R.S.B. Dermatology, Inc.  

                                                             & Cosmetic Surgery Center  

Robert S. Bader, M.D.

Board Certified in Dermatology • Ivy League Trained Physician • Fellowship Trained in Cosmetic Surgery and Mohs' Surgery

Official Dermatologist & Dermatologic Surgeon for the Florida Panthers NHL Hockey Team • Voted one of America's Best Dermatologists 2004-2006

Eyelids

One of the telltale signs of the aging face, is one's eyes.  Typically, sunshine and one's genetic make-up cause changes to the eyelids that are perceived to cause some persons to look tired or older.  Several procedures are available to improve the appearance of the eyes and are discussed below.

Blepharoplasty (pronounced "blef-are-'O'-plast-'E'") is a cosmetic surgical procedure to improve the appearance of one's eyes.

Dr. Bader is no longer performing this procedure.

Upper eyelids   

With time, the upper eyelid skin becomes loose. As more time passes, the upper eyelid hangs down and eventually may rest on the eyelashes or even hang over the eyelashes. With the blepharoplasty procedure, this is easily corrected by surgically removing the excess skin and muscle from the upper eyelid through incisions that are made in the crease of the upper eyelid. In nearly all, little if any scar is visible after the procedure. Some surgeons use dissolvable stitches, others use stitches that need to be removed, and some use skin glue. Most patients resume most activities two to three days after surgery, and usually return to full-unrestricted activity within 10 days following surgery. There may be some bruising after the procedure, which may take 5 days or more to completely resolve. The final results may not be appreciated for 3 months or longer.

Anesthesia: Many patients can have the procedure performed entirely under local anesthesia (while awake).  The area is numbed with tiny needles and only takes 30 seconds.  Some patients take a pill to help them relax.  Others prefer to have conscious sedation—medication is given through an I.V. that makes one sleepy and have no discomfort.

The Procedure: The upper eyelids are cleansed using a sterilizing solution.  Depending upon the physician’s preference, a scalpel, laser, or electrical device is used to make incisions in the skin and remove the excess skin and muscle.  Occasionally, excess fat is removed.  The skin is then closed using sutures and/or skin glue. 

What to expect after the procedure: Patients are to sleep upright with several pillows for the first few days to reduce swelling.  Ice should be applied for 20 minutes every hour.  A bag of frozen peas or corn serves as an excellent icepack.  Some patients will have bruising that may last 5 to 10 days.  Swelling of the upper lids is expected and is improved greatly within 5 to 7 days.  All swelling may take 3 months or even longer to resolve completely.  Most patients return to normal activities several days after the procedure.

Lower eyelids

The eyeball is surrounded by clumps of fat, called "fat pads” that act as a cushion. Imagine as one jumps, the eye needs some cushion to prevent injury. Fat is the perfect living cushion. These fat pads are not in direct contact with the eyeball. These pads are held in place by thin membranes that are like a rubber balloon, and act to hold the fat in place. With time these membranes stretch and the fat starts to protrude outward causing "bags" to form under the eyes. With the blepharoplasty procedure, the bags under the eyes can be removed. Two methods of removal are commonly used. With the external approach, a cut is made just beneath the lashes of the lower eyelid through the skin and muscle. Excess skin and muscle are removed and fat from the fat pads. The cut is then stitched together. The problem with this procedure is that patients often get a rounder shaped eye that is obvious, and in some cases unattractive. Using a newer procedure called trans-conjunctival blepharoplasty, cuts are made through the inside (pink) surface of the lower eyelid. Through this incision (cut), the fat is removed that causes the bulging. No skin or muscle is removed. Therefore, the shape of the eye is not changed and there are no visible scars. Recovery is fast and most can resume  most non-exertional activities within one or two days. 

Chemical Peeling has been performed for decades to tighten facial skin and reduce wrinkles.  Both the upper and lower eyelids can be treated by applying the chemical to the skin.  Only mild to early moderate wrinkles can be improved.  If moderate to severe wrinkling is present, a bleparoplasty is usually recommended.  Most commonly, trichloracetic acid is used, also called TCA.  This chemical is applied to the skin, causing a burning sensation.  After 60 seconds the discomfort resolves.  Patients can be awake or may be treated under conscious sedation, when medications are infused via an intravenous catheter that causes drowsiness.  After the procedure there is darkening of the treated skin and peeling that last up to 7 days. 

Laser resurfacing has been performed on the eyelids since the 1990's using one of several lasers.  All laser resurfacing systems target the water present in one's skin cells, boiling the water, and therefore blowing apart the cell.  Lasers have the advantage over chemical peeling of rather precise depth of destruction and is preferred over chemical peeling by many.  But, as with nearly everything in life, there are disadvantages.  There are several different laser systems available, which are described in a table to illustrate the advantages and disadvantages of each.

Non-Ablative Lasers are a newer generation of lasers that do not remove skin, but stimulate new collagen formation.   Many different lasers are available. Some lasers can be used on any color of skin, unlike ablative lasers or chemical peeling.  Typically, only those with fine wrinkles can be treated.

Radiofrequency rejuvenation is a newer procedure that uses electricity to heat the skin to tighten and stimulate new collagen formation.  Mild to moderate results have been seen and treatments are often costly.

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Copyright © 2005 R.S.B. Dermatology, Inc.
Last modified: 09/26/07