THIRD QUARTER 2005, VOLUME 19, NO 3

Your eyes tell it all; ethnicity plays a part … explore your surgical options

IN THIS ISSUE

Relax. Enjoy the sun without wrinkling and skin cancer worries

Your eyes tell it all; ethnicity plays a part … explore your surgical options

Ask the Surgeon / Health Tip / What’s New

Trends in 2004 show facial plastic surgery on the rise

Skin characteristics and facial structure differ depending on your ethnic background. These differences influence the aging process and whether you may be a good candidate for blepharoplasty (surgery of the eyelids). Is the skin around your eyes sagging or showing wrinkles? Perhaps friends and co-workers are commenting on how tired you always look. After careful evaluation, your facial plastic surgeon will discuss your optimal plan for a natural, rejuvenated, and revitalized you.

Caucasians with light complexions
Light skin shows signs of aging relatively early, and may develop fine, deep wrinkles. The skin is thinner and more easily moved; however, bone and cartilage irregularities are more obvious. Typically, Caucasians seek blepharoplasty to reduce the signs of aging around their eyes. According to a recent survey from the American Academy of Facial Plastic and Reconstructive Surgery, 24 percent of all blepharoplasties were performed on this race.

Hispanics
The skin of those with Hispanic, Southern Mediterranean, and Southern European heritage usually shows signs of aging later, with fine wrinkling less common. Within this ethnic group, only 15 percent of all procedures were blepharoplasty.

Asian Americans
Signs of aging among those of Asian ancestry usually do not appear until very late, and fine wrinkling typically does not occur.

Blepharoplasty is usually performed not to reduce the signs of aging, but to create a double eyelid. In many cases, the Asian eyelid hangs like a smooth curtain from the brow to the lashes. The double eyelid procedure creates a fold that separates the eyelid into two portions. It gives patients a more energetic look without changing their ethnic features. Forty-nine percent of all blepharoplasties were performed on Asian Americans.

African Americans
The signs of aging in dark skin typically appear very late, and fine wrinkling is very limited. The skin may be thick and less easily adjusted. Facial plastic surgery procedures for those of African heritage are more likely to focus on correcting facial disharmonies and refining features that are out of balance with the rest of the face. Blepharoplasty is not a very popular procedure with this ethnic group. In 2004, blepharoplasty accounted for five percent of surgeries.

Understanding the procedure
Regardless of race, you may be a candidate for blepharoplasty and you would like to understand what the procedure is all about. Blepharoplasty provides different operations for reshaping and adjusting the lids for both cosmetic and functional purposes. The first step is to determine if two or all four eyelids will be done and what techniques will be used in order to bring optimal results.

Cosmetically, you may want to reduce the excess skin in your upper eyelids to create a younger, more wide-eyed appearance. In upper eyelid surgery, your physician will follow the natural lines and creases of the eyelid in order to minimize the appearance of scars. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incision. A variation of this surgery is the double eyelid procedure (as mentioned above) for patients who seek to add a crease to their upper eyelid.

Blepharoplasty can also be used to correct ptosis, a drooping upper eyelid that is congenital or develops with age. Patients whose field of vision is limited due to ptosis may be able to seek insurance reimbursement since the procedure is medically necessary.

Most people seek lower blepharoplasty to reduce the bags under their eyes. There are two common approaches for lower eyelid surgery. In the first approach, the surgeon makes an incision inconspicuously under the lower lashes and removes skin and fatty tissue. Again, scarring is hidden in the inherent folds. The second approach, called transconjunctival blepharoplasty involves making incisions from the inside of the lower lid to remove excess fat. This method works best for the patient who has a pocket of fat beneath the lower eyelid with no sagging skin.

Transconjunctival blepharoplasty is usually performed on younger patients with thicker more elastic skin. The incisions may be closed with self-dissolving sutures, or they may not be sutured at all.

Blepharoplasty will neither eradicate the wrinkling around the eyes (crows feet), nor eliminate the dark circles under the eyes. There are procedures that may be performed in conjunction with blepharoplasty to address these concerns, so be sure to discuss your needs with your surgeon.

After the procedure
Immediately following surgery, the eye area may feel tight. Your physician will prescribe a pain medication to control any discomfort you may feel. Convalescence usually lasts one to two weeks. Be sure to follow the specific post-operative instructions to ensure a quick recovery.

  • Keep your head elevated
  • Use cold compresses to reduce swelling and bruising
  • Apply prescribed eye drops to ease dryness or itching

Two to seven days after surgery, the stitches will be removed. The swelling and discomfort will gradually diminish.

The goal of blepharoplasty, regardless of race, is to improve the appearance of your eyes. If you think you may be a candidate for the surgery, schedule a consultation with your facial plastic surgeon. During this visit, be prepared to discuss your goals, expectations, and motivation for the surgery. Whether your surgery is inspired by cosmetic or functional reasons, your surgeon will evaluate your face and answer all your questions.