Blepharoplasty (Upper & Lower) Dallas

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Blepharoplasty refers to the rejuvenation of the eyelids through the removal of excess tissue. For the upper eyelid, Dr. Lam only believes in removing skin in most cases rather than removing fat since we actually lose volume around our eyes. For the lower eyelid, Dr. Lam only believes in removing fat and not skin (the opposite of the upper eyelid) to preserve the eyelid shape. He performs the lower eyelid procedure through a no-incision approach (called transconjunctival) not to avoid a scar but, as mentioned, to preserve the shape of the eyelid. He believes that when the lower eyelid is approached by a skin incision the strength and integrity of the lower eyelid needs to be restored with what is known as a lateral canthopexy or canthoplasty. This maneuver can change the shape of the eyelid unfavorably and thereby alter the naturalness and the identity of a patient. Further, Dr. Lam believes that removal of tissue is only part of the solution to aging. Since volume loss is a vital component, he almost always believes in restoring lost volume through either fat grafting or fillers.

Key Points:

Dr. Lam believes that upper eyelid aging is mainly caused by loss of volume. Most people have a fuller upper eyelid when they are young that becomes progressively deflated as they age. However, in youth one could have a very full upper eyelid (Type 1) or a modestly full upper eyelid (Type 2). In either case, there is still more fullness than is present in aging. This is why Dr. Lam does not believe that just removing upper eyelid skin is the answer in most cases. He likes to use the analogy of the brow like a balloon that deflates as one ages. Accordingly, the loss of fullness makes the eyelid look sagging. He believes that in many cases simply revolumizing the eyebrow (with fat grafting or fillers) will be sufficient to rejuvenate the brow. However, when the upper eyelid starts to truly sag over the eyelashes or become very crepey and wrinkled in appearance, then a simple upper-eyelid procedure will work well.

For the lower eyelid, most times Dr. Lam can simply cover an eyebag with the use of fillers or fat grafting. He likes to use the analogy of rocks (eyebags) along the shoreline that become exposed when the tide is low (the fat around the area has receded to expose the eyebag). However, at times when the eyebag is more prominent then it simply should be removed for optimal results. Removing an eyebag alone can make an eyelid appear hollower (and thereby older). Accordingly, he believes that it is always wise to add some fat or fillers back when an eyebag is removed to create the most youthful shape. He will use lasers to tighten the lower eyelid skin as needed and prefers not to remove any skin. In fact, Dr. Lam does not use any incisions at all, as he performs what is known as a transconjunctival blepharoplasty. He believes that removing skin or making a skin incision in the lower eyelid can change the eyelid appearance in an unfavorable way by distorting the outer canthus. The outer canthus (the junction of the lower and upper eyelid) should be maintained in its position and shape.

FAQs:

How is the upper eyelid procedure performed?

What is the nature of the recovery period? For the upper eyelid, the procedure can be easily performed awake in the office since only the skin is removed. Dr. Lam uses topical numbing cream that makes the procedure virtually painless and fast. Although you are awake with maybe a little oral sedation, he requests that you have someone take you home or hire a limousine/taxi/Uber ride home. The recovery is typically very fast since only skin is removed. Oftentimes there is not a lot swelling or bruising even during the first week and the sutures are often well-hidden when the eyes are open. However, it is advised to take a week off from work just in case there is some bruising or swelling that may make going to work more difficult. Sunglasses can help camouflage any swelling or bruising. Stitches/sutures are removed in the office 7 days after surgery. Again, many individuals can return back to work very quickly. As an alternative, an upper-eyelid procedure can be performed with sedation with other facial rejuvenative surgeries like a lower-eyelid blepharoplasty, fat grafting, and/or facelift.

How is the lower-eyelid procedure performed?

What is the nature of the recovery period? Unlike the upper eyelid, the lower-eyelid procedure must be performed under sedation since it is uncomfortable to remove fat from the lower eyelid when you are awake. Accordingly, Dr. Lam routinely performs fat grafting along with the removal of the lower-eyelid bag at the same time. Fat is harvested from the belly and injected along the bony orbital rim after the fat bag is removed through a no-incision approach (transconjunctival). Although no actual incisions are made in the lower eyelid, the eyelids can be more swollen that first week than following an upper-eyelid procedure. As needed, Dr. Lam will also use a laser to tighten the lower eyelid skin at the same time. The recovery is typically 7 to 10 days.

Does Dr. Lam perform browlifts?

What does he think of the brows? In general, Dr. Lam does not believe browlifts are needed in most individuals. The brows appear to sag because the eyelids become hollow and the upper eyelid skin becomes redundant. Simply removing some skin and filling the brow can be sufficient to make an individual appear rejuvenated. Too often browlifts do not look natural since most attractive, youthful brows are actually relatively low. However, in brows that are too aesthetically low, he performs a very simple elevation of only the outer brow to create an improved brow shape. This technique involves a hidden incision along the temporal hairline and what is known as a temporal lift. He believes that the central brow should remain low. Otherwise, you will look surprised.