Upper & Lower Eyelid Surgery (Blepharoplasty)

Your eyes are one of the first things people notice about you. They are also one of the first to show signs of aging. In the upper eyelid, as the skin around the eyes begins to sag over time, the eyelids look droopy or puffy and the skin folds covering the lashes may even block your peripheral vision. In the lower eyelids, excess fat can cause puffy “bags” and shadow under the eyes, imparting a tired or sad look to your face. Fortunately, eyelid surgery (blepharoplasty) can significantly reverse these effects of time providing a more rested, youthful look to your eyes. After treatment, the upper lids will be tighter and eyelid folds better delineated. The skin under the eyes will be tighter and smoother with baggy appearance resolved.

 

In the upper eyelid, an incision is made along the natural fold of your eyelid. Appropriate amount of excess skin, fat, and muscle are removed. In essence, Dr. Kang “sculptures” the upper eye to appear well rested and more youthful. The incision is then closed and protected with ointment. Incision usually heals imperceptibly, hidden in the natural fold of the eyelid. At the time of consultation, it is also very important to evaluate the entire peri-orbital complex including the brow position. In some patients, the brows tend to sag much faster and worsen the drooping and puffy appearance of the upper eyelids. With proper repositioning of the brow, either surgically or non-surgically (using Botox), a more optimal, natural look can be achieved. For Asian upper eyelid surgery, please refer to the appropriate section for more comprehensive information.

 

In the lower eyelid, the puffy or baggy appearance is corrected by removing fat deposits through a small incision made “inside” the lower lid (transconjunctival approach). This surgery alone will address most of the lower eyelid aging, usually up to age 40 or so. Between ages 40 and 45, half the patient will need, additionally, “pinching” (trimming) of the excess skin as well. After age 45 or so, most patients will benefit from transconjunctival fat removal combined with appropriate pinching of the outside excess skin. Dr. Kang believes that the transconjunctival approach minimizes swelling and bruising, and therefore allows quicker recovery. Because there is no incision outside the skin, the technique is wonderful for patients who want quick recovery and do not want to give away any signs of having undergone surgery. Even when combined with pinching of the outside excess skin, because the in-between “muscle” layer is never manipulated or weakened, complications such as weakening of eyelid tone or positioning is minimized. Dr. Kang has championed this technique since the beginning of his practice 15 years ago with great success, since he learned it from one of the best, Dr. Wallace K. Dyer, his Fellowship Mentor, who had been nationally recognized for this technique during a time when most surgeons were still using open “outside” incision technique. Over the years, Dr. Kang has refined this technique to a point where patients have to deal with only minimal swelling and almost no bruising during the immediate post-operative period resulting in minimal down-time. As with the upper eyelid, Dr. Kang will first carefully analyze the entire peri-orbital complex, including the prominence of the cheekbone and the degree of sagging of your mid-cheek, and then recommend just the “right” amount of fat to be trimmed. In many cases of the lower eyelid surgery, the old adage “it is not what you take out but what you leave behind” which holds true.

 

Dr. Kang always reminds the patient that while the eyelid surgery significantly improves the overall appearance, it doesn’t “erase” all the fine wrinkles around the eyes. For further improvement of this area, Dr. Kang recommends Botox, sometimes in combination with dermal fillers. For patients wishing further improvement of the eyelid skin tone and texture, he will recommend a series of light chemical peels or quick recovery laser peels. Finally for patients with significant volume loss of upper eyelid sulcus, he will recommend lipo-transfer to this area either at the time of surgery or following surgery. For patients with severe tear trough deformity, he will recommend lipo-transfer or use of dermal fillers to “fill-in” the trough, ultimately to provide a more youthful frame work around the eyes.