resurfacing
is needed for fine wrinkling or loss of elasticity of
eyelid skin.
transcutaneous or subciliary
blepharoplasty -(Transcutaneous means through the
skin. Subciliary means below the lashes). For patients
with a significant excess of lower eyelid skin, an incision
just under the eyelashes is made to remove the skin.
At the same time, fat can be removed, repositioned,
or added, if necessary, and at the same time, this incision
can also be used for a midface
lift. Sometimes, removing too much skin can lead
to the lower lid being pulled down (a complication called
lid retraction) or turned out (ectropion) causing the
eye to appear more round and/or more of the white part
of the eye to show (scleral show). A canthoplasty procedure
(see below) done at the same time can help to prevent
this complication.
transconjunctival blepharoplasty
- (also known as "transconj bleph") - Transconjuctival
blepharoplasty means eyelid surgery through the inside
tissue (known as the conjunctiva) of the lid. The trend
right now is to do the majority of lower eyelid surgery
with this technique for patients needing fat removal,
but not skin removal because there is no visible scar.
Since no skin is removed, a chemical peel or laser resurfacing
can be used to smooth the eyelid skin in conjunction
with a transconj bleph. The transconjunctival incision
can also be used for a midface
lift. The transconjunctival incision is not a good
option for patients requiring skin removal, those with
poor lower lid elasticity, or for patients with festoons
(see below).
SOOF (Sub Orbicularis Oculi Fat)
Lift - SOOF is an acronym for Sub-
Orbicularis Oculi Fat, meaning the fat beneath the lower
eyelid muscle at the top of the cheek. A SOOF lift raises
the fat to fill in a depression or hollowness at the
top of the cheek or under the eye. Frequently, a SOOF
lift is inadvertently referred to as a midface lift,
but a true midface lift
is much more extensive and includes repositioning fat,
muscle, and sometimes skin over the whole cheek. A SOOF
lift can be done through the skin or through the inside
of the eyelid.
fat transposition / arcus marginalis
release (AMR)- Sometimes with aging, tissue sagging,
and fat loss, the bone beneath the eye at the top of
the cheek (known as the infraorbital rim) becomes more
visible and creates a noticeable ridge. In patients
with bulging fat just below the eyelashes, but absence
of fat over the orbital rim (bone), the bulging fat
can be rolled down under the muscle (called the arcus
marginalis) to fill in the depression and cover the
bone. This is done instead of removing fat, which can
contribute to hollowness and accentuate the ridge. Although
the fat is moved down and sutured into place over the
bone, the fat remains attached to it's blood supply
so it should remain age normally as it would if it had
not been repositioned.
fat preserving blepharoplasty
- The recent trend in eyelid surgery is not to remove
any eyelid fat, unless it is truly bulging. Removing
fat unnecessarily can create a hollow, sunken appearance
when a youthful lower eyelid is ideally full and rounded.
With fat preserving blepharoplasty the fat can be left
attached but moved it into a better position (see fat
transposition above), or left in place with additional
fat transferred around it to create a smooth contour.
(see fat transfer below)
fat graft / fat transfer / lipotransfer
/ fat injection - Instead of removing fat around
the eyelid, it is often advantageous to add fat which
is naturally lost with aging, or which never was present
in the first place. This is done by removing a small
amount of fat from another area of the body such as
the abdomen or hips, and reinjecting it around the eye.
To prevent lumpiness and fat reabsorption, the should
be placed deep and should only be done by an experienced
surgeon. The fat can be injected either directly through
the skin or through the inside of the eyelid. Click
here to read more about facial
fat transfer.
canthoplasty / canthopexy
- Canthoplasty and canthopexy refer to tightening of
the ligament and/or muscle that support the outer corner
of the eyelid. (A canthoplasty reshapes the eye, while
a canthopexy supports without changing the eye shape.)
This procedure can be used to prevent or correct pulling
down of the lower lid, such as in lower transcutaneous
blepharoplasty. (More advanced cases of lid retraction
may require a graft to adequately repair it). Canthoplasty
can also be used to create the "cat eye" look
with an upwardly slanted outer eyelid corner.
laser blepharoplasty (laser assisted
blepharoplasty) - Instead of making the eyelid incision
with a scalpel, a laser is used in laser blepharoplasty
to cut through the skin. Theoretically this can produce
less bleeding and bruising since the laser cauterizes
the blood vessels and stops bleeding as the incision
is being made. Some surgeons have noticed irregular
scar healing with the laser because it burns the skin
edges, while others prefer the laser for it's precision
and cautery. If a scalpel is used instead of the laser,
an electric cautery is used to seal the blood vessels
instead of the laser. The remainder of the procedure
is the same as with any blepharoplasty.
functional blepharoplasty -
When excess, overhanging eyelid skin obstructs vision,
a functional blepharoplasty can be performed to remove
skin and improve the "function" of the eye.
Some people with overhanging eyelid skin do not adequately
see objects in the upper or the peripheral fields of
vision. Functional blepharoplasty is considered a reconstructive
procedure when it improves visual fields, and insurance
may pay for all or part of the procedure. As required
by your insurance plan, a visual field exam performed
by an optometrist can document whether the vision is
obstructed by overhanging eyelid skin.
asian blepharoplasty (double
eyelid surgery, eyelid crease surgery, anchor blepharoplasty)
- About half of Asian people are born without a crease
in the upper eyelid, creating the appearance of a full
or puffy upper lid. Additionally, a normal asian lid
crease when present is much lower (by about 3 to 5 mm)
than a caucasian eye. The fullness is caused by missing,
weak, or low positioned attachments that normally create
the eyelid crease, allowing the fat normally held back
by the attachments to push forward on the eyelid. The
goal of asian blepharoplasty, then, is to create a fold
in the eyelid and minimize fullness without losing the
ethnic beauty of the patient. (If the fold is placed
too high, it can look unnatural in an asian patient).
The most prevalent technique currently to accomplish
this is sometimes referred to as the "anchor blepharoplasty"
in which the deep skin of the upper eyelid is sutured
("anchored") to the connective tissue of the
underlying muscle. This allows for a crease when the
eye is open, and disappearance of the crease when the
eye is closed.
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