If the upper eyelids are pulled up too high, it is difficult for
the eyelids to close properly. The eyelids must be able to close
completely to protect and bathe the entire surface of the
cornea. Eyelids that don’t completely close or that don’t hug
the eye can cause a very common problem following upper eyelid blepharoplasty known as Dry Eye Syndrome. Dry eyes can become
chronically irritated resulting in tearing and discharge in the
body’s effort to lubricate the eye and preserve vision. Over
time the cornea can breakdown. Removing upper eyelid skin and
tissue can also result in the eyebrow being too pulled down.
When this happens, the patient is left with an angry,
cosmetically unpleasing look, as seen below.
BEFORE |
AFTER |
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This patient underwent an upper
blepharoplasty elsewhere which
resulted in the eyebrows being
pulled down. The eyes are wider open
and the overhanging tissue removed,
but the low eyebrow position,
especially medially, imparts an
angry look. A higher, arched eyebrow
would be more feminine and
aesthetically pleasing. To raise low
eyebrows, adequate tissue must be
present in the upper eyelids to do
so. In this case, the tissue
remaining is vertically inadequate
and therefore the forehead, eyebrow,
eyelid continuum cannot be raised. |
|
Evaluation of the entire upper eyelid continuum by a specialist
will show whether you are a candidate for an upper
blepharoplasty or whether another procedure or combination of
procedures would better meet your goals and maximize your
appearance. One alternative for patients interested in an upper
blepharoplasty may be an eyebrow/forehead lift. An eyebrow/
forehead lift can raise the entire upper eyelid continuum and
allow for the tightening of the forehead, precise positioning of
the eyebrows, and smoothing and lifting of the upper eyelids.
Addressing the entire upper eyelid continuum has the potential
to rejuvenate the entire upper face. An experienced specialist
will help you determine which options are best suited to you.
Options should always be based on your individual structure,
features and goals.
Lower Eyelid Surgery
Like the upper eyelids, the lower eyelids are also part of a
continuum. That continuum contains the lower eyelid, cheek and
midface. When a patient complains of too much lower eyelid skin
or “bags” they often want what appears to them as extra skin and
fat removed by having a lower blepharoplasty. A lower
blepharoplasty is the removal of fat, and sometimes skin and
muscle from the lower eyelids. Altering the lower eyelids has
the potential to affect not only the appearance and position of
the eyelids but that of the the midface and cheeks as well.
Therefore a careful evaluation of the entire lower eyelid
continuum is essential prior to undergoing any lower eyelid
surgery.
Understanding the Potential Problems
The main risks associated with lower blepharoplasty are lower
eyelid retraction and hollowness.
Retraction means that the lower eyelid is pulled down and the
white part of the eye below the iris is showing. This often
occurs due to a vertical inadequacy of one or more layers of the
lower eyelid following blepharoplasty. It can also occur due to
scarring during healing.
Hollowness is the sunken, gaunt or tired look which occurs due
to too much fat removal from the eyelids (upper or lower).
BEFORE |
AFTER |
|
This patient presented with lower
eyelid retraction as well as
hollowness of all four eyelids
following upper and lower
blepharoplasty performed elsewhere.
Revision surgery corrected the lower
eyelid malposition. Fat transfer
surgery provided a smoother fullness
to her hollowed out periorbital
areas. |
|
The Madame Butterfly Procedure
The most common revision surgery we perform is the Madame
Butterfly Procedure which corrects the specific problems of
lower eyelid retraction and hollowness which can occur following
a lower blepharoplasty. This procedure was invented by Dr.
Norman Shorr to address the problems of the unhappy post-blepharoplasty
patients and is now used worldwide.
The Madame Butterfly Procedure utilizes reconstructive and
cosmetic surgery techniques to raise the lower eyelids so that
they close completely and function properly. The eyelids must be
able to interface perfectly with the eye, to hug its surface and
act as “windshield wipers”, evenly spreading the moisturizing
tears we produce across its exposed surface. Overexposure to air
due to eyelids that are retracted or that don’t close properly,
can cause the cornea to breakdown over time and the eye to
become chronically irritated. Tearing and discharge will occur
in the body’s effort to lubricate the eye and preserve vision.
In order to obtain the slack necessary to properly raise a
retracted lower eyelid, the entire continuum (of eyelid, midface
and cheek) must be raised together. This is accomplished by
combining a cosmetic midface lift with lower eyelid
reconstruction techniques. The medical benefit of the Madame
Butterfly Procedure is restored structure, function and comfort.
The cosmetic bonus is a higher, rounded and more youthful lower
eyelid, cheek and midface contour.
BEFORE |
AFTER |
|
This patient presented with lower
eyelid retraction, eyelids that no
longer interface properly with the
eye, and significant lower eyelid
and midface hollowness. The Madame
Butterfly Procedure restored
structure and function to the
eyelids and provided a higher,
rounded and more youthful lower
eyelid, cheek and midface contour. |
|
Eyelid Hollowness Correction
Sunken in areas of the face, especially around the eyes, can
make one appear tired or older than they are.
Therefore, removing the right amount of fat during a
blepharoplasty is extremely important. Too much fat removal,
even a slight amount, may leave the area around the eyes looking
sunken in and hollow. Therefore, fullness and contour of the
eyelids are topics patients must discuss carefully with their
surgeon prior to surgery.
Fat Transfer Surgery
To correct hollowed eyelids, fat transfer surgery may be
performed. Donor fat is harvested from the abdomen and carefully
placed or injected into the eyelids. During the same surgery,
fat may also be transferred to other deflated areas of the face
such as the eyebrow pads, temples, cheeks, nasolabial folds and
lips for total facial rejuvenation.
BEFORE |
AFTER |
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Left: Too much fat removal during an
upper and lower blepaharoplasty gave
this patient a gaunt, tired
appearance. Fat transfer surgery
provided fuller, more youthful upper
and lower eyelid contour continuums. |
|
As ophthalmic plastic reconstructive and cosmetic surgeons who
specialize in eyelids, eyebrows, forehead and midface, we try to
educate patients so that they may make the most informed
decisions when it comes to their health and facial appearance.
Our goal is to develop with each patient a well thought out,
logical surgical plan which helps them achieve their goals and
maximize their appearance. Primary and revision eyelid and
facial surgery is what we specialize in.
Dr. Norman Shorr is an early pioneer and innovator of many
cosmetic and reconstructive eyelid, eyebrow, forehead and
midface procedures performed today worldwide. He and our
surgeons continue to innovate and contribute to the specialty of
cosmetic and reconstructive facial surgery. Call today to
schedule your personal consultation.
CONTACT US /
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