Eyelid Surgery (Blepharoplasty)
As we age, the upper and lower eyes develop loose skin and excess fat that creates puffiness. Dr. Rizk favors minimally invasive techniques to remove excess skin and fat and rejuvenate the upper and lower lids. Most patients are able to return to normal activity within one week, looking more refreshed and youthful.
Dr. Rizk employs an advanced scarless technique using an incision inside the lower lid (transconjunctival) and reducing wrinkles with laser surfacing or skin excision as indicated. Blepharoplasty can rejuvenate puffy, sagging or tired-looking eyes by removing excess fat, skin and muscle from the upper and lower eyelids. It may be performed for cosmetic reasons or to improve sight by lifting droopy eyelids out of the patient's field of vision. The procedure is usually performed in an office with local anesthesia in as little as 45 minutes. Blepharoplasty can be combined with a facelift or BOTOX® treatments to raise the eyebrows or reduce the appearance of wrinkles, crow’s feet or dark circles under the eyes.
Dr. Rizk is a double board certified facial plastic surgeon who specializes in plastic surgery of the eyes, brows, face and nose only. He is one of a handful of surgeons with this expertise. Dr. Rizk is not a general plastic surgeon and does not perform plastic surgery on the body. Dr. Rizk has presented his techniques at conferences and published his rapid recovery methods for a natural look in the most prestigious journals of plastic surgery.
Dr. Rizk published his techniques and algorithm for analysis and treatment of the lower lid in
Plastic and Reconstructive Surgery Journal (2003). Dr. Rizk’s article on blepharoplasty speaks about making eyes look youthful and not hollow. He performs a scarless technique for lower lids with no external scar. He also performs a modified version of upper eyelift to address the sagging hooded eye.
What are the aging changes associated with the eyelids?
As we age, the upper and lower eyes develop loose skin and puffiness. The quality of the skin also changes and may become wrinkled, especially in thin-skinned people with sun exposure. Crow's feet develop on the sides of the eyes. The puffiness under the eyes is hereditary and may occur at an early age from weakening of the layer of tissue that holds the fat in the eye (orbital septum). As such, the fat may protrude through this weak layer and appear as puffiness under eyes.
What are some contraindications to having eyelid surgery?
A history of thyroid disease, dry eye, or any ophthalmological disorder needs to be evaluated and may preclude a patient from having eyelid surgery. A medical clearance is always obtained to check the patient's medical condition and an ophthalmologic evaluation may sometimes be warranted if the patient has a history of eye diseases or dry eye.
What does a blepharoplasty do and how long does it last?
Basically, the procedure removes excessive drooping skin and sculpts/redrapes/removes bulging fat. The net outcome is younger appearing eyes that look brighter than before. As a rule, the results are most impressive and long-lasting (up to 15 years). Just think for a moment: When you talk to someone, she/he invariably looks at your eyes - the "window" of your soul - and judges your age according to how they appear. Of all the features of aging on the face and neck, the ones that respond best to surgery and last the longest, are the eyes and the double chin. Depending on your appearance and your age, the eyelid operation can reduce your visible age anywhere from 5-15 years, or even more.
How do I choose a surgeon?
Your best choice in selecting the right doctor is to look for a surgeon who specializes in facial plastic surgery; one who has an extensive background of experience to give you a safe and successful outcome; and preferably one who is an artist, since this operation requires skills for making surgical incisions precisely to remove redundant skin and fat. Realize also most eyes and brows are not symmetrical. Attempts are made to vary amount of skin removal to create more symmetry. Some incisions are placed in natural creases above the eyelids but some outside natural creases on the corner upper eyelid hooding to lift the corner upwards. Furthermore, the experienced doctor will not only rejuvenate your eyelids, but will also remove the droopy skin that many people have at outer edges of the eyelids in the areas of the smile lines. Selecting a board certified facial plastic surgeon is also important. The best recommendation is from a friend who has had work on his/her eyes.
How does Dr. Rizk's technique differ from the traditional approach to eyelid rejuvenation?
Dr. Rizk's technique for the upper and lower eyelids is based on the concept of a natural result which avoids the older "hollowed eye look" . To do this, Dr. Rizk conservatively removes some fat, while also sculpting fat with the laser and also repositioning it into deeper creases at border of eye/cheek regions.
Additionally, his eyelid incisions in the upper eyelids curve upwards on the corners to lift the corner hoods up, rather than place the incision lower in a crow's feet, which may lower the eyebrow. Additionally, he uses the laser to sculpt the fat pads in the upper eyelids rather than remove them which avoids the hollowed appearance.
In the lower eyelids, Dr Rizk favors the reduction of fat pads through the scarless transconjunctival approach (incision inside eyelid, rather on outside), and fat sculpting with the laser and repositioning, again to achieve a natural contour, rather than older fat removal techniques. For a smoother result the skin of the lower eyes and crow's feet is either lasered with the Fraxel co2 laser or a pinch of lower eyelid skin is removed if it is redundant. Dr. Rizk published a landmark article in Plastic and Reconstructive Surgery Journal and created an algorithm for the lower eyelids which combines newer treatments with the older techniques and discusses how to obtain an excellent result and avoid ectropion or malpositioning of the lower lid. This article is in "in the news" section of website.
What is laser blepharoplasty?
Laser blepharoplasty is one in which a laser is employed during procedure to change or cut some of tissue. Dr. Rizk utilizes the latest Fraxel-co2 laser technology both in cutting and sculpting the muscle and fat as well as to smooth the skin under the eyelids. The laser use results in less bruising and swelling and is part of Dr. Rizk's rapid recovery protocol. For more information on the fraxel-CO2 laser see the laser section of this website. The laser may not be used in some cases on the skin of darker skin individuals.
The upper blepharoplasty incision?
The upper lid operation should always have a fine line, hairline incision placed in the normal crease of the eyelid-the one you have had since birth-where it will be mostly out of sight. If you have drooping skin on the outer aspect of the eye in the region of smile wrinkles, this can also be included in the excision. This excision of lateral excess hooding has been modified by Dr. Rizk to lift the corner upwards and open the eye, rather than curve down and bring the eyebrow down. This will leave a fine line in this lateral hood region resembling a crow's feet. After removing the redundant droopy skin, the underlying bulging fat is sculpted, trimmed and repositioned as needed and the incision is meticulously closed with as little sutures as possible (the more sutures used it may leave pimples or milia which can be removed later). Dr. Rizk uses very fine, non-reactive removable sutures. Dr. Rizk does not use absorbable sutures as they leave a tiny skin reaction when they absorb.
The lower blepharoplasty incision?
The major problem in the lower eyelids is usually the bagginess or puffiness produced by fat protrusion (herniation) of fat under the eyes. Consequently, this operation is often done by placing the incision on the inside of the eyelid (transconjunctival) where it is completely invisible. After removing, sculpting and redraping the redundant fat, if redundant skin is also present, it will be excised with a pinch from a small line under the eyelashes or the wrinkled lower eyelid skin may be lasered.
What anesthesia is employed? How long is procedure?
Either local anesthesia with sedation or general anesthesia is used. If only the upper eyelids are performed, only a local anesthetic is needed and procedure takes 45 minutes. If upper and lower eyelids are performed, then either sedation or general anesthesia may be used. The procedure for upper and lower eyelids together takes approximately 1.5-2 hours. Patient returns home same day as surgery and stitches are usually removed at 5 days after procedure. Occasionally some stitches in corner of upper eyelids where tension may be greater are left longer.
How about recovery?
The healing of the eyelids is extremely rapid in most patients, which enables sutures to be removed at 4-5 days. Sometimes there is a little bruising, especially in light-skinned people. It takes about one week to look well in most cases, but this depends on extent of work performed and patient's healing ability. Dr. Rizk sometimes employs certain herbal medicines like arnica montana, vitamin K and other supplements to expedite recovery. There is usually minimal pain after the procedure. Because of some swelling, it is normal not to be able to close the eye completely after the procedure for the first few weeks and ointment is prescribed to keep the eyes moist at night. As Dr. Rizk is very conservative in skin excision, the eye always closes after swelling resolves. Most patients do not even notice this mild inability to close eyes in first few weeks as it may only be 1mm.
Can this procedure be combined with other procedures?
An eye lift may be performed as a separate procedure or combined with laser resurfacing of the skin, a browlift, or a face/neck lift.
What the Eyelid Operation Will Not Do
The blepharoplasty operation by itself will do very little to reduce wrinkles around the eyes in the crow's feet region or under the eyes unless it is combined with the laser. Sometimes chemical peels may be recommended or creams in patients who are not good candidates for the laser. The skin resurfacing is the only method of reducing the wrinkles around the eyes and is usually done at the same time with the laser. Botox may be necessary to maintain crow's feet reduction after the procedure.
What is the role of fillers or fat injections in the lower eyelids?
Fillers such as Juvederm or Restylane may be used in conjunction with lower blepharoplasty but not in place of it because fillers are good for the crease between the lower eyelid puffiness and the cheek area but they do not correct the lower eyelid puffiness or redundant or wrinkled skin. They would merely camouflage the crease created by the puffy lower lid and the cheek region and their use is only temporary. Most often, this crease disappears when the lower lid puffy fat pockets are trimmed, sculpted and redraped and most often the fillers are not needed. Dr. Rizk does not recommend the use of fat injections around the eye region as they have been implicated with rare cases of blindness and often leave prolonged bumps and often worsen the bags. Even Restylane and Juvederm can form bumps and lumps for up to 2 weeks or longer after injection. Fillers can also cause bruising and swelling for 2 weeks. He prefers to use Restylane than Juvederm in the lower eyelid crease if needed in rare cases because it does not migrate as Juvederm does more frequently.
How much does it cost?
Cost depends on each individual patient, whether they are doing upper, lower eyes or both and whether laser is being used. Also, prices differ depending on whether it is a revision or primary blepharoplasty. For best assessment of price, a consultation is recommended. If you decide to have surgery, the consultation fee will be deducted from your surgical fee.