Volumetric sculpting of the eyes

Blepharoplasty (eyelid surgery) represents one of the most delicate cosmetic and functional procedures involving the face. Designed to restore a more youthful appearance in an area that conveys so many emotions, subtle changes, when executed correctly, can be transformative.  As an oculofacial plastic surgeon, Dr Papageorgiou has a unique understanding of the eyelid anatomy and physiology. Blepharoplasty requires a customizable approach, meticulous surgical skills and the ability to identify and balance all the variables involved in the aging process: skin elasticity loss, muscle tone, fat prolapse and bone structure, are critical in restoring the aging anatomy of the eyelid.

Recent advances have emphasized the need of a conservative approach (augmenting blepharoplasty) with the aim being to preserve the function and redistribute the eyelid tissues (fat and muscle layers) rather than subtracting them as has been the practice in recent years. Unlike traditional techniques, which alter volume proportions, replacing and augmenting what is lost is the key element in enhancing a natural and more functional outcome for the patient.

Upper eyelid

Upper eyelid blepharoplasty has evolved into a sophisticated multilayered surgery extending beyond ‘skin excess excision’ that can leave patients with an undesired tightness or even restricted movement and expression.

Using a comprehensive three-dimensional approach, Dr Papageorgiou utilizes several surgical techniques to achieve a natural and predictive outcome. During this delicate one-hour procedure an incision is made along the natural crease of the eyelid, allowing the surgeon to manipulate the skin, muscle and fat layers to achieve a natural result. In selected cases re-enforcement of the weakened levator muscle (the muscle that lifts the eyelid) is essential

Lower Eyelid

In the lower eyelid, the procedure involves transferring the prolapsing fat pads across the bony orbital rim through hidden incisions (transconjuctival approach