Thanks for your question regarding upper eyelid blepharoplasty. Blepharoplasty has very good longevity. It is possible that you might see enough age related changes that you could need a slight touch-up in the future, but it can also be life-long. It also somewhat depends on your current anatomical situation. If you have a forehead and brow that is not likely to descend over time then a blepharoplasty may be all you need and it could be the only time you ever have one. If your forehead and brow are not in need of a forehead lift currently, but descend enough in the future, you may need to have a brow lift down the road. It is also possible that you just develop some additional skin laxity over your life that could be improved by a secondary blepharoplasty. There are also laser treatments such as Fraxel that can be performed on the upper lids to improve skin tone. I hope this helps.
I can assure you that you will look like yourself, only better following your facial rejuvenation procedure. More specifically, the reason patients look unnatural after a brow lift is that the brow has been pulled too high, especially the central brow. This gives a deer in the headlights look. We usually perform endoscopic browlifts and focus on lateral elevation which is natural in appearance. Regarding blepharoplasty an unnatural look occurs when incisions are placed out of the natural skin crease and/or too much fat is removed. This gives the eyelid a hollow cadaveric appearance. By utilizing natural incision placement and preserving fat the upper lid maintains its natural look. With the lower eyelid we usually make the incision inside the eyelid, transconjuctival. This hides this incision. Again, only removing fat from the lower eyelid will lead to a hollow unnatural appearance. By performing a fat transfer we are able to fill the lower eyelid groove and cheek to restore volume loss in a natural way. By adding volume we are also able to give natural lower facelift results. A lower facelift can leave an operated look by moving hair from its normal position, poor scar placement or putting too much tension on the closure. We avoid all of these pitfalls with our incision placement and by performing a deep plane facelift. This allows all of the tension to be placed on the tough fibrous layers of the face and leaves the skin tension free.
The best way to convince yourself however, is to review our before and after gallery. I think you will agree that we provide substantial results, but in a natural way. Please feel free to call and to set up a consultation at your earliest convenience.
Thanks for your question regarding fat transfer. In short, no a fat transfer will absolutely not make your face look fat. Depending upon your age, the fat in your face undergoes progressive loss or atrophy. In younger patients this may be limited to just the lower eyelid, as you age it becomes apparent in the other areas of the face. We tailor the fat grafting procedure to each patient based upon where they need the volume replacement. In all patients however we avoid putting fat in the areas of the face in quantities that would give the appearance of being over-weight vs. having a youthful face with good contour. The upper cheek, similar to a cheek implant, and the area under the eye is where the majority of the fat is targeted. This changes the relationship between the cheek and the lower eyelid to give the appearance of a youthful high cheek-bone without augmenting the lower cheek, which is associated with excess weight.
There is a more complete description of fat transfer on this website with many before and after photos. I encourage you to review this section and give us a call to schedule your personal consultation.
What you are referring to is a coronal browlift. This procedure is still performed by some surgeons, but is much less popular now. Currently most browlifts are performed using endoscopic techniques. Occasionally open techniques, such as a coronal incision, are still perfomed, but usually with incisions at the front of the hairline not back in the hair as a coronal lift is. We feel the endoscopic technique is superior because the incisions are smaller, the swelling and bruising is less, the risk of scarring is much less, the risk of hairloss is less and the results are reliable and long lasting.
The social recovery for a browlift, ie. the time it takes to get back in the public eye, is 7-10 days. You will still have some swelling at that point, but the bruising and significant swelling will have subsided. The final result from a cosmetic standpoint is 6 weeks to 3 months. The risk of hairloss from an endoscopic browlift is rare and minimal, and in our hands always temporary.
I hope this has answered your questions. Please review our before and after photos and browlift section for more information. We would love to hear from you in person as well.
Lower eyelid blepharoplasty may be perfomed either by going through the skin or by going inside the eyelid (internal or transconjunctival incision). Under most circumstances we prefer to make the incision inside the eyelid. We do that not so much to hide the incision, as a blepharoplasty skin incision if done correcty can be hidden completely, but because we do not believe that excision of skin in most cases is necessary to produce a great result. Also, skin excision in blepharoplasty carries with it a higher risk of eyelid malposition ie. the eyelid is pulled down showing too much of the white part of the eye and changing its shape. When we perform blepharoplasty we believe that the groove under the eyelid at the junction of the cheek is more important that the eyelid fat contouring. A youthful eyelid must be short in length from the lashes to the junction with the cheek. In order to produce a youthful eyelid the groove under the eyelid must be filled in essentially elevating the cheek and shortening the appearance of the eyelid. This filling can be done during blepharoplasty by repositioning the fatty tissue of the eyelid to a lower position to fill in the groove and elevate the cheek or by using an autologous fat transfer. It can also be done non-surgically in the office by using Restylane or other fillers. We often tighten the skin of the lower eyelid with a chemical peel to reduce the skin wrinkles and add to the result of the blepharoplasty.
I hope this has been helpful. Please feel free to review our before and after photos and of course call us with any further questions or to schedule a consultation. We would love to meet you.
