Eye Lift (Blepharoplasty)
Young eyes have a smooth upper lid, with a well-defined crease and no excess skin. Older eyes have excess skin, and may have some bulging medially (meaning near the midline). This bulging is actually fat inside the orbit. The orbital septum is a layer of connective tissue that keeps the fat inside the orbital cavity from bulging out. As we age, this layer of connective tissue weakens, allowing the fat to bulge out. In addition, our skin stretches and droops as we age.
So how do we fix this? It’s actually a relatively simple procedure:
- Take off the excess skin. The resulting scar is well-hidden in the crease of the upper eyelid.
- Remove the bulging fat. Removing just a pinch or two of fat smooths the contour of the upper eyelid.
Upper eyelid lifts are occasionally covered by insurance. For the procedure to be covered, the upper eyelid skin has to be drooping so much that it actually obstructs your vision. In order to find out for sure, you will need to see your ophthalmologist for a visual fields exam, which will determine if your excess eyelid skin is blocking your vision.
Lower eyelids age in a similar way to the upper eyelids. In addition to skin becoming more lax, the fat around the eye becomes more noticeable as well. This fat is held back by a thin layer of connective tissue that stretches from the cheekbone to the lower eyelid. This connective tissue weakens and stretches as we age, allowing the fat to “pooch out”, resulting in bags under the eyes.
The diagram to the left is a cross section of the eye. The big circle on top is the actual eyeball, or globe. The cheekbone is highlighted in orange, and the lower eyelid is highlighted in green (this is actually the tarsal plate, a firm supportive layer of the lower eyelid, but for our purposes calling it the lower eyelid is close enough). The blue line highlights this connective tissue layer, the orbital septum. You can see the fat behind it, highlighted in light yellow.
Lifting the lower eyelids is similar to to lifting the upper eyelids with one major difference:
- The excess skin is taken off
- The bulging fat is removed
- Here’s the difference– the lower eyelid is sometimes tightened. The canthal ligament, which is the tough connective tissue that supports the lower eyelid, is suspended higher into the outer corner of the bones that make up the orbit. Not every patient needs this, but it is commonly done to help provide support to the lower eyelid during the healing process.
Eyelids are a delicate area, so you can expect some bruising and swelling after surgery. The bruising usually resolves within 1-2 weeks, and mild swelling may persist for up to a month or longer. Most patients experience discomfort after surgery rather than true pain. This often takes the form of a dry eye or irritated eye. You may be given eye drops or ointment to help with these symptoms. In terms of activity restrictions, patients are limited from engaging in heavy lifting or vigorous exercise for a month after surgery. Return to work depends on what type of job you have, and if you prefer to wait for all bruising and swelling to go back prior to returning to work.
Before and After Photos***
Face Lift (Rhytidectomy)
Patients often expect that having a face lift will rejuvenate everything from sagging eyelids to loose skin over the neck, but this is actually not the case. A standard face lift addresses only the mid-face: the area from your cheekbone to your jawline. The main area of improvement is along the jawline where lax skin shows up as unflattering jowling. Face lifts may also soften, but will not completely eradicate, lines around the mouth. Lax skin over the neck or under the chin is treated by a neck lift. This is commonly done at the time of a face lift, but is actually a separate surgical procedure.
The scar from a face lift is frequently an area of concern for patients. Even though the incision is theoretically in plain sight, placing it at the boundaries of anatomic landmarks, such as directly in front of the ear or along the hairline, allow the surgeon to camouflage the incision so that the scar is nearly invisible.
Before and After Photos***
Repair of Stretched or Torn Earlobes
Earlobes may become torn accidentally, or stretched out intentionally by wearing large earrings. Regardless of how this happened, it can be fixed, and often in the office with just some local anesthetic to numb the area.
If you have intentionally stretched your earlobes, the first step is to stop wearing earrings in the stretched holes. The skin will shrink back to some extent, although this takes several months, and the hole almost never closes completely. But letting nature do some of the work is the best way to start. After the piercing hole has stopped shrinking in size, we can fix the earlobe by removing the pierced part and rearranging the skin that is left. This does leave scars on the earlobe, but they are generally much less noticeable than a stretched piercing.
If your earlobes were torn accidentally, repair is a little bit easier. But you do have to wait 6 weeks before re-piercing your ears.
Before and After Photos***
Treatment of Skin Cancer
There are two different surgical options to treat skin cancer:
- Wide local excision. This means that a surgeon takes off the skin cancer with a margin of normal tissue. Many types of surgeons do this type of procedure, including General Surgeons, Plastic Surgeons, and Otolaryngologists. This is done in either the office or the operating room, depending on the size of the skin cancer. When wide local excision is done in the operating room, the surgeon may send the tissue to the pathologist for what is called a frozen section, meaning he or she will freeze that bit of tissue and look at it to see if there is any skin cancer left. This doesn’t work well for melanoma, and still isn’t 100% accurate for other types of skin cancer. We only know for sure after the pathologist processes the tissue with chemicals and special stains, which takes a few days.
- Mohs surgery. This is named after the doctor who created it, and is only done by specially-trained Mohs surgeons, who are dermatologists. This type of surgery is done in an office, using numbing medicine. The difference between this and a wide local excision is that the Mohs surgeon first takes out the cancer, then takes out just the rim of the wound and looks at that flat under a microscope himself (as opposed to sending it to a pathologist). This concept is a little hard to explain; this diagram clarifies the procedure. The take-home point is that Mohs surgery takes a little longer, because the surgeon takes the cancer out in multiple steps. But they remove as little normal tissue as possible, because they look at it under the microscope at each stage, and when you’re done with the Mohs surgery you know your cancer is gone.
What About Afterward?
If you have a skin cancer removed, generally the physician who did the procedure will also close the wound. If you have had Mohs surgery, however, the Mohs surgeon may refer you to a Plastic Surgeon for skin cancers on the face. If this is the case, you will often see the Plastic Surgeon before your Mohs surgery, so that you have have the closure done as soon as possible afterward. The reconstructive surgery you have depends on how big the wound is, and where it is location. But options including skin grafting and local rotation flaps. See some before and after pictures below.
Before and After Photos***
***All patient results may vary, these procedures are for cosmetic purposes only and results are not guaranteed, nor are permanent. All patients are different and in no way will any procedures be alike, nor the recovery period.
“Over time I saw signs of aging creeping in on me. I have tried fillers in the past but I knew I wanted something more permanent. I was hesitant about having a facelift and coming out looking like Joan Rivers; I didn’t want to look entirely different, and I was reluctant about how painful it would be. All of my questions were answered after my first consultation, and as I thought of more questions, Dr. Greer answered those questions as well. She really did an excellent job of letting me know what to expect at all phases of recovery. I had a face lift, neck lift, and fat grafting to the face. Now the lines I had are gone! My skin feels tight again, and my face and neck look 100% better. And the pain was minimal. People have commented if I did something different to my hair, or asked if I changed my makeup or beauty products. Some just have said I look refreshed. I highly recommend it; every woman needs to feel good about herself. Women/moms put themselves last, especially when kids are younger; at some point we deserve to be number one.”