Thank you for your question.
You submitted a photo of your eyes and you are asking about undergoing upper and lower
eyelid surgery and you are asking what age is best to do it.
You state in your question that you are 45-years-old, you have a history of dry eye and glaucoma
and that you go to an ophthalmologist every 6 months to have your eye pressure checked.
You also have a history of issues with keloid scarring and so I think that what you are
basically looking for is just some guidance as to what to do and when to do this.
Well, I can certainly give you my perspective as an oculofacial plastic surgeon.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and dealing with
issues where there is ocular issues as well as cosmetic issues is basically the focus
area of my practice.
So, when assessing someone like yourself, we first start with of course asking about
what are the key aesthetic issues that you are concerned about.
When I look at your eyes, I noticed a few things.
First, looking at the upper eyelids, I noticed that the right upper lid is a little bit lower
than the left upper eyelid.
Now this may be just one angle of taking the photo but if that’s the case, it is important
to recognize that you may have a concurrent issue called eyelid ptosis.
And eyelid ptosis means that the eyelid is drooping because typically of a muscle called
the levator muscle and that muscle is the muscle that is responsible for lifting the
eyelid.
Now, it doesn’t mean that every time someone has a mild degree of ptosis that it needs
to be addressed but I feel it is always important to recognize it and to bring it to the patient’s
attention that it is present.
So when you look at your upper lids, the question is do you feel like you have too much skin
in the upper eyelids or does it feel like the upper eyelid is a little bit too droopy,
bilaterally or in both eyes and I would tend to lean towards the latter.
It doesn’t look like you have a lot of skin over your eyes but it does look like the upper
eyelids look a little bit droopy and that is something to consider on what is the best
approach.
Do you address the drooping of the eyelid from the muscle?
Or do we address additionally some of the skin.
Now, it is very important when you consider eyelid surgery especially when you have a
history of dry eye to prevent any risk or minimize the risk of ocular exposure.
So the procedure has to be done with eye health in mind.
This is such an important issue that I simply can’t overstate it.
So that being said, moving onto your lower eyelids, the lower eyelids I see essentially
some puffiness and possibly some sagging of the lower eyelid and that issue can be dealt
with, typically, what I would do is something called lower eyelid transconjunctival blepharoplasty
which is to address the anatomic issue which is the fat pockets that are under the eyes
as well as possibly a lower eyelid tightening procedure in order to maintain the proper
tone of the lower eyelid to allow proper tear film distribution over the eyes.
Patients come to us from all over the world who have complications of eyelid surgery such
as eyelid retraction or exposure and they need reconstruction in order to get the proper
functional process of their eyelid back in order.
So it is something that I am very attuned to and especially when you have other ocular
conditions has to be again factored in when you discuss a surgical plan.
Now, there are other procedures that are often done concurrently with eyelid surgery to help
improve the maximal benefit and this includes procedures such as the use of platelet-rich
plasma (PRP) which is derived from your own blood and is a concentration of growth factors
to help skin quality improve.
We also do things like fractional CO2 laser and Erbium laser to improve skin quality.
And to address the question of course about the keloid scarring, you know a lot of times
people think of keloids because they have other areas of the body such as a C-section
scar or an incision on their arm or some part of their abdomen got thick, so they feel are
a keloid former.
Generally speaking, in my experience in over 20 years of practice and being someone who’s
always been attuned to the needs of different skin types and ethnicities, I would say that
eyelid skin is actually remarkably forgiving, even in people who are in high risk of keloid
forming.
And so I think that this is a matter of proper management technique and minimizing the risk
and it is likely that you won’t have an issue with keloid scarring.
As far as the question about the age in which to do a procedure, it really doesn’t, in
my experience, it’s kind of immaterial what the age is.
We have treated people as young, my youngest patient for under eye bags surgery is 14-years-old.
And so far my oldest patient is in their 90s and we have one patient years ago who was
actually over a hundred and so it is actually a question of combination of aesthetics, functionality
and the need for these procedures as long as you are physically healthy.
So, it is important that you factor in the relative importance of the procedure and all
the other ocular issues and then do the procedure when you feel like it really will make an
impact on your appearance.
Clearly, this is something that’s bothering you so obviously, by presenting this question
to us, I think it is something that is important to you but I think it is more important to
actually understand all the variables that have to be factored in before you do any type
of eyelid surgery.
So, I would recommend that you meet with qualified, experienced cosmetic surgeons and I think
I would be more inclined to recommend an oculofacial plastic surgeon and beyond that someone who
does a lot of cosmetic surgery.
I think even a specialized field like oculofacial plastic surgery, there are colleagues who
do a lot more reconstructive and there are colleagues who do a lot more cosmetic.
My practice for example is a practice where we do a lot of cosmetic surgery.
So, I think that there is a different frequency in which people are attuned into when they
do a lot of cosmetic versus doing a lot of reconstructive excluding cosmetic.
So it is just a matter of being comfortable with the doctor you choose.
So I hope that was helpful, I wish you the best of luck and thank you for your question.