Eyelid Lift

Your eyes are often the first feature people notice about you, and they are the focal point of your face during a conversation. As we age, the structures of the eyelid loose tone and sag leading to a change of the shape of the eyes. This process can be accelerated by environmental (i.e. sun damage and smoking) and hereditary factors. This leads to excess, puffy or lax skin, and stretched out muscles leading to a more tired or aged appearance. An “eyelid lift” is a commonly used term to describe surgery performed to rejuvenate the eyes/eyelids. However, this term doesn’t accurately describe the different procedures that achieve periocular rejuvenation. There are three main procedures used to improve the appearance of the eyelids via a “lift”:

Blepharoplasty [upper and/or lower eyelids]

Ptosis repair [upper eyelid]

Retraction repair [lower eyelid]

BLEPHAROPLASTY

Pronounced “blef-a-ro-plasty”, this is the most commonly performed facial cosmetic procedure in both men and women. As we age, eyelid skin becomes thinner and redundant. The skin excess is medically termed “dermatochalasis”. Blepharoplasty procedure can give the eyes a more rested or rejuvenated look by removing excess skin, and re-positioning bulging fat or lax muscle from the upper or lower eyelids.

Upper Blepharoplasty

The main component of an upper blepharoplasty is removal of excess skin, a condition named dermatochalasis. This will decrease “hooding” of the eye and present more eyelid platform, which women often appreciate as it facilitates application of eyelid makeup.

If the sagging upper eyelid skin obstructs peripheral vision to a severe enough degree, blepharoplasty may be covered by insurance, and will eliminate the obstruction and expand the visual field.

The excess skin is removed through an incision hidden in the natural eyelid crease, rendering the resultant scar virtually invisible. In years past, upper eyelid fat and muscle were often removed in addition to skin, but we have since recognized that this eventually may lead to a deep upper eyelid “sulcus”, a more hollowed, aged appearance. We now strive to retain as much upper eyelid volume as possible, including muscle. Removing muscle not only can lead to loss of volume, but can also harm the blink strength of the eyelid, potentially leading to dry eye symptoms.

During the evaluation process, careful attention is given to the eyebrow position, as brow descent may give the appearance of excess skin. A browlift may then be indicated in addition to, or instead of, removing eyelid skin.

Lower Blepharoplasty

Lower blepharoplasty is a more complex and potentially risky procedure. In addition to prolapsed fat, stretched out eyelid muscle and skin may compromise the appearance of the lower eyelids. Furthermore, cheek descent can worsen this appearance by creating a groove below the eyelid, often termed the “tear trough”. Swelling in cheek/eyelid transition zone, termed “festoons”, can further complicate treatment. These features may require a combination of approaches: fat may need to be removed or repositioned through an incision hidden on the inner surface of the eyelid (transconjunctival), or through an eyelid incision just below the lashes (subciliary) if removing skin and tightening muscle is also planned. If skin creping or festoons are present, laser resurfacing or a chemical peel can be performed to smooth and tighten the lower lid skin.

 

Can Upper and Lower Blepharoplasty be done during the same surgery?

Upper and lower blepharoplasty is often performed together and also can be combined with other procedures such as eyebrow or forehead lift, midface lift, face lift, neck lift, or laser skin resurfacing

What are the risks/complications of Blepharoplasty?

Though with any surgery, there are possible risks and complications, surgery performed by an experienced and knowledgeable surgeon minimizes these risks.
Because of Dr. Amadi’s expertise in this area, many other plastic surgeons refer patients with complications of eyelid surgery to Dr. Amadi for treatment and repair.
The risks/complications of blepharoplasty include dry eye, poor blink, eyelid asymmetry, eyelid retraction, “rounding” of the eyes (loss of “almond shape” of the eye), excess tearing, inability to fully close eyelids, and, extremely rarely, loss of vision.

Will Blepharoplasty be covered by insurance?

