Eyelid Surgery in New York City

Upper Eyelid Surgery

Upper Eyelid Surgery creates crisp upper lids, corrects fatty protrusions without hollowing the eyes, preserves the length and height of the palpebral aperture, avoids scleral show and lagophthalmos, and corrects deep grooves, all while maintaining a healthy natural appearance. Performed through an incision in the superior palpebral sulcus (ie. upper eyelid fold), Upper Eyelid Surgery takes about 1-2 hours. Traditionally, Upper Eyelid Surgery was an extirpative procedure wherein tissues were only removed. These older techniques gave patients a hollow, sunken appearance (ie. think of your favorite octogenarian politician, actor or actress). Today, Dr. Warren redistributes upper eyelid fat to eliminate the fatty protrusions while adding fat under the superior orbital rim, into temporal area, along the inferior orbital rims, and into the cheeks to rejuvenate the periorbital tissues.

Why is fat grafting such an important addition to Upper Eyelid Surgery? Fat grafting provides volumetric rejuvenation; this a relatively new and different way to improve facial appearance. Unlike dermal/subdermal fillers, fat integrates with facial tissues and becomes part of the face. This seamless integration produces a more natural-appearing, sustained, and long-lasting improvement. In addition, Dr. Warren’s own laboratory research as well as the research of others indicates that stem cells contained within the fat may be inducing improvement in the quality of the facial tissues– this may constitute, for the first time, a true rejuvenating technique.

Avoiding (or correcting) hollow upper eyelids is so important to achieving a natural appearance. Whether the result of weight loss, aging, or previous well-intended surgery, filling the hollow upper orbit produces a marked improvement in an unnaturally sunken and elderly appearance. Correction of this owl eye’s appearance is most practically done by placing fat along the inferior margin of the supraorbital rim. This approach is best conceptualized as lowering the supraorbital rim and filling the upper orbital area to push skin that has retracted up into the orbit down onto the eyelid to create a full and appropriately creased upper eyelid. Fat grafting is an artistically demanding technique that requires a considerable amount of creativity, but it is a routine part of Dr. Warren’s rejuvenating Upper Eyelid Surgery.

Asian Eyelid Surgery

There are a number of anatomic differences between Asian and Caucasian eyelids. In Asian upper eyelids, the skin and subcutaneous fat tend to be thicker. The orbital septum is often weaker and thinner and it tends to drape below the upper border of the tarsal plate. The levator aponeurotic dermal extensions are weak or nonexistent. The paucity of levator-dermal extensions is responsible for the low-lying or absent supratarsal fold. Epicanthal folds may cover the medial angle and lacrimal caruncle. Trichiasis is caused by the overhanging upper eyelid skin pushing down on the eyelashes. Collectively, these features give the Asian eyelid more fullness, a lower lid crease, and a narrower palpebral fissure.

Asian Eyelid Surgery (aka. Double Eyelid Surgery) refers to a blepharoplasty technique designed to create a natural looking upper eyelid crease (ie. superior palpebral sulcus). In Asian Eyelid Surgery, the upper eyelid crease is typically set at the height of the tarsal plate (6-8 mm above the lid margin). The crease shape can be parallel or nasally joining. Either shape can be right for you. After making the initial lid crease incision, a very small amount of skin is removed (1.5–2 mm). A superiorly beveled trans-orbicularis dissection is performed to remove a small amount of orbicularis muscle and preseptal fat. Creating the eyelid crease does not require permanent sutures encircling the levator-Mueller muscles complex. This antiquated technique often produces a ligature-induced indentation that results in a static, harsh crease. To replicate the natural anterior interdigitation of the levator aponeurosis with the orbicularis muscle fibers and subcutaneous tissue to create a supratarsal fold, one only needs to direct a fraction of the levator aponeurotic fibers to the under-surface of the skin along the superior tarsal border. This yields a natural, dynamic crease.

Lower Eyelid Surgery

Lower Eyelid Surgery targets wrinkled skin, herniating fat bags, and periorbital hollows (ie. tear troughs and separation at the lid-cheek junction) to alleviate the tired appearance. Performed through either a transconjunctival (ie. no scar) or subciliary (ie. fine scar just under the eyelashes) incision, Lower Eyelid Surgery takes about 1 hour. Traditionally, Lower Eyelid Surgery was an extirpative procedure wherein tissues were only removed. These older techniques give patients a hollow, sunken appearance (ie. think of your favorite octogenarian politician, actor or actress). Today, Dr. Warren redistributes lower eyelid fat to eliminate the bags while adding fat into the tear troughs, along the inferior orbital rims, and into the cheeks to rejuvenate the periorbital tissues. Judicious use of fat grafting creates a natural appearance and avoids the telltale signs of treatment. Lower Eyelid Surgery can also lift, tighten, and correct a sagging lower eyelid (ie. ectropion) by adding canthopexy or canthoplasty techniques. Finally, skin resurfacing techniques (eg. chemical peel, laser, etc) can be added to treat fine lines and wrinkles. With so many options, Dr Warren will help identify your key concerns, discuss treatment options, and find the right treatment plan for you.

Eyelid Revision Surgery

Eyelid revision surgery (aka. Revision Blepharoplasty) is a secondary surgical procedure performed to correct complications or untoward outcome after previous eyelid surgery. Post-surgical complications come in a variety of flavors including, lagophthalmos, ectropion, canthal malposition, ptosis, epiblepharon, rounding of the eyelids, etc. Complications can be irritating to the eye and treatment is often necessary to relieve functional issues (eg. dryness, redness, tearing, chemosis, etc.) Post-surgical untoward outcomes include superior orbital hollowness, persistent eyelid hooding, persistent lower eyelid bags, persistent crepey skin, etc. Unsatisfactory outcomes are disappointing, but typically do not endanger your ocular health. Fortunately, unsatisfactory outcomes can often be corrected or substantially improved with technically detailed, but relatively small procedures.