Ask a Surgeon - Eyelid Surgery - I am considering having the hoods over my eyelids removed. Can you tell me the...

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I am considering having the hoods over my eyelids removed. Can you tell me the best...

Q:

I am considering having the hoods over my eyelids removed. Can you tell me the best procedure for this type of operation and what the recuperation time might be? Also, when I interview the surgeon, what are some pertinent questions to ask?

A:

The best method to correct the hooding is to surgically remove the redundant upper eyelid skin and fat and contour the upper lid. Patients are usually back to work within 5-10 days. Sometimes patients with upper eyelid hooding also have sagging of the eyebrows and may, in fact, need a procedure called a brow lift. A board-certified ASAPS-member surgeon can easily evaluate what procedure or combination of procedures will be best. Be sure that you understand the risks of surgery and what to expect during your recovery. Ask your surgeon if he or she has performed many of these procedures and for how long. Most important, ask about board certification. Choosing a surgeon who is certified by the American Board of Plastic Surgery is an excellent method to obtain someone who has a minimum of 5 years of surgical training after medical school, has completed an accredited residency in plastic surgery, and has passed both oral and written examinations. Additionally, selecting a member of ASAPS as your

plastic surgeon helps to ensure a high level of experience in cosmetic surgery.

Malcolm D. Paul, M.D., FACS - View Other Answers by this Doctor

Newport Beach, CA

Practice Website

A:

Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.

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.

When you interview a surgeon be sure they are certified by the American Board of Plastic Surgery. Look at many, many photos that are appealing to you and speak to former patients.