Although less severe dermatochalasis (excess eyelid skin) can be a cosmetic concern, more severe forms can compromise visual function, and as such, will be covered by insurance. Formal visual field testing and photography will be required to document the patient’s condition for the insurance company, and prior authorization is often required. It should be noted, that more recently, insurance approval has become increasingly difficult, and sometimes frustrating for both the surgeon and the patient.

Why Should you choose Dr. Amadi to perform your Blepharoplasty?

When choosing a surgeon to perform blepharoplasty, look for a cosmetic and reconstructive facial surgeon who specializes in the face, with extensive experience in eyelid surgery. Dr Amadi’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he is a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, with extensive training in Oculofacial plastic reconstructive and cosmetic surgery.
Dr. Amadi’s practice has been dedicated to this field since 2001. Furthermore, he has trained dozens of other surgeons [residents and fellows] in this area of surgery as Co-Director of the Oculofacial Plastic and Reconstructive Surgery Service and Fellowship at the University of Washington Medical Center and Harborview Medical Center.

EYELID PTOSIS REPAIR

Eyelid Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision.

Less severe forms of eyelid ptosis do not hamper or restrict vision, but they do give the patient a more tired or sleepy appearance. Patient’s will often complain that they often get asked whether they are tired or have gotten enough sleep. In these instances, ptosis is a more of an aesthetic concern for the patient.

What Causes Ptosis?

There are many causes of ptosis including age related weakening of the muscle, congenital weakness, trauma, or sometimes neurologic disease. As we age, the tendon that attaches the levator muscle, the major muscle that lifts the eyelid can stretch and cause the eyelid to fall. This represents the most common cause of a droopy eyelid, and can be exacerbated or hastened by contact lens wear over years. Ptosis may also occur following routine lasik or cataract surgery due to stretching of the muscle or tendon. Children may be born with ptosis or may acquire it due to trauma or neurologic reasons.

How Can Ptosis Be Corrected?

Ptosis can be corrected surgically and usually involves tightening one of the muscles that elevate the eyelid (Levator or Muller’s muscle). The surgical repair maybe performed through a skin incision along the eyelid crease, or more alternatively, by flipping the eyelid inside out, and tightening the muscle from the back side of the eyelid, thus avoiding an external scar.

In severe ptosis, when the levator muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s).

Dr. Amadi will perform testing at the time of your consultation to determine the best form of correction for the individual patient. The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid, while minimizing risks of surgery.

What are the risks/complications of Eyelid Ptosis repair?

The risks/complications of ptosis surgery include dry eye, poor blink, eyelid asymmetry, eyelid retraction, excessive tearing, inability to fully close eyelids, and, extremely rarely, loss of vision. Ptosis surgery is one of the most challenging surgeries done by Oculofacial plastic surgeons, and need for revision surgery is not uncommon (about 15%).

As with any surgery, there are possible risks and complications. Surgery performed by an experienced and knowledgeable surgeon minimizes these risks.

Because of Dr. Amadi’s expertise in this area, many other plastic surgeons refer patients with complications of eyelid surgery to Dr. Amadi for treatment and repair.

Will Insurance Pay for Eyelid Ptosis Surgery?

Sometimes. Depending on the degree of droopy, your insurance may cover the cost of surgery, at least partially, depending on your plan. If the eyelid droop is compromising the superior visual field, this will need to be confirmed by a formal visual field test. If the visual field test AND photographs demonstrate that the ptosis is severe enough (your insurance company has specific criteria), your surgery may be pre-approved . This process, unfortunately, will take additional time, and is sometimes fraught with bureaucratic difficulties. We do our best to streamline this process!

Why Should You Choose Dr. Amadi Perform Ptosis Surgery?

