Eyelid Surgery in Manchester, Vermont

I want to discuss the signs of ageing around the eyes: in the upper eyelid, lower eyelid and the adjacent areas which include the eyebrows and the cheek just below the eyes. All of these are the areas of the face that contribute to an aged, tired or sad look around the eyes. What can be done about these problems? Let’s break it down a bit into the different sections.

We start with the upper eyelid. Over time, upper eyelid skin seems to stretch out so that, in fact, there is actually more skin. How do we treat this problem of extra upper eyelid skin? Remove skin. When I was first taught to do upper eyelid surgery, or blepharoplasty, I was taught to take out all of the skin from the skin fold to where the skin changes from eyelid skin to eyebrow skin. That turns out to be a mistake because it is clearly possible to take too much out. Yes, it is necessary to remove some skin but it needs to be done in a careful, conservative way so as not to overdo it. When I do this, I do it in a measured way in order to be sure to leave enough eyelid skin so that there won’t be a shortage. That way we can be confident that patients will be able to close their eyelids after the procedure. After all, that’s their critical function.

In addition to too much skin, fullness in the upper eyelids is often caused by a protrusion of fat. For some reason, the membrane that holds the fat back into the eye socket seems to weaken with time; allowing the natural fat to bulge forward and adding fullness to the upper eyelid. The same, by the way, is true in the lower eyelid but we’ll get to that later. In upper blepharoplasty, in addition to taking some skin out, I also take out upper eyelid fat in patients that require it. Not everybody needs to have fat removed but many do.

The other aspect of what appears to be upper eyelid ageing is, in fact, descent, lowering or sagging of the forehead-eyebrow area that brings the heavier eyebrow skin down into and impinging on the upper eyelid. A lot of people come in saying, “I need to have my upper lids done”, and show me what they want by using their fingers to pull up on their eyebrows. What they are mimicking is the effect of a forehead or eyebrow lift. (To me those terms are the same, forehead lift = eyebrow lift). Many people need to have a forehead or an eyebrow lift done either in conjunction with the upper eyelid blepharoplasty or maybe, in some cases, instead of the upper eyelid blepharoplasty in order to achieve the desired effect.

Let me explain how I do not do the forehead- eyebrow lift.I do not use the old-fashioned ear to ear incision across the top of the head. Instead, I use the so-called endoscopic method, meaning that I make short incisions in the scalp and put a miniature television camera underneath to see what I need to see in terms of nerves, muscles, attachments etc. Then I separate along the bony rim of the eye socket, lift and reposition the entire forehead, and anchor it into place with internal sutures. In my experience this high-tech method gives a much more natural look, is virtually impossible to overdo, and no one ends up with the“deer in the headlights” surprised look that some people are worried that they could get with a forehead lift. The other advantage is that I do the procedure without removing any scalp or shaving any hair so there is no alteration in hair pattern and no need to change hairstyle.