Dr. Buckinghams Q&A

Question:
I’m from Austin, Texas. I think both my eyes could benefit from eyelid surgery, but one eyelid is droopier than the other. Will surgery be able to make them more even?

Answer:
Usually asymmetry can be improved with eyelid surgery. Review of the blepharoplasty photo gallery indicates these results. However, sometimes the difference is due to bony orbital differences that can’t be changed. One of the items addressed at the consultation should be to determine what the cause of the asymmetry is and what it will take to correct it.

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Question:
Are aging problems of the lower eyelid mostly due to saggy skin or is excess fat ever a problem too?

Answer:
In my opinion aging problems of the lower eyelid are mostly due to a loss of fat in the upper portion of the cheek forming a hollow at the inferior aspect of the lower eyelid. The second most common cause is orbital fat which protrudes forward. Wrinkling of the skin is also a contribution but less common than the previous two. We often combined treatment for all the causes which would include reduction of orbital fat, augmentation and the upper cheek orbital groove and improvement of the skin through either resurfacing modalities or at times skin removal.

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Question:
Are there any medical reasons for blepharoplasty that would allow my insurance company to pay for the surgery?

Answer:
Significant upper eyelid skin redundancy may lead to visual field obstruction. There is a test that can be performed by an eye physician to document this obstruction. For a patient that has a functional eyelid obstruction we refer them to an oculoplastic surgeon. Insurance companies have more favorable reimbursement policies with ophthalmologists for functional upper eyelid issues.

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Question:

A friend of mine from Austin just had eyelid surgery and she looks amazing! She said it was transconjunctival blepharoplasty, which I’d never heard of before. What is this? Is it better than regular eyelid surgery?

Answer:

A transconjunctival blepharoplasty is a blepharoplasty for the lower eyelids which is performed by making an incision inside the eyelid. It is usually combined with either transposing lower eyelid fat into the upper cheek or utilizing fat grafting techniques to fill in the upper cheek orbital groove. The procedure has less risk of eyelid malposition or scarring then techniques which incise the skin.

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Question:
I’m from Austin and I’d like to get an eyelid lift. I recently heard of a laser eyelid lift procedure. Are their benefits of using the laser? Is this a good technique for everyone or are only certain people candidates?

Answer:
There are no advantages to using the laser for an eyelid lift or blepharoplasty. The laser is a cutting tool which is used to perform the procedure, however this can also be done with old-fashioned scalpels. The advantages of using a scalpel is that no injury occurs to the surrounding tissue so that when the incision is sutured the cells are healthy. The laser causes significant thermal injury to the surrounding cells and so therefore healing may be delayed. Lasers tend to draw an audience however they are not necessarily better.

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Question:
Is blepharoplasty the only solution for droopy eyes? I am 66 years old, from Lakeway, and the skin over my eyes droops down too far. Aren’t there any non-invasive techniques that could tighten up the skin in this area?

Answer:
For most individuals a blepharoplasty is the procedure of choice for droopy eyes. Some patients however have an additional problem of the eyelid itself being depressed and they need a procedure called ptosis surgery which involves shortening of the upper eyelid muscle. On occasion, injectable fillers may be used to improve the appearance of the eyelid without surgery.

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Question:
I am a 42-year-old Asian woman and I’ve recently moved to Austin. I have had bags under my eyes for the past 10 years or so, and they seem to be getting worse and worse as I age. The bags have a full appearance to them, not like loose skin. Would lower blepharoplasty work on someone like me?

Answer:
A lower eyelid blepharoplasty is the usual procedure to remove eyelid bags. Often there is a teartrough or orbital hollow inferior to the orbital bag. This is usually filled with autologous fat or filler to improve the results.

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