When choosing a surgeon to perform eyelid ptosis surgery, look for a cosmetic and reconstructive facial surgeon who specializes in the face, with extensive experience in eyelid surgery. Dr Amadi’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he is a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, with extensive training in Oculofacial plastic reconstructive and cosmetic surgery.
Dr. Amadi’s practice has been dedicated to this field since 2001. Furthermore, he has trained dozens of other surgeons [residents and fellows] in this area of surgery as Co-Director of the Oculofacial Plastic and Reconstructive Surgery Service and Fellowship at the University of Washington Medical Center and Harborview Medical Center.

EYELID RETRACTION REPAIR

Lower eyelid retraction (link to photo) is a condition where the lower eyelid sags too low on the surface of the eye, sitting below the lower edge of the cornea. This leads to scleral show [link to picture] where you can see the white of the eye between the cornea and the eyelid margin. This leads to an aesthetically unpleasing shape of the eye, creating a tired, aged appearance to the eye. Furthermore, in some patients, this may cause “dry eye” symptoms such as redness, burning, foreign body sensation, excess mucous production, crusting of the eyelids, sandy/gritty sensation tearing, often worse on awakening.

What causes lower eyelid retraction?

A variety of factors may be implicated, but the most common cause is increased tissue laxity secondary to aging. This process, exacerbated by a more prominent (bulgy) eye, weaker cheekbone support, and loss of lower lid and cheek volume, results in the descent of the eyelid.

Other causes of lower lid retraction included weakness of facial muscles due to facial nerve weakness/paralysis, Thyroid Eye Disease, and scarring from prior trauma or surgery, or laser resurfacing.

How can lower lid retraction be corrected?

Lower eyelid retraction can be surgically corrected by lengthening the height of the inside layer of the eyelid with a variety of different grafts, the most natural being the mucous membrane lining from inside the mouth, or the inside of the upper eyelid (tarsus) in milder cases. Other grafts such as derms-fat, ear/nose cartilage, or processed porcine tissue can also be used, depending on the circumstance. Not only must the eyelid be augmented in this fashion, the attachments of the eyelid to the bone of the eye socket need to be reinforced as well. In severe cases, suspension of the eyelid and cheek skin may be also be necessary to decrease the downward pull on the eyelid.

After surgery, the eye will feel more comfortable and will be better protected from possible corneal infections or scarring.

What are the risks/complications of Eyelid Retraction repair?

Besides the usual complications of surgery, i.e. bleeding, and infection, other potential problems include scarring, asymmetry, under- or over-correction, and recurrence of the retraction. In most cases, a “pre-emptive” over-correction is necessary, as with time, tissue will shrink and settle. It is important for patients to be educated about this phenomenon so that they are not startled by the immediate post-operative results.

Will insurance cover the costs of the surgery?

Though this may be sometimes be considered an elective cosmetic procedure, in some instances, depending on the severity of the condition as well as the patient’s symptoms, your insurance may cover part or all the costs of the surgery. However, in our experience, insurance companies have become increasingly difficult in providing pre-authorization for this, and in some instances deny payment even after prior pre-authorization has been obtained! Increasingly they consider this an elective cosmetic procedure. We share your frustration with this situation and will do our best to advocate on your behalf.

Why should you choose Dr. Amadi to perform your surgery?

When choosing a surgeon to perform eyelid retraction repair, look for a cosmetic and reconstructive facial surgeon who specializes in the face, with extensive experience in eyelid surgery. Dr Amadi’s membership in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) indicates he is a board certified ophthalmologist who knows the anatomy and structure of the eyelids and orbit, with extensive training in Oculofacial plastic reconstructive and cosmetic surgery. His extensive experience in reconstructive procedures at Harborview Medical Center and the University of Washington has honed Dr. Amadi’s skills and judgement in choosing the right technique for you.

Dr. Amadi’s practice has been dedicated to this field since 2001. Furthermore, he has trained dozens of other surgeons [residents and fellows] in this area of surgery as Co-Director of the Oculofacial Plastic and Reconstructive Surgery Service and Fellowship at the University of Washington Medical Center and Harborview Medical Center