Rejuvenation of the upper and/or lower eyelids involves the variable removal of skin and fat. No two patients are alike, and no two blepharoplasty operations are identical. Surgery is tailored to the specific needs of each patient based on a thorough pre-operative evaluation.

Upper blepharoplasty involves the removal of skin based on the upper eyelid crease. Eyelid skin is the thinnest in the body. The skin is quite delicate, but when handled gently during surgery heals with almost imperceptible scars. By placing the incision in the crease of the eyelid, the incision falls into a natural crease line to further camouflage the resultant scar. Fine sutures are utilized, which are generally the “dissolvable” type. These dissolve in approximately 12-14 days.

The goal with upper blepharoplasty is to remove an appropriate amount of skin while still allowing for normal closure of the eyes after surgery. The eye-brows are always assessed in the consultative examination to determine whether a drooping eyebrow/ forehead is contributing to upper eyelid fullness. If this appears to be the case, Dr. DeBacker may recommend a brow lift be performed as well.

Lower blepharoplasty rejuvenates the lower eyelid by removing the “puffy fat pockets” and any excess skin. Dr. DeBacker utilizes a technique known as the “transconjunctival blepharoplasty” to remove the fat pockets from the lower lid. This technique requires a skill set not universal to surgeons performing eyelid surgery. Surgeons need to be more familiar with the eyelid anatomy to perform this skillfully. It is Dr. DeBacker’s opinion that this leads to a more attractive eyelid, and less scarring and possible dry eyes and eye shape changes than the more common methods. This places the incision on the back of the eyelid, and does no require sutures for closure. If skin removal is necessary, an incision is placed just beneath the lower eyelash line, and fine dissolvable sutures are used as for the upper eyelids. As with the upper eyelids, the lower lid skin is very thin and the incisional scar is well camouflaged.

Newer techniques for upper and lower eyelid rejuvenation include the injection of “fillers” such as Juvederm or Resylane to add volume around bulging fat pockets and skin folds. These techniques have shown success in a select number of patients.

Eyelid surgery takes about an hour to perform (2 hours for both upper and lower eyelids) and can be safely performed in the office with mild sedatives given by mouth and local anesthetics. Patients are quite comfortable in this setting, and Dr. DeBacker and his staff are committed to making your experience as comfortable and non-stressful as possible. Some patients will elect to have their surgery performed in an outpatient surgery center or hospital. In these situations a board-certified anesthesiologist will provide either intravenous sedation or general anesthesia. Patients with significant medical problems are encouraged to have their surgery in this setting to allow for additional monitoring during the surgery. Patients who elect to undergo multiple procedures at the same time, such as face-lifting or brow lifting, may also be encouraged to pursue this surgical setting.
Iced compresses are applied for 2 days while awake, with a break every 20 minutes. Discomfort after surgery is mild, and usually controlled with Tylenol, although a prescription is given for stronger pain relievers as well. Antibiotic ointment is applied to the sutures, and antibiotic eye drops and oral antibiotics may be prescribed, as well. No eye patches are necessary. Patients are encouraged to sleep with their head slightly elevated for the first 2-3 nights. Bruising and swelling are common, and tend to peak the day after surgery. Recovering in a calm, quiet environment allows for improved and more rapid healing by eliminating stressors and maintaining a normal blood pressure. Activities for the week following surgery should be light, with no heavy lifting, stooping over, or heavy exercise. Walking is encouraged after surgery, and patients can resume driving within a few days as long as they feel they feel safe and are not taking strong pain medications.

Forehead and brow lifting is performed to elevate the eyebrows, improve eyebrow contour, and to eliminate muscles that cause wrinkling of forehead and brows (these are the same muscles targeted for Botox treatment). Brow lifting can be done via an endoscopic approach through small incisions behind the hair line. Some patients will benefit from a longer incision in front of or behind the hair line, depending on the height of the hair line, the density of the hair, and the hair style favored by the patient. The most appropriate approach to fit your needs will be decided after a thorough discussion with Dr. DeBacker.

A face lift is designed to “turn back the clock” by addressing ageing changes along the jaw line (“jowls”) and in the neck. You can simulate the “lifting” achieved with a face-lift by pulling tissue along the jaw line and in the neck back towards the scalp behind the ears. During a face-lift excess skin is removed by strategically placing incisions along the borders of the ear and hairline. The soft tissue of the face is comprised of multiple layers, and these are shifted and repositioned during the face lift. The goal of a face lift is a natural look, and the avoidance of an appearance that is overly tight, or that gives the patient a “wind-swept,” un-natural look. Sutures and metal clips are used to close the face lift incisions, and these are removed 7-10 days after surgery. Pain tends to be minimal, and is managed similarly to eyelid surgery and forehead surgery.

Laser Resurfacing Surgery is performed with a “super-pulsed” carbon dioxide (CO2) laser to minimize wrinkles and lines on the face. Laser surgery involves a specialized beam of light energy, which is absorbed by the skin and surrounding tissues and minimizes lines or makes precise surgical incisions. In laser resurfacing, lines on the face can be significantly improved. This procedure is performed under sedation with local anesthesia. Redness may persist for several weeks and make-up can usually be applied in seven to ten days.

A chemical peel is a treatment that chemically exfoliates the skin’s top layers to reveal the softer and healthier skin below. Chemical peels are used to treat a variety of skin conditions. This can include environmentally damaged/hyperpigmented, acne prone, and even sensitive skin types. In many cases, wrinkles caused by sun damage, aging, and heredity can be reduced and even eliminated through the use of a series of chemical peels. Irregular skin pigmentation, sun-damaged skin, and even precancerous keratoses may improve as a result of chemical peels. Chemical peels can increase the skin’s tolerance to external factors and control acne. The strength of the chemical peel is determined by the patient’s individual skin type and the degree of damage to the skin.

This procedure is not effective in the treatment of more severe wrinkles, sagging, and budging which often require a surgical procedure such as a facelift or liposculpture.

Botox injections are used to weaken the fine muscles around the eyes and forehead that are responsible for the frown lines and deep wrinkles that occur in these areas. By selectively weakinging the proper muscles, the surgeon can eliminate the wrinkles without disturbing normal function.

Treatment consists of a number of tiny injections made through a very fine needle directly into the muscle. Effects of the injections begin to appear within a few days. The results generally last around four to six months, after which time, the injections must be repeated.

The use of injectable facial fillers is one of the fastest growing areas in the field of cosmetic surgery. Many advances in have been made in the last 5 years that have led to safer, more predictable and longer lasting fillers.
As one ages, the face loses volume. This creates more prominent wrinkles and skin folds while features become less distinct. Dynamic wrinkles caused by facial movement such as smiling and frowning appear. Injectables were designed to subtly reduce these signs of aging.

Injectables include two basic classes: fillers, to restore lost volume, and botulinum toxin injections, to lessen the appearance of wrinkles with smiling, frowning, concentrating and looking surprised. Most fillers work by filling the lip or wrinkle with volume and are gradually digested by the body. While botulinum toxin injections work by weaken the underlying muscles to decrease their overlying dynamic movement.

FDA approved injectable fillers include Collagen, Hyaluronic Acid Fillers, Fillers with microscopic beads and Poly Lactic Acid.

For those wishing to avoid the injection of any foreign material, lipotransfer, the harvesting and reinjection of your own fat, may be an option.

Hyaluronic Acid Fillers: These were the first of the new fillers to be FDA approved. Hyaluronic acid is a naturally occurring carbohydrate which occurs in skin. It is a clear gel with a thick consistency. Since skin testing is not required, injections may be done on the same day as the initial consultation. Manufacturers have manipulated particle size (thickness) and crosslinked molecules to offer both normal and longer duration products.

Restylane and Juviderm are examples of normal duration products that are injected in more superficial lines and have easier flow characteristics. Perlane and Juviderm Ultra Plus are examples of longer duration products are usually injected into deeper lines and folds.

The newest advance has been the addition of local anesthetic, Lidocaine, to the filler to reduce discomfort upon injection. By combining a local anesthetic with the filler, the injection process is more comfortable for the patient, although most surgeons use local anesthetic injection routinely before filler administration.
Fillers With Microscopic Beads: This class includes Radiesse and Artefill. Radiesse contains calcium based microspheres suspended in a water based gel. Since skin testing is not required treatment may be received on the same day as consultation. Artefil contains polymethyl methacrylate (PMMA) synthetic microspheres suspended in a bovine collagen gel and lidocaine. A skin test is required and must wait at least one month following the skin test for injection. The advantage is its longer duration of effect since the body does not reabsorb the synthetic PMMA microspheres.

Poly Lactic Acid Fillers: Sculptra is substance known as L-Poly Lactic Acid which is similar to the material used to make a type of suture that is used to close lacerations. This material does not require allergy testing. Following injection the body produces new collagen in the area injected. The reaction is not immediate but increases over the next 3-4 weeks after injection.

Who is a Candidate?
• Facial fillers are administered over a wide age range.
• Younger patients seeking fuller, plumper lips
• Older patients seeking wrinkle reduction and fuller lips.
• Men who wish reduction of folds around the mouth to look younger.

Intended Results
• Fuller and plumper lips.
• Softening of superficial and deep wrinkles.
• Softening of wrinkles which appear during facial movement (smiling, frowning, concentrating and looking surprised).

Procedure Description
• This procedure is usually performed in the office.
• Most surgeons use a topical anesthetic cream and also administer local anesthetic injections prior to injecting fillers.
• Ice may be applied before and after injection.
• Immediate swelling may create the appearance of over treatment – his swelling generally resolves in several hours.

Recuperation and healing
• For most patients, fillers can be injected in the lips or wrinkles and they can return to work the next day.
• Occasionally a patient swells dramatically, especially in the lips. A first time patient may want to schedule the initial injection on a Friday.
• Bruising may occur but can usually be covered with makeup. It is a good idea not to schedule filler injection right before an important social function.
Other options
• Lipotransfer: the use of your own fat taken from one area and reinjected into facial lines and wrinkles after preparation.
• Volume restoration through cheek or chin implants.
• Forehead and facelift.
• Eyelid surgery (blepharoplasty).
• Chemical peel.
• Laser resurfacing.

Note
• The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation with your