Considering Cosmetic Surgery?
There are several important factors in making the decision to have cosmetic surgery. You must feel totally comfortable with your physician and the choice of procedure that both of you have decided on. It is imperative that you know your physician’s credentials, see before and after photos, know the post-operative course of treatment, and most importantly, that you are on the same page with your physician regarding what you are realistically wanting to achieve. Many patients have done their homework already when they come in for their initial consult. The internet provides a wealth of information on health issues including cosmetics. It is the Neigel Center’s goal to have every patient comfortable, knowledgeable and happy with their decision and results.
Cosmetic and functional eyelid surgery goes under many names, but when most people think of the procedure that can reverse the effects of aging and eliminate bags under the eyes, they’re thinking of a surgery called blepharoplasty, which is the removal of skin, muscle, and sometimes fat from the eyelids to enhance the appearance and tighten the area. Blepharoplasty, essentially an “eyelift”, can also result in a more wide awake look as well as eyes that appear larger and brighter.
The delicate, thin skin of the eyelid can sag because of a number of factors: age, heredity, allergies, and other systemic diseases. But a drooping eyelid can cause more than cosmetic problems. In some cases, this skin can hang over the eyelashes and actually block peripheral vision. At this stage surgery is more than cosmetic, and corrects a serious functional problem known as mechanical ptosis.
Some patients who require eyelid surgery not only have excessive skin on the eyelid but also cannot fully open the eyes because the muscle that opens the eyelid (levator muscle) has detached, weakened or become too loose. Although this can be compensated for by raising the eyebrows, the eyelid might eventually droop even more and block the front as well as side vision. Eventually raising the eyebrows doesn’t work and surgery is the only solution. Surgery to correct ptosis involves opening the eyelid in the same manner as a cosmetic blepharoplasty, with the additional step of strengthening the levator muscle. In a simple cosmetic blepharoplasty, only skin and muscle are removed. Here’s how it works: The first incision is made where the normal lid crease should be (this varies according to gender and ethnicity), and the appropriate amount of excess skin is removed.
With ptosis surgery a more extensive surgery is performed. A deeper cut is made, and the fat is exposed and possibly removed. The muscle that opens the eyelid is then exposed and tucked or pleated with several sutures across the eyelid. The incision site is closed with sutures, giving a precise plastic surgery hairline scar, positioned so that it will be hidden in the eyelid crease.
In lower lid blepharoplasty, the incision can be made just below the eyelashes or, in some cases, through the inside of the eyelids so the scar is completely and in most cases successfully hidden. Some patients also require a tuck in the corner of the lower eyelid to tighten any lax tissues so that the eyelid remains in a normal position at the end of surgery. The lower eyelid skin can be resurfaced with the carbon dioxide laser, which shrinks the excess skin and has the added advantage of diminishing crow’s feet, those fine wrinkles at the corner of the eyes.
How do you know if your surgery was successful? Compare your results with normal eyelids: The upper eyelid should be one to three millimeters below the limbus, the area where the colored part of the iris meets the white part of the sclera. The lower eyelid position should be at or just above where the edge of the lid margin meets the limbus. Remember, some skin must remain in the upper eyelid to allow it to close. If too much skin is removed, many complications can result, such as inability to close the eyes (lagophthalmos) and/or lid retraction in which the eyes open too widely and too much white is visible. This can lead to exposure problems, dry eyes, and the inability to blink properly. These are just general guidelines and may not be appropriate for every patient.
Although this general overview gives you an idea of what eyelid surgery entails, there are many parts to the procedure that must be tailored individually to each patient. A surgeon who fails to individualize each surgery increases the risk of complications.
Heaviness of the upper lids that causes “hooding” and no platform in which to apply makeup can be easily corrected. The “bags” under the eyes that give the look of tiredness also can be easily corrected. The surgery to repair this difficulty is called an Upper Lid Blepharoplasty and a Lower Lid Blepharoplasty, respectively. On an Upper Lid Blepharoplasty, the incision using CO2 laser is made in the crease of the upper lid. The fat is sculpted out and excessive skin is removed. The lower lid incision is made on the inside of the lid and the same process of sculpting is done. In some cases, if there is excessive skin on the lower lids, a “pinch of skin” or an extended blepharoplasty is performed to tighten and smooth out the area. In that case, a hairline incision will be made by the eyelash line, which heals well. As a patient, you should experience no post-operative discomfort. Your “down-time” will be 7 to 10 days, and that is only due to swelling and bruising that varies between individuals. In all, this is a commonly performed surgery with results that can take years off your eyes.
Whether it be conducted in another part of the body or within the face or neck area, liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, of totally by local anesthesia.
The S-Lift, also known as a mini-facelift, has caught the attention of many patients due to its natural results and minimal down time. As we all grow older, our bodies seem to be really affected by gravity. Our age can show in the area of the lower face, around the mouth and the jaw line. The S-Lift is pulling up from the jaw line and back from the mouth area smoothing out and softening the jaw line jowls and nasal-labial lines (lines between the nose and the corner of the mouth) to give a younger appearance. Although this is not a full-facelift, it is a subtle approach for patients not quite ready for the more involved facelift. The beauty of the surgery is minimal downtime due to the limited swelling and bruising seen afterwards.