Archive for May, 2011

Fixing dark under-eye circles

Saturday, May 7th, 2011

Question:Can a blepharoplasty effectively remove my dark under-eye circles? Answer: It really depends on your individual circumstances. Dark circles under the eyes can be due to a number of things and it would be necessary to see photos or perform an exam to see if a blepharoplasty would be effective for your condition. If you [...]

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Blepharoplasty Table

FAT REPOSITIONING
Figure 1 Frontal of a female patient following traditional transconjunctival removal of lower eyelid herniated orbital fat with resultant tear-trough deformity (nasojugal fold). Figure 2a Frontal of a patient with midface decent and a double-convexity contour deformity (lower eyelid herniated orbital fat convexity followed by the cheek/malar mound convexity).
Figure 2b One year post operative photograph demonstrating improvement in lower eyelid contour following lower eyelid transconjunctival fat repositioning and an endoscopic sub-periosteal midface lift. An endoscopic brow lift and upper blepharoplasty were also performed. Figure 3 Transconjunctival incision at the inferior edge of the tarsus using a Colorado needle – right eye.
Figure 4 A preseptal dissection is performed bluntly keeping the septum intact – right eye.  Figure 5 Sharp dissection between the medial fat pad and the inferior oblique muscle using scissors – right eye.
Figure 6 The medial and central fat pads are grasped with forceps and a “see-saw” movement is made allowing free movement of the fat pads from the inferior oblique muscle – left eye. Figure 7 A retractor is used to retract the lower eyelid and the orbicularis oculi muscle exposing the inferior orbital rim and arcus marginalis – left eye.
Figure 8 A suture and needle is passed through the skin and orbicularis oculi muscle medial to the nasojugal groove and retrieved in the subperiosteal pocket – right eye.  Figure 9 The medial fat pad pedicle is splayed-out prior to placement of suture – left eye.
Figure 10 The central fat pad is repositioned inferolateral to the medial fat pad – left eye.  Figure 11 Fat granuloma of the right lower eyelid following fat repositioning.
RESULTS
Figure 12a Before Figure 12a After
A, Frontal of before (left) and after (right).
Figure 12b Before Figure 12b After
B, Right (oblique), before (left) and after (right). A 55-year-old-woman with dermatochalasis and herniated lower eyelid fat. Before (left) and 1 year post-operatively (right) following lower eyelid transconjunctival fat repositioning, endoscopic brow lift and bilateral upper blepharoplasty. Notice the improvement of the lower eyelid contour and tear-trough deformity.
Figure 13a Before Figure 13a After
A, Frontal of before (left) and after (right).
Figure 13b Before Figure 13b After
B, Left (oblique), before (left) and after (right). A middle-aged woman with brow and midface ptosis, dermatochalasis and herniated lower eyelid fat. Before (left) and 20 months post-operatively (right) following lower eyelid transconjunctival fat repositioning, endoscopic brow and midface lift and bilateral upper blepharoplasty.
Figure 14 Before Figure 14 After
Frontal of before (left) and after (right). A 38-year-old female complaining of “a deep groove under her eyes and heavy upper eyelids.” The before photo on the left reveals minimal herniated lower eyelid fat with a moderate tear-trough deformity. Following lower eyelid transconjunctival fat repositioning and an upper blepharoplasty, the after photo on the right shows improvement of the tear-trough deformity.
Figure 15a Before Figure 15a After
Frontal of before (left) and after (right).
Figure 15b Before Figure 15b After
Right Frontal Close Up, before (left) and after (right). A 35-year-old male complaining of “deep groove below my eyes.” The before photo on the left demonstrates minimal to no visible herniated lower eyelid fat with a moderate tear-trough deformity, especially of the right eye. Following lower eyelid transconjunctival fat repositioning, the hollowness is improved.

Blepharoplasty HTML Table

FAT REPOSITIONING
Figure 1 Frontal of a female patient following traditional transconjunctival removal of lower eyelid herniated orbital fat with resultant tear-trough deformity (nasojugal fold). Figure 2a Frontal of a patient with midface decent and a double-convexity contour deformity (lower eyelid herniated orbital fat convexity followed by the cheek/malar mound convexity).
Figure 2b One year post operative photograph demonstrating improvement in lower eyelid contour following lower eyelid transconjunctival fat repositioning and an endoscopic sub-periosteal midface lift. An endoscopic brow lift and upper blepharoplasty were also performed. Figure 3 Transconjunctival incision at the inferior edge of the tarsus using a Colorado needle – right eye.
Figure 4 A preseptal dissection is performed bluntly keeping the septum intact – right eye.  Figure 5 Sharp dissection between the medial fat pad and the inferior oblique muscle using scissors – right eye.
Figure 6 The medial and central fat pads are grasped with forceps and a “see-saw” movement is made allowing free movement of the fat pads from the inferior oblique muscle – left eye. Figure 7 A retractor is used to retract the lower eyelid and the orbicularis oculi muscle exposing the inferior orbital rim and arcus marginalis – left eye.
Figure 8 A suture and needle is passed through the skin and orbicularis oculi muscle medial to the nasojugal groove and retrieved in the subperiosteal pocket – right eye.  Figure 9 The medial fat pad pedicle is splayed-out prior to placement of suture – left eye.
Figure 10 The central fat pad is repositioned inferolateral to the medial fat pad – left eye.  Figure 11 Fat granuloma of the right lower eyelid following fat repositioning.
RESULTS
Figure 12a Before Figure 12a After
A, Frontal of before (left) and after (right).
Figure 12b Before Figure 12b After
B, Right (oblique), before (left) and after (right). A 55-year-old-woman with dermatochalasis and herniated lower eyelid fat. Before (left) and 1 year post-operatively (right) following lower eyelid transconjunctival fat repositioning, endoscopic brow lift and bilateral upper blepharoplasty. Notice the improvement of the lower eyelid contour and tear-trough deformity.
Figure 13a Before Figure 13a After
A, Frontal of before (left) and after (right).
Figure 13b Before Figure 13b After
B, Left (oblique), before (left) and after (right). A middle-aged woman with brow and midface ptosis, dermatochalasis and herniated lower eyelid fat. Before (left) and 20 months post-operatively (right) following lower eyelid transconjunctival fat repositioning, endoscopic brow and midface lift and bilateral upper blepharoplasty.
Figure 14 Before Figure 14 After
Frontal of before (left) and after (right). A 38-year-old female complaining of “a deep groove under her eyes and heavy upper eyelids.” The before photo on the left reveals minimal herniated lower eyelid fat with a moderate tear-trough deformity. Following lower eyelid transconjunctival fat repositioning and an upper blepharoplasty, the after photo on the right shows improvement of the tear-trough deformity.
Figure 15a Before Figure 15a After
Frontal of before (left) and after (right).
Figure 15b Before Figure 15b After
Right Frontal Close Up, before (left) and after (right). A 35-year-old male complaining of “deep groove below my eyes.” The before photo on the left demonstrates minimal to no visible herniated lower eyelid fat with a moderate tear-trough deformity, especially of the right eye. Following lower eyelid transconjunctival fat repositioning, the hollowness is improved.