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In upper eyelid surgery, what technique will provide the best result, with less...

Q:

In upper eyelid surgery, what technique will provide the best result, with less scarring and long lasting results: using a "cool" laser or the traditional method?

A:

If it were a member of my own family, I would recommend the traditional method. The scar is 95% in the eyelid fold and cannot be seen. In most cases, there is excess skin as well as fat that must be removed, and this necessitates the traditional method.

Stephen A. Brown, M.D., FACS
Clinton, CT

A:

Upper Eyelid Surgery - Upper Blepharoplasty

Very few plastic surgeons use a laser for upper eyelid surgery. The real concern with upper eyelid surgery is making sure the upper eyelid is not left looking hollow.

 

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume candramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery – it just looks youthful.

 

A:

Upper Eyelid Surgery - Upper Blepharoplasty

Very few plastic surgeons use a laser for upper eyelid surgery. The real concern with upper eyelid surgery is making sure the upper eyelid is not left looking hollow.

 

My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.

The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.

Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume candramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery – it just looks youthful.

 

A:

Best Results with Eyelid Surgery – The optimal result for eyelid surgery is by using the traditional method with a scalpel. There are no studies that show that laser or any other radiofrequency blepharoplasty techniques are better. These are excellent marketing techniques, but have no real advantage other than potential risks and expense.

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