What is supratarsal fixation and how does it differ from anchor blepharoplasty?
Supratarsal fixation is really an antiquated method that invites the surgeon to form a crease that is simply too high for virtually every patient. The natural eyelid crease is caused by connective tissue fibers that firmly connect the eyelid platform skin to the underlying levator aponeurosis tendon. This tendon connects the upper eyelid to the levator palpebrae superioris muscle in the orbit. This muscle is responsible for opening the eyes. The connective tissue fibers from the levator aponeurosis to the skin form the upper eyelid crease and support the eyelid platform skin and upper eyelid lashes. If these fibers stretch out, which happens as we age, or are not present, which is seen in some Asian eyelids, the skin of the eyelid platform will be loose and the eye lashes will hang down (eye lash ptosis).
Anchor blepharoplasty is a blepharoplasty technique where the levator aponeurosis is exposed at the time of surgery, and stitches are placed from the cut upper eyelid platform skin and muscle to the exposed levator aponeurosis. By doing this in a very precise fashion, the upper eyelid lashes are supported and perky and the eyelid platform skin is snugged over the eyelid platform much like someone might pull a bed sheet taut. This technique requires both absolute precision to be done well and a very detailed knowledge of eyelid anatomy. In Dr. Steinsapir’s experience less than 2% of all eyelid surgeons are able to perform an anchor blepharoplasty.
So-called supratarsal fixation should be another name for an anchor blepharoplasty. However, it is seldom actually practiced this way. Surgeons often interpret this procedure to mean “above the top of the tarsus.” Effectively they do away with the surgical dissection needed to identify the levator aponeurosis. Instead they interpret supratarsal to mean sewing the cut edge of the eyelid platform skin somewhere above the top of the tarsus. Effectively this often means sewing the skin to something much more superficial such as the orbital septum. This is not the same thing. The levator aponeurosis is a mobile structure. When you open the eyes, the levator aponeurosis slides up and back. Anything attached to the levator will also slide up and back. When the eyelid platform skin and underlying muscle are accurately attached to the levator aponeurosis, the eyelid platform skin stays well snugged and the eye lashes well supported whether the eyelids are open or closed. In contrast, if the skin is “supratarsally” fixed, the skin is snug (or too tight i.e. the eyelids are short of skin) when the eyes are closed and loose when the eyes are open.
Another issue with so-called supratarsal fixation is that it is often associated with a surgical look. This is because the upper eyelid crease is made too high. The top of the tarsus is 10 mm from the actually eyelid margin. To fixate above the tarsus, the crease is being made north of 10 mm. In addition, with healing the crease normally creeps even higher by one or two millimeters. It is not unusually to see crease height of 12 or even 14 mm. This height is at the expense of the upper eyelid fold which is often surgically wiped-out. This makes the upper eyelid look too hollow-think Barbra Walters.
In contrast, a properly done anchor blepharoplasty can be done at almost any height above the eyelid margin with preservation of the upper eyelid fold.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I have had a heavy upper eyelid since childhood. What are my options?
There is often confusion regarding what part of the eyelid is heavy. Eyelid surgeons draw an important distinction between a full upper eyelid fold (which is actually part of the eyebrow just below the eyebrow hair) and a heavy or ptotic eyelid margin. Ptosis means fallen and it is a general term than is used to describe a number of anatomic issues. How we address a ptotic upper eyelid margin and how we deal with a heavy eyebrow are very different. Upper eyelid ptosis where of margin of the upper eyelid rests low on the eye itself, is often present from childhood onward. The condition can pose both aesthetic and functional problems. Depending on the nature of your case, you may be dissatisfied with a “droopy” appearance of the eyelid, you may have concerns about asymmetry noted by other people, or you may have visual impairment and diminished peripheral vision. Heavy eyelids may be described as “bedroom eyes,” or sleepy eyes. Because the heavy eyelid convey a lack of attention, the presence of upper eyelid ptosis can be undesirable in both social and work situations. In contrast, an eye that is open correctly makes you look alert, interested, and engaged and is socially desirable in both work and social situations.
Ptosis usually does not go away on its own, particularly if this is a problem you’ve had since childhood. Ptosis can also develop after childhood. Considering how the upper eyelid tendon in held in the eyelid, it is actually quite amazing that more people do not have this condition. After a few million blinks of the eyelids, it is common to see some degree of upper eyelid ptosis. If you have a bothersome heavy upper eyelid and are beginning to consider your treatment options, it is important to research upper eyelid ptosis and clearly understand your choices. Ultimately there is no substitute for consulting with a qualified oculoplastic surgeon because every eyelid is different.
Correcting eyelid ptosis requires upper eyelid surgery. The challenge is determining the best approach that is right for your needs. This is not a place for having work done by a non-specialist lacking training, skills, and experience. Having ptosis correctly diagnosed increases the likelihood that surgery will correctly address your issues. Having things done the right way the first time is so much better than needing to undo the wrong surgery. Ptosis surgery can often be done in conjunction with other cosmetic eyelid procedures. The surgery will elevate the eyelid to an appropriate, natural level. It can also address eyelid asymmetry. Having the heavy eyelids corrected can make a huge difference in your confidence level, the business world, and personal interactions.
The first step is to consult with a cosmetic surgeon who specializes in eyelid surgery, including concerns related to ptosis, heavy eyelids, and asymmetry. At your consultation, your physician should give you a close and thorough examination, discuss your options and probable outcomes, and the likelihood of a surgery’s success and factors that can complicate surgery. The doctor will also make a formal diagnosis at this time, which will identify the ptosis and any compounding issues. For example, some individuals also have a heavy brow or dark under-eye circles, which may exaggerate the problem. Your surgeon should specialize in understanding on how each part of the face functions and relates to the other parts, and also advocate for nonaggressive surgery for natural-looking results. He or she can then design an individual treatment plan for you that leaves you with an overall balanced look.
The first step really begins by seeing the right surgeon. The key to being happy with your results is to never take a shortcut in choosing a surgeon. Your surgeon must be a true specialist in ptosis correction, and similarly will not take any shortcuts or use a “one size fits all” approach to your care. It is important to understand the value of seeing an aesthetically oriented, fellowship trained oculoplastic surgeon. The plastic surgeon who did your girlfriend’s breast surgery or nose is all too often the wrong choice because they lack specialized training in ophthalmology and in oculofacial surgery. To be a fellowship trained oculoplastic surgeon means the surgeon is board certified in ophthalmology and has spent a minimum of two additional years training in eyelid plastic surgery. Dr. Steinsapir is board certified in ophthalmology and completed three years of training in oculoplastic surgery fellowships and two additional years of cosmetic surgery fellowship training. This advanced training early in his career has helped propel him to the forefront of his field.
A highly qualified cosmetic eyelid surgeon is the best option. Surgeons do vary, so it is recommended that you review unretouched before-and-after photos of eyelid surgery; spend time with the surgeon beforehand discussing your options, plan, and follow-up care; and understand your doctor’s treatment philosophy, which should advocate for a nonaggressive, individualized approach.
Dr. Steinsapir is highly qualified to treat eyelid ptosis, asymmetry, and related concerns. With particular attention to individualized care, multiple fellowships in eyelid surgery, and a specialization in ptosis correction, he can help you with your goal to realize a bright and natural appearance. Dr. Steinsapir is internationally regarded as a top eyelid surgeon. Call us today to schedule a consultation and finally take that next step in addressing your longstanding concern. You shouldn’t have to wait any longer.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Can I have upper eyelid surgery without looking like I have been operated on?
This questions cuts both ways. What you are hoping for in having surgery is an improved look. What the question gets at is whether you will end up with the operated look. No one wants the surgical results of famous people talked about in the tabloids, such as the singer Kenny Rogers or the socialite Jocelyn Wildenstein. As much as it would be great to say that overaggressive, unnatural surgery results are a thing of the past, it is simply not true. Avoiding this type of result not simply a matter of choosing a surgeon with the right training and credentials. The advice of seeking a board certified general plastic surgeon does not guarantee any level of expertise when it comes to eyelid surgery. In fact general plastic surgeons are poorly trained in eyelid plastic surgery compared to oculoplastic surgeons. Even training in oculoplastic surgery is not guarantee of natural results. The truth is that good people are were you find them, and this is true for highly qualified cosmetic eyelid surgeons.
The surgical look can come from removing too much tissue in the upper eyelid, or creating an upper eyelid crease that is too high. Dr. Steinsapir advocates for a more conservative approach that preserves as much tissue as possible, complimenting your natural eyelid structure. “Surgeons misunderstand the goal of cosmetic eyelid surgery. The surgery should be invisible leaving the eyes natural and alive,” notes Dr. Steinsapir.
A carefully planned surgery takes into account your goals, the balance of all your facial features, and functionality. There is no one-size-fits-all approach, so take time to find a doctor who individualizes each treatment and makes upper eyelid surgery a major focus of his or her practice. A specialized physician will be able to answer your questions, discuss your options, and show you before-and-after photos of eyelid surgery examples, without special lighting, retouching, or camera tricks. Provided you take the time to seek out a great surgeon, don’t opt for shortcuts, and are willing to listen to expert medical advice, there is no reason to expect nothing but the best.
In medicine there is no such thing as a no-risk surgery. For this reason, your potential surgeon needs to spend time talking with you to investigate your personal history in detail. They need to perform a very detailed and comprehensive examination. This should be followed by an equally detailed discussion regarding risks, benefits, alternatives and the likelihood of surgical success. If your surgeon cuts corners in the consultation process, it is reasonable to assume that they may cut corners in the surgery as well. If your surgeon spent only a few moments with you and did not bother to examine your face and eyelids before referring you to the practice closer, it is reasonable to ask yourself if your are in the right place.
The details of your upper eyelid surgery will depend on your individual eyelid contour, the specific improvements you are seeking, and a detailed examination and treatment plan created specifically for your needs by a specialist in oculoplastic surgery. Dr. Steinsapir is respected across the world as a leader in eyelid surgery with natural results, and he practices both in Beverly Hills and at UCLA, where he is an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute. He is dedicated to the needs of his patients and provides a rare level of unique personal care. We invite you to consult with Dr. Steinsapir to learn if upper eyelid surgery is right for you. Please call today to learn more about how eyelid surgery can help you improve your appearance and your confidence.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I am unhappy with my eyelid surgery. What are my options?
Eyelid surgery is one of the most popular cosmetic procedure today. It has the potential to provide extremely positive results that rejuvenate your appearance and make both an aesthetic and functional difference. Eyelid surgery can be very technical. Your surgeon may also be surprised by the disappointing outcome of your surgery. If you have had eyelid surgery in the past, such as an upper blepharoplasty or Asian eyelid surgery, but are dissatisfied with your results, help is available.
First, allow your eyelid surgery to heal. The initial healing after surgery can be a time of uncertainty. Recovery takes you out of your normal schedule and routine. Friends and family can make inappropriate comments that lead to second guessing and uncertainty. Please recognize that family members may be right but they are not eyelid experts. Surgical results that initially look rough because of swelling and bruising, often settle down and look remarkably better with time to heal. There are rare, immediate eye health concern, and these should prompt immediate attention from your surgeon. These included increasing pain, swelling, redness, and bruising, or changes in vision. When these occur in hours or days after eyelid surgery they can represent vision threatening issues such as bleeding behind the eye or infection. Immediate care by your surgeon is essential. If you are having this type of an issue and your surgeon is not immediately available, it is advisable to be seen in an emergency room where the emergency care of an ophthalmologist or plastic surgeon can be arranged.
Another set of urgent post-operative issues include difficulty opening or closing the eyelids, double vision, or other restrictions in eye or eyelid movement. Right after surgery, local anesthesia can account for some of these types of issues, but after 24 hours, the presence of this type of an issue, suggests a mechanical problem created by the surgery. In some cases, these issues require urgent surgical exploration. In all cases, you should be seen by your surgeon to assess what is going on. Recognize that non-eyelid surgery specialists often perform eyelid surgery. These surgeons lack the ability, skill, training, and equipment to properly examine your eye. Eye pain and light sensitivity can be caused by a corneal abrasion, corneal ulcer, or intraocular inflammation. Without a slit lamp and the necessary training, your surgeon cannot diagnosis these issues. Immediate consultation with an oculoplastic surgeon or general ophthalmologist may be necessary.
Once you get about a week out from surgery, the issues tend to be related to eyelid shape, surgical symmetry, visible scars, and eyelid malposition. Generally, these types of issues get better with time. However, problems that can persist are evident even this early after surgery. It can be difficult to determine which issues will settle down and resolve on their own to your personal satisfaction. It is important to discuss your concerns with your surgeon. Surgeons will sometimes attempt to minimize your concerns. This may be appropriate. It often comes down to a level of trust. If you feel like your trust and confidence in your surgeon is being abused, that is a significant warning sign. Patients are not often wrong. If you have a concern, your surgeon should also be able to see it and explain to you why or why it is not a concern, and what will need to be done about it. It may be as simple as “we will watch this.” When your feelings are not validated or your feel you are not being told the truth, there is often a break-down in the doctor-patient relationship. This is when a second opinion can be helpful.
It you have healed and surgery is in the past, this does not mean you have no options. A detailed personal consultation can establish precisely what is causing your issues and how best to correct the problems. This type of work requires considerable maturity and experience. It is often necessary to have unique solutions tailored to you personal situation. A cookie-cutter approach is not going to do it. Dr. Steinsapir takes the necessary time to define your problems and the best approach needed to help you achieve your goals.
Dr. Steinsapir provides attentive, comprehensive care to ensure you achieve the results you desire, and he always designs your care on an individual basis, making himself available to answer all your questions so you can feel confident both before and after treatment. He can take over your post-operative care if necessary or coordinate with your surgeon to provide input and suggestions to help speed your recovery. To learn more about fixing eyelid surgery, please call today to schedule a consultation with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
My lower eyelid is sagging after eyelid surgery-what should I do?
First take a deep breath. Things happen after eyelid surgery. Many things fix themselves with a little time. Before surgery, your surgeon went through a lengthy list of things that might happen with surgery. Of course it is human nature to think that none of that will happen to you. In some cases I think that the surgeon sends a subliminal message that even though all this stuff is in the consent, it is a mere formality. Having an issue after surgery is an unwelcome shock. If you trust your surgeon, that confidence should help get you through the rough patches after surgery.
There can be a number of reasons for why the lower eyelid sags after surgery. In some cases swelling can push the lower eyelid away from the eye. This can occur in conjunction with a process called chemosis. Chemosis is the medical term for swelling of the white of the eye or the conjunctiva. Just as the eyelid will swell after surgery, the conjunctiva can swell. When it is swollen, the conjunctiva has been described to look like “jelly.” The best treatment for this is ocular lubrication and time. This often resolves with tincture of time.
Another cause of lower eyelid sagging is preexisting laxity of the lower eyelid. Swelling after surgery causes the laxity to be exaggerated resulting in the unsatisfactory position of the eyelid. In many cases again time is the best treatment.
When the surgeon cuts the skin of the lower eyelid to remove “extra lower eyelid skin,” malposition of the lower eyelid can be more serious. Under these circumstances the lower eyelid can be short of skin or the muscle that helps hold the lower eyelid against the eye can actually be damaged by the surgery. Rather than allowing this to heal, surgeons often feel the need to provide an early fix. That early fix can help resolve the issue or make it worse.
Generally, due to mechanical issues, some of the simple treatments can actually be helpful. These include steroid injection, mechanical finger winking, and when appropriate a pull up suture placed to support the eyelid corner for a few weeks. When these measures fail, it is best to let the eyelid heal before attempting revisional surgery. So often Dr. Steinsapir is called in to fix an eyelid where the original surgeon has made several well meaning attempts to “tuck up” the eyelid early after the original surgery with each procedure making the situation worse.
What will your eyelid need? It often depends on precisely what factors are contributing to the circumstance. If your surgeon was not a fellowship trained oculoplastic surgeon, it is often helpful to see someone who is. The additional training and experience may be precisely what is needed to address the situation.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a
I had a midface lift at the time of my eyelid surgery, and now my eyes look different. Will canthal surgery correct my problem?
The most critical issue here is to understand how your face has changed.
You are absolutely correct to say that your eyes have changed. However, your analysis of the problem is not correct. I suspect that very few surgeons you consult will understand the issues. At the same time I am equally certain that many surgeons would be more than happy to perform a lateral canthoplasty for you. They will mean well but they are simply going to make your situation worse, not better.
I completely agree that surgery has altered the shape of the eyes. This is the most obvious change. The outer corners of the eyes are higher after surgery compared to your preoperative status. There is also a subtle lower eyelid contour abnormality of the lower eyelids. It is true that a properly executed lateral canthoplasty has the potential to reposition the lateral canthal angle. In my many years of repairing prior eyelid surgery, I have found that very few surgeons are capable of actually achieving that type of result in a natural way. Not impossible, just very difficult as the surgery must be done with the patient at least awake enough to open and close the eyes to judge the effect of repositioning of the angle. If surgery is performed under general anesthesia, then in my opinion, the likelihood of success is very low.
Canthoplasty, and to a lessor degree, cathopexy, risk over shortening the lower eyelid. It is true that many surgeons will shorten the lower eyelid as part of the canthoplasty procedure. The procedure is taught this way and this maneuver is important for pathologically lax eyelids. However, over shortening an eyelid that does not need to be shortened will simply force the lower eyelid below the curvature of the eye. This will actually make the lower eyelid look more pulled down. The outcome will be disappointing.
So lets talk about the real issue. It is interesting how important the eyes are in interpersonal interaction. Subconsciously, we scan the face of the person we are speaking to. During conversation, we actually scan a triangle on the face that includes the eyes, the nose and to a lesser degree, the mouth. This is so profoundly ingrained, that one expects someone listening to you to look at you in this manner. We are not even be aware of this gaze pattern. However, we can be acutely aware when the pattern is altered in someway. What you would experience when you are speaking to someone is the sense that they are not really paying attention to you. When does this happen? Studies have shown that changes in the face will alter this scan pattern. There are some very nice studies of this in the head and neck literature in looking at scan patterns when viewing someone who has a facial lesion or just had surgery to remove a facial lesion.
How does this apply to this situation? If you look carefully at your after photograph, you face demonstrates a classic facial defect caused by your mask lift. The forehead dissection has resulted in atrophy of the fat pads that extend from the temple to the orbital rim. This hourglass hollowing of the temple areas I call the plateau midface deformity. Essentially the loss of the fat volume skeletonizes the zygomatic arch. This little bit of facial fat plays a critical role. This cushion of fat at the side of the face serves to separate the eye aesthetic area from the temple aesthetic area. This slight cushion of volume helps maintain gaze on the eyes. Without this fat volume, the scanning gaze is falls off the eyes and is drawn into the temple area. You are left with the feeling that people are not paying attention to you. Since the primary reason many women (and men) have cosmetic surgery is to stay relevant, this feeling of being ignored can precipitate a narcissistic crisis. The fact that your surgeon cannot understand your concerns (and I promise you they really don’t get it) is even more infuriating. Because like you, they don’t see what the issue is, you get treated like a problematic, ungrateful, impossible to satisfy (insert your own description here) person. Naturally this can precipitate a break down in the doctor patient relationship.
In the example shown here, surgery was used to correct the problem. Previously placed cheek implants were removed and replaced with a hand carved ePTFE orbital rim implant. The lower eyelid was also lengthened using hard palate graft. Because it is necessary to sew the eyelid closed for a week to allow healing means that only one eye can be done at a time. For some individuals who only have the plateau midface, fillers can be used as an alternative to facial surgery.
First, there is no substitute for an actual personal consultation. Generally for this type of problem the best solution for many is adding hyaluronic acid filler to the area where you have lost volume. These products last quite a while and this can be a workable alternative to corrective surgery. For some, surgery is necessary. The most important thing is to avoid having a fix by doctors who do not understand what the issues are. Unfortuately, if you don’t see it, you can’t fix it.
Kenneth D. Steinsapir, MD
About Dr. Steinsapir
Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.
To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Upper blepharoplasty made my eyelids heavier and the skin wrinkled. What is going on?
Dr. Steinsapir specializes in fixing unsatisfactory eyelid surgery. As a fellowship trained oculoplastic and cosmetic surgeon, and a board certified ophthalmologist, Dr. Steinsapir is experienced in working closely with his patients to create a personalized treatment plan. If you are experiencing eyelid ptosis and crepey (wrinkled) skin following upper blepharoplasty, it may be that your original surgeon did not have the proper experience to successfully perform your upper blepharoplasty.
Crepey Skin
When performing upper blepharoplasty, simply removing extra skin is not enough to create a desirable outcome. Successful blepharoplasty requires what Dr. Steinsapir calls a ‘structured’ blepharoplasty. It is essential to properly support the upper eyelid skin to avoid crepey upper eyelid―platform skin that simply won’t hold makeup. To correct this problem, your surgeon will need to remove skin from below the upper eyelid crease and anchor the eyelid platform skin and underlying muscle to the levator tendon, which raises the upper eyelid. This places the upper eyelid skin on a slight stretch resulting in a smooth platform for makeup.
An experienced and skilled surgeon can address crepey upper eyelid skin after unsatisfactory upper blepharoplasty with a carefully planned excision of the excess skin left on the eyelid platform. With the eyelid open, the upper eyelid skin is anchored to the levator tendon to create a long lasting adhesion to the eyelid elevator. Recovery is usually somewhat shorter than standard upper blepharoplasty.
An anchor blepharoplasty is an important part of any comprehensive eyelid surgery. This part of your procedure specifically addresses loose skin and drooping eyelashes on the upper eyelid platform. Excess, wrinkled or loose skin here can give you a tired appearance associated with eyelash ptosis and crepey eyelid platform skin.
While ideally anchor blepharoplasty is a part of every blepharoplasty, unspecialized or less skilled surgeons may not be comfortable offering this important aspect of treatment. Anchor blepharoplasty is a very technical skill that requires great precision and specialized expertise. Without great experience, education and an artistic skill, your cosmetic doctor may have difficulty performing an anchor blepharoplasty as part of your upper blepharoplasty; unfortunately, in these cases you may find yourself disappointed after you heal and wish your eyes appeared more alert.
Heavy eyelids
Heavy eyelids following upper blepharoplasty are often the result of a pre-surgical condition that your surgeon failed to address during you consultations. Before you underwent blepharoplasty, you presumably already had heavy lids and heavy brows. The brain compensates for the heavy eyebrow by activating the frontalis muscle, the forehead elevator. The forehead lifts the eyebrow until the skin in the upper eyelid no longer rests on the upper eyelashes.
Clinically, this situation can be detected by looking for lines in the forehead and an abnormally elevated eyebrow. When upper blepharoplasty is performed in this setting, the excess skin in the upper eyelid is removed. This reduces the amount of forehead muscle activation that is needed to keep the upper eyelid skin off the upper eyelashes. The forehead relaxes and the eyebrows come down. The net result is that it appears that almost nothing was done surgically. Of course the forehead is smoother but if the objective was to make the eyes brighter by clearing space above the eyelashes, the net effect can be disappointing. Under these circumstances the best option is to perform a forehead lift in conjunction with the eyelid surgery.
About Dr. Steinsapir
Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked at the top with a handful of medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns. Contact us today to schedule a personal consultation with Dr. Steinsapir.
