An upper blepharoplasty or eyelid lift is a wonderful procedure that shapes the upper eyelid.  The result will frequently give you a more youthful, less tired appearance, brightening up the entire face.  The cosmetic upper eyelid lift does involve an incision, created with a laser, radiofrequency device, or scalpel.  But the scars almost completely disappear with time.  How does that occur?

The upper eyelid has a natural crease, usually 6-11 millimeters above the eyelashes, following a smooth arc.  The upper eyelid lift scar can be placed so that it coincides with your pre-existing crease.  In the photo below, the dotted red line shows the position of the eyelid crease, and the right side demonstrates an eyelid that already had a blepharoplasty, with a barely detectable scar.  

If you are considering aesthetic blepharoplasty, ask your surgeon if he or she plans to place the scar within the eyelid crease.  There are techniques that facilitate the scar/crease alignment.

Dr. Brett Kotlus is a cosmetic eyelid specialist that offers free consultations in the Detroit Metro area in Michigan. To learn more about cosmetic eyelid procedures, visit his website, EyeliftCenter.com. 

In this month's Plastic Surgery Practice Magazine, Dr. Kotlus defines the "tear trough", a groove under the eyes that appears as a dark circle.  He approaches the tear trough with a combination of therapies, laser resurfacing (seen above), injectable fillers, and possible eyelid lifting surgery. Because everyone has different anatomy, a customized treatment plan is needed in most cases. 

Fillers for the tear trough are most commonly composed of hyaluronic acid, a soft gel.  When used under the eyelid, the results can last longer than a year. There may be limited swelling or bruising after the procedure, but downtime is often minimal. 

Laser resurfacing can have downtime lasting for days, but the outstanding improvement in fine lines and skin texture are often worth the recovery investment. 

Earlier this month, Dr. Kotlus spoke in Seoul, Korea to a group of plastic surgeons about minimally invasive techniques for eyelid and facial rejuvenation.  Dr. Kotlus uses an approach that tailors the treatment to a patient's specific needs.  For example, certain people would benefit from BOTOX alone, while others may require volume corrections with fillers or fat transfer.  Other cases may require surgical procedures such as fat repositioning or an eyelid lift.  He explains that a combination treatment often works best.  Dual-depth fractional laser resurfacing is the latest wrinkle-eraser on the scene that can also be combined with fillers, BOTOX or Dysport, and surgery. In Asia, there is enormous interest in less-invasive cosmetic procedures. 

Dr. Kotlus also lectured at the American Academy of Facial Plastic and Reconstructive Surgery fall meeting in Boston last week, describing how intense pulsed light and photodynamic therapy can benefit people experiencing facial redness, brown spots, sun damage, large pores, and pre-cancerous spots. Along with Florida cosmetic surgeon John Martin M.D., Dr. Kotlus shared his experience with photofacial treatments, particularly in those who have already undergone facial plastic surgery.  

A new laser treatment for eyelid wrinkles was published by Dr. Kotlus in the latest issue of Dermatologic Surgery, a peer-reviewed journal.  He describes a "dual-depth" laser treatment using the fractional CO2 laser on the eyelid skin.  The laser is also called ActiveFX and DeepFX, two applications of the laser that treat different levels of the skin.  By treating superficial and deep skin layers at the same time, Dr. Kotlus has been able to improve surface sun damage, brown spots, and deep wrinkles in one treatment. 

Shown here is a patient who received the dual-depth laser treatment at the same time as a lower eyelid lift to shift bulging fat, reducing the appearance of lower eyelid bags. The laser enhances the lower eyelid lift by firming the eyelid skin and creating a smoother appearance. Patients should expect about a week of redness after the laser, although swelling can last longer than a week.