Window to the Soul
by Staff

Commentary, Questions & Answers by Dr. Andrew G. Berman

Over the past decade, blepharoplasty has surpassed the popularity of the face-lift and the nose job, becoming the most popular facial cosmetic-surgery procedure among women. According to the American Society of Plastic Surgeons, 269,873 women had “eye-lifts” in 2000. Over 7,500 of them were ages 19 to 34 (shedding a hereditary legacy, puffy lower lids), while 90,200 women were between 35 and 50 (reversing eye bags or smoothing upper lids that have developed folds). The trend continues to escalate as the new century unfolds.

What is the ideal age for getting an eyelift?
Eyelid surgery is performed on women of all ages. Fat bulges under the lower lashes, another inherited trait that makes women appear tired when they are not, is best altered in their early 20’s or 30’s. Operating early allows for incisions in the inside of the lower lids so there are no scars. By age 40, for some women, an eyelift may be an easier decision than a face-lift-- resulting in a refreshed, youthful, and rested appearance. For women who have tired eyes and sagging cheeks, jaws, or deep smile lines a rhytidectomy (full face-lift) may be in order.

What is involved in an eyelift?
Surgeons can reshape the upper lid and recreate the crease (upper blepharoplasty) by removing the skin, muscle, or fat through an incision in the crease area, or pull an overhanging lid upward (blepharoptosis repair). Surgeons can give the eye an almond shape with a canthopexy, which means “corner lift”. The can also reshape the lower eyelid (lower blepharoplasty) by removing some skin and fat and/or tightening the thin tissue under the skin of the lower lid and stretching it out like leggings. Showing the doctor old yearbook photos during the consultation can help patient and doctor decide which areas need work.

How long does an eyelift last?
An eyelift done well should last “10+ years at which time there may be some tissue to be removed”, says Walter E. Berman, MD of the Beverly Hills Surgical Institute. The Beverly Hills Surgical Institute was spearheaded by Walter E. Berman, MD 48 years ago and is now thriving with the addition of his son Dr. Andrew Berman, MD. Over 11,000 blepharoplasty procedures later, this father and son combination comprises over 60 years of experience.

Can Botox delay an eyelift?
Botox can only temporarily relax the appearance of lines around the eyes. It’s better to think of Botox as an adjunct to an eyelift. Crow’s feet, caused by squinting cannot be erased with a standard eyelift procedure (although a corner lift may soften them by stretching the skin). However, Botox can temporarily relax crow’s feet for about 4-6 months. The diluted toxin can also flatten the “eleven’s” (the two vertical frown lines between the eyes), lift a drooping outer eyebrow, and, when injected cautiously under the eyes, reverse the downward pull on a lower lid. Botox cannot eliminate bulging fat or excess skin under the eye.

Will there be visible scars?
Minor scars are always a possibility yet usually not apparent. The delicate skin around the eyes heals better than any other part of the body. When excess skin is removed from the upper lid, a fine scar in the crease can be slightly visible to a sharp-eyed friend. Traditional lower-eyelid surgery where the incision is placed just below the lower lashes, the scar is virtually invisible.

Will an eyelift change the size or shape of the eyes?
Only if you want it to. Most patients basically like their eyes and just to rid them of the bags, puffiness, or fine lines. Some patients do request a walnut or an almond shape, smaller or larger eyes. A patient may also control the slant of the lower eyelid with a corner lift, or tighten and reposition the lower lid if the sclera (white) is too large. A lower lid that is too relaxed, is not only unattractive it may cause dry eyes. New techniques now allowed sagging lids to be brought into line without diminishing the size of eye. Bring pictures of eyes you admire to your consultation and the vision will be clear between you and your doctor.

Who should perform an eyelift?
Legally, any M.D. can perform any operation in a private office. This means that your urologist can legally perform a face-lift. Therefore, choosing a qualified doctor is a crucial decision. Plastic surgeons operate on all parts of the body. Ear, nose, and throat doctors are primarily experts in those areas; ophthalmologists treat eye diseases and vision problems; and oculoplastic surgeons—ophthalmologists with extra training in plastic and reconstructive surgery of the eyelids and bone around the eye—specialize in cosmetic eyelid work. Ideally, choose a surgeon who is an ENT and has a lot of experience under his/her belt performing these procedures.