Facial Procedure

Upper Eyelid

Upper eyelid surgery is one of the most common procedures that we perform in our outpatient surgery center. Patients of all ethnic background and age are candidates for upper eyelid surgery but the technique and approach is variable so it is very important to have a plastic surgery consultation to determine the best technique for each individual. We specialize in Asian upper eyelid surgery. This procedure can be safely done under IV sedation and local anesthetic to make patient comfortable, but also awake enough to cooperate during surgery to determine the desired outcome of the upper eyelid fold. This is only way to make sure that the shape and size of the eye is symmetrical.

At our certified outptient surgery center, this procedure is performed either with general anesthesia or under iv sedation with local anesthesia. The incision is made starting inside the hair above the ear, and down in front of the ear, and then behind the ear tracing down to the hairline in the neck. The skin is not lifted up much, but a layer of tissue called the SMAS/platysma is elevated extensively. This is used to re-elevate the facial structures and reposition the tissues to it/s more youthful location. This ensures a natural appearance.

After the procedure, you will need to do serial follow ups to receive medications to minimize swelling. You will be given specific instructions to how and when to wash your hair. Sutures will be taken out in 5 days then in 10-12 days and you will need to wear a facial garment to help minimize swelling and help reshaping the neck line. Most of the scars are well hidden and they will fade over time. Temporary swelling and numbness of the face are expected and the patient usually can return to work in 2 weeks.

We believe that there are several aspects of upper eyelid surgery in young people that is essential.

The pretarsal show, that is the size of the supratarsal show should not be greater than 3mm. Greater than this size will make the upper eyelid appear heavy and puffy.
The supratarsal fold should be crisp, but not be too deep. This results in unnaturally operated on appearance.
The fat resection should be very conservative. Over resection of fat can lead to sunken in look of the upper lid.
The outer edge of the fold should taper off gradually and not turn downward abruptly.
In people with mild ptosis, plication of the levator muscle can open the eyes more.

The Asian blepharoplasty surgery techniques can be divided into two major categories.

No incision/minimal incision technique: This technique is ideal for younger patients who have thin skin, and no excess fat with no excess skin to be removed. Patients can achieve a natural appearing crease, with minimal downtime. Under sedation, the upper eyelid is everted and from inside, suture is passed from the upper border of the tarsus to the dermis of the skin and the knot can be placed either on the inner side or just under the skin. Anywhere from 3-5 sutures are placed. This suture approximates the dermis to the levator muscle thereby creating the crease. The patient is asked to open and close the eyes during surgery to ensure adequate symmetry and shape.
Incisional Technique: This technique can be used for most Asian patients including younger patients. The incision line is well concealed within the natural structures of the eyelid region when the supratarsal fold is created. This technique is also ideal to correct droopy eyelids (ptosis). While creating the supratarsal fold, the upper eyelid muscle can be tightened to restore normal anatomy, fat can be removed or repositioned and excess skin can be removed. The results of eyelid surgery will appear gradually as the swelling and bruising subside to reveal a smooth, better designed eyelid and surrounding region. Some patient's find that the mild swelling can persist for several weeks, while others may see swelling resolve in as little as one week.

Lower Eyelid

Lower lid is one of the first places that change as part of our aging process. It is probably the most common surgery that is performed in both men and women. Usually in men, the condition is more severe and noticeable. Patients usually complain of:

"Bags" under the eyelid (protruding fatty bags)
Wrinkles
Deep dark circles
Depression of the lower lid border (tear trough)
Rounded contour of the lower lid margin
Lack of the lower lid orbicularis muscle protrusion.

Aging Eye

We believe that there are several aspect of aging upper eyelid surgery that is essential.

Most patient who complain about droopy eyelid skin, desire for all of the loose skin to be taken out. However, removing all of the excision of skin can lead to a very unnatural appearance and even complications such as inability to close ones eyes completely. We believe in conservative approach to skin excision. We only remove enough skin to rejuvenate the eyes to maintain a soft, natural look.
Normal process of aging involves fat atrophy in the orbital space. This can lead to a gaunt and tired look. Also, if the fat loss is severe enough, one can get multiple supratarsal folds. To correct this condition in addition to performing a blepharoplasty, fat should be transferred into the orbital space to achieve a fuller youthful appearance.
From the upper blepharoplasty incisions, several ancillary procedures can be peformed if necessary. For people with deep corrugator lines, the corrugator muscle can be weakened. For slight ptosis of the eyebrow, the eyebrow position can also be elevated from the upper blepharoplasty.
Clean and rejuvenated outer end of the supratarsal fold is important. This is where the skin excision should be performed the most.

Rejuvinating the periorbital region can be safely done in our certified outpatient surgery center in our Koreatown office or Beverly Hills office. IV sedation is given to make the patient comfortable but also allow the patient to be awake enough to assist during the surgery by opening and closing the eyes to optimize the shape of the eyes.

Epicanthoplasty

Some Asian patients have a condition where the width of the eyes are too narrow. To restore the normal anatomy, the soft tissue in the inner and outer corners of the eyes can be rearranged to make the eyes appear wider. This procedure can be done in conjunction with upper and/or lower eyelid surgery.

Medial Epicanthoplasty

Medial epicanthoplasty is a procedure to rearrange the excess skin (Mongolian fold) which obstruct the inner corner of the eyes. This procedure decreases intercanthal distance and also reveals medial half of the eyes by turning aside the redundant drooping Mongolian fold. As a result, the eyes will look bigger and brighter, less slanted.

Lateral Canthoplasty

The outer corner of the eye can also be reshaped to lengthen the eye. Lateral canthoplasty is a procedure to reposition the lateral canthal tendon by detaching the junction of the outer upper and lower eyelids. Scars are hidden within the eyelid margins and are usually not visible. Approximately, 1-3 mm can be elongated on each eye and they rarely re-attach. This procedure is also convenient for the eyes that are slanted upward, but because of individual factors, not everyone will achieve the same result. In-office consultation is recommended.

Jawline Reduction

Rhinoplasty

Eyelid

Cheekbone

Facelift

Fat Transfer

Chin Implant

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