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Plastic Surgery of the Eyelids

 

 

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Eyelid reduction (Blepharoplasty)

A blepharoplasty removes excess eyelid bagginess creating a more youthful appearance. This is often done under local anaesthetic as a daystay procedure. Some medical insurance companies will pay for an eyelid reduction if there is a demonstrated functional impairment such as visual obstruction.

Upper blepharoplasty
It is important to first ensure that a browlift is not also required as this may not be able to be done afterwards. The loose fold of skin that hangs over the upper eyelid is removed making the eye appear wider and more youthful. The scar is placed where there is a natural fold of skin and in most cases is difficult to detect after a few weeks. There has been a vogue for removing the fat that bulged around the eye. I avoid this as this may leave a hollow eyed appearance.

Lower blepharoplasty
In a lower blepharoplasty I reposition the periorbital fat rather than removing it. This augments the cheekbone region. It important to reduce lower eyelid folds with a lateral vector to avoid producing ectropian, a hanging over of the eyelid.

Asian eyelids
Some Asian eyelids are characterized by epicanthal folds and absence of a pretarsal crease. Some people seek to have “westernization” of their eyelids which leaves a dramatically different appearance.

I do not perform surgery to excise epicanthal folds as the scarring is too unpredictable. In most cases these folds can be removed by augmenting the nasal root region

Absent pretarsal creases are caused by an anatomical variation of the levator palpebral muscle which does not insert into the deep layers of the skin and instead allows herniation of pretarsal fat above the eyelid. My technique for correcting this involves reattaching this muscle to the dermis and the scars are usually excellent.

Cholesterol deposits. (Xanthelasma)

Xanthelasma is a subcutaneous deposit of cholesterol around the inner eye region. This does not occur without an elevated serum cholesterol and correction of this is an important aspect of management.
It is critical to carefully analyze just how much can be safely removed as the deposits tend to occur in locations away from where surgery for eyelid bags occur. Over zealous excision may cause an ectropian (rolling over of the lower eyelid) 

 

 
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