Holger G. Gassner, M.D., Board Certified Facial Plastic Surgeon (USA)

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Changes to the eyelids due to ageing or other factors (genetic, for exampe) can be corrected using an operation called, Blepharoplasty.   Generally speaking, excessive eyelid skin hanging over the upper eyelids would be removed.  Sagging skin, or excess fat located in the underlids areas may also be removed, depending on what has been discussed as the desired results of the operation meaning the tear sacks of the eyes may also be corrected.

For Professor Gassner,t is important to accurately analyze the age related changes of the eyelids and surrounding tissues in order to plan your treatment appropriately.  The age related changes may result in loose skin of the upper eyelid that is hanging down.  This may create the sensation of heaviness of the eyelids.  With time the loose skin may cover the entire eyelid and may even start to fall down over the eyelashes.  With more extensive age related changes, even the field of vision may become reduced.  In the lower eyelid wrinkles may form because of the extra amount of loose skin under the eyelids.  In addition orbital fat may start to bulge and create the appearance of bags under the eyes.

The reasons why a patient may wish to explore eyelid surgery include the feeling that the appearance has become tired, sad or aged.  Moreover, the patient may be bothered by eyelid skin making it more difficult to apply makeup to the eyelids.  Also you may be looking to improve the heaviness of the eyelids or to improve the field of vision.  In the lower eyelid, frequent wishes are to improve the appearance of the bags under the eyes and to correct the wrinkled appearance of the eyelid skin

Various techniques to correct the upper and the lower eyelid are available.  It is important that the correct technique or the correct combinations of techniques are very carefully chosen after careful and detailed analysis of the anatomic changes as well as your wishes and expectations.

In the upper eyelid typically an area of skin and a strip of underlying musculature is removed.  This is the so-called skin-muscle flap technique.  If there is excessive fat around the eye that bulges into the upper eyelid skin, this may be removed at the same time.  The skin cut maybe performed with a surgical knife or with a laser.  Dr. Gassner prefers the surgical knife as he feels this affords greater precision.  Moreover, the laser requires more extensive precautionary measures which includes placement of metal cap protectors on your eyeballs.  These protectors may distort the anatomy of the upper eyelid during the surgery and may cause some imperfections in the placement of the incision.

For the lower eyelid there is also a variety of techniques.  These include the open or skin-muscle flap technique with or without removal of orbital fat.  This technique is typically performed for more advanced age related changes.  A gentle cut is performed right below the eyelashes and is curved about 1 centimeter to the side of the eyelid.  A small strip of skin is then taken.  During the same procedure some fat that maybe bulging from the orbit and that maybe contributing to visible bags under the eyes may be removed.  The skin cut is then meticulously closed with suture material that will dissolve.

The transconjunctival technique allows removal of fat without a skin incision.  With this technique, a small cut is placed on the inside of the eyelid and the fat of the bags under the eyes is removed through this route.  This technique may be combined with a so-called pinch excision of lower eyelid skin.  With the pinch excision technique, a relatively smaller area of skin is removed while the underlying musculature remains intact.

The position of the eyebrows has important influence on the appearance of the eyelids.  With ageing, the eyebrow starts to descent.  This is typically more pronounced over the parts of the eyebrows on the sides rather than in the centre.  The descent of the eyebrows may cause the upper eyelid to become crowded, full and droopy.

When the eyebrow has descended too far, a correction of the upper eyelid alone may not be sufficient.  In such a case too much eyelid skin would have to be removed and the result would not be optimal since the eyebrow would remain in its unnatural position.  Moreover, the amount of eyelid skin that may be removed is limited.  If the removal of eyelid skin becomes too large, one gets into skin of different color and texture that makes the resulting scars potentially visible.

A simultaneously performed brow lift may also make the eyelid correction less extensive and more easily performed.  Once the eyebrows have been lifted into a more natural position, the amount of lid skin that requires removal is often markedly reduced.  You may simulate this for yourself in front of a mirror.  Look at your mirror image and move the sides of eyebrows about 1 centimeter up with your fingers.  The eyebrow should assume a position slightly above the bony rim of the orbit.  With this maneuver one may observe how the skin of the upper eyelids is also lifted and the appearance of the upper eyelid changes.  If this maneuver results in a marked reduction of the redundancy of skin over the upper eyelid, the option of an endoscopic forehead lift should be discussed.

In about one-third of the patients that undergo upper eyelid blepharoplasty, Dr. Gassner performs a simultaneous endoscopic brow lift.  However, it is important to note that while an eyelid surgery can typically performed under local anesthesia, an endoscopic eyebrow lift will typically require general anesthesia with its associated cost.  Both procedures may typically be performed as outpatient procedures.

The patient can contribute in an important manner to the success of eyelid surgery.  The following information and instructions are meant for patients of Dr. Gassner only.  These instructions and information should only be followed after a personal discussion with Dr. Gassner after surgery.

Please bring previous reports and test results from visits with your eye doctor and general physician to the first appointment with Dr. Gassner.  Dr. Gassner will ask about important aspects of your medical history including changes in your vision, the use of glasses and contact lenses, the use of eye drops or a history of diseases of the eye and its surrounding structures.  Dr. Gassner will also ask you about use of medications, allergies, previous surgeries and more.

If you decided to proceed with surgery, you will be given very detailed instructions.  These likely include to avoid blood thinning substances 3 weeks prior to surgery.  Blood thinning substances include medications such as ibuprofen, Advil, Aspirin and Voltarol.  These also include dietary supplements such as vitamins, kinko or garlic.  Three weeks before eyelid surgery, excessive sun exposure should be avoided.  A moisturizing lotion applied at night may help to get the skin in well prepared condition for surgery.

Contact lenses should be avoided 3 days prior to the surgery.  The night before surgery all makeup should be gently removed and the skin should be cleaned.

Professor Gassner adapts eyelid correction techniques to your individual desires and anatomical requirements.  Accordingly, the after-treatment is also adapted to your specific needs.  The following instructions are only intended as guidelines for Dr. Gassner’s patients and any instructions given to you by Professor Gassner during your consultation are more important than the following general notes.

The procedures can be performed on an out-patient basis or with an in-patient stay.

It is highly advised to refrain from sauna, tanning beds (Solarium) and strong sunlight for at least 3 months after surgery.  For one year following surgery, the facial skin should be protected by a sunscreen or make up with a high SPF.  Light sports (such as cycling) can be started again after 3 to 4 weeks after surgery and after 3 months, you can begin to re-engage in more strenuous sporting activities.

Make-up can be applied after one week for coverage.  After ypproximately a week, the swelling will have gone down enough so that the signs of surgery are rarely noticed in public.

Professor Gassner has been doing over and under-eyelid surgeries for over 10 years and has the experience of over 1000 eyelid procedures.  Dr. Gassner has extensive experience with all of the techniques listed above.  He will be able to explain to you in detail which technique is best suited for you to meet your wishes and expectations.  In addition, he has profound experience dealing with complex and often difficult surgeries such as reconstructions and revisions.  He is a globally recognized expert in eyelid surgery and a frequent lecturer at major international meetings, courses and conferences on upper and lower eyelid surgery.

Dr. Gassner has also written multiple chapters dealing with eyelid surgery in textbooks and one is included in his recent book, The Art and Craft of Facial Plastic Surgery – A Surgical Atlas, which he co-authored together with the world-renowned expert, Wayne Larrabee of Seattle, WA and the surgical artist Brian Walsh of Minneapolis, MN, USA.