Blepharoplasty Procedure, Los Angeles, Beverly Hills

The upper and lower eyelids behave somewhat differently in the aging process. The upper eyelids tend to become lax and develop loose skin that hangs down, thereby reducing the beauty of an open eye. The lower eyelids tend to also have this looseness; however, the supporting structures tend to weaken, which causes puffiness of the lower eyes due to herniation of internal fat pads. Additionally, the area around the lower eyes tends to become more and more hollow as we age which result in skeletonization around the eyes.

Blepharoplasty, also known as eyelift procedure, has gone through a significant transformation over the past five to six years. In the past, blepharoplasty surgery routinely involved the removal of significant fat, skin and muscle from the eyelid and brow areas in order to obtain what were perceived as “youthful” eyes.

Unfortunately, this approach often resulted in a trend toward hollowness of the eye area and a significant “cat-like” look of the corner of the eyes that looked unnatural and changed the entire appearance of the patient. Also, complications were more common with these types of procedures.

Today we know that the aging changes around the eyes do not simply involve sagging skin. There are multiple components to consider before performing any eyelift surgery, such as hollowness, loss of skin elasticity, drooping of the eyebrows and cheek fat pads and weakness of supporting eyelid structures that lead to puffiness under the eyes.

We don’t just want to address the eyes without considering the rest of the face, so when we evaluate aging eyes, we also want to consider how the forehead and mid face area will not only affect the look of the eyes but how they will be affected in return.

Figure 1-8 The ideal eyebrow position. The brow begins medially through a vertical line drawn perpendicularly from the alar base. The lateral aspect of the brow should terminate laterally at a line drawn obliquely through the lateral canthus of the eye and the alar base. The brow should lie at the same horizontal level and be fuller medially, gently tapering while progressing laterally. The apex of the brow should lie on a vertical line drawn from the lateral limbus.

Through a better understanding of eyelid anatomy, facial analysis and aging changes, Dr. Babak Azizzadeh often utilizes a very different approach to blepharoplasty correction. Depending on the patient, Dr. Azizzadeh’s approach can include the use of fillers/injectables such as Restylane or Juvederm, fractionated laser skin resurfacing, conservative surgical eyelid contouring (Blepharoplasty), fat grafting (Multi-level Fat Grafting), endoscopic brow and/or mid face lift to create the most natural and long-standing results.

Below you will see before and after pictures from a successful Blepharoplasty procedure:

(Left) before and (right) after Upper Blepharoplasty

Endoscopic Browlift & Upper BlepharoplastyEndoscopic Browlift & Upper Blepharoplasty

By carefully examining the eyes in relation to the rest of the face, and considering multiple complementary procedures to create a full, youthful expression, each individual receives a personalized approach to his or her eyelift. The results are natural and involve minimal risks, complications or down-time.

How Does the Procedure Work?

Blepharoplasty is basically eyelid surgery during which excess skin – sometimes in combination with fat and muscle – is removed from either the upper or the lower eyelids. The procedure can be performed simultaneously on both the upper and lower eyelids.

Dr. Azizzadeh will make tiny incisions in the creases of skin (this cuts down on scarring and makes the incisions barely noticeable). For upper lid Blepharoplasty, Dr. Azizzadeh will make the incision in the crease of the eyelid. For lower lid Blepharoplasty, he will make the incision on the inner aspect of the eyelid, thereby avoiding an outside scar (transconjunctival approach). In some patients, it is necessary to also make an incision just below the lashes.

Once the incision is made, Dr. Azizzadeh will separate the skin from the muscle and fatty tissue lying beneath. Once that part of the procedure is performed, he or she will remove or reposition a specific amount of excess fat before trimming muscle and sagging skin for the desired effect. The incision(s) will then be closed with fine sutures.

How Long Does the Procedure Take?

Your upper or lower Blepharoplasty will be performed on an outpatient basis. Dr. Azizzadeh can perform this operation under local anesthesia; sedation can also be used if the patient desires additional relaxation. The surgery will take anywhere from one to two hours, depending on how many – and which – lids are being done.

What Is The Recovery Time?

As far as the recovery time goes, give yourself a solid week to fully recovery. While most patients can return to work within several days, vigorous activity should be avoided for the first week. Bruising and swelling takes about 7 to 10 days to clear up enough for patients to feel comfortable in social gatherings.

What Are the Risks of Blepharoplasty?

            Blepharoplasty procedures are extremely safe with predictable results. The main issues that you need to be aware of occur with lower lid blepharoplasty. The lower lids are very finicky. Aggressive surgical intervention with inappropriate preoperative evaluation can lead to unwanted changes in its shape and lowering of the lid, leading to rounding and widening of the eyes. This can lead to excess show of the white portion of the eye (“scleral show”) and outward turning of the lower lid (“ectropion”). Other risks of blepharoplasty include asymmetry, persistent eyelid hooding and injury to the internal muscles.

The Eyes Have It: Non-surgical Alternatives to the Eye Lift

                Today a variety of non-surgical alternatives exist to treat these critical areas that are so vital to retaining your desired, youthful appearance.

As the art and science of eyelid lift rejuvenation has advanced, there has been a significant improvement in the non-surgical solutions for improving the appearance of the eyes. Over the past decade we have learned that volume loss in and around the eyes contribute a significant amount to the aging process of the area.

As a result, we utilize non-surgical volume restoration to address these changes in appropriate candidates. The main advance in this area is the use of in-office injectables to improve the hollowness of the lower eyes and the laxity of the upper eyelids. The three products that are commonly employed in eyelid lift procedures are Restylane, Juvederm, and fat.

Restylane and Juvederm are hyaluronic products (proteins that are naturally found in the skin). Restylane or Juvederm is generally injected in the tear-trough (hollows) region of the lower eyes and can also be used to reduce the laxity of the upper eyelids by improving the position of the eyebrows. Restylane and Juvederm generally have few side-effects and can last up to eight months.

Botox injections can also be used to reduce the crow’s feet wrinkles in an Eyelid lift procedure, further enhancing the overall appearance. Fat transfer (MFG) can achieve similar results as Restylane and Juvederm. The main difference, however, is that fat can be a permanent solution for about 90% of individuals.

Fat is usually harvested from the abdominal region under local anesthesia and injected in the appropriate regions of the eyes, midface and brows for an eyelid lift. For individuals with significant hollowness and sagging, fat provides a better solution than hyaluronic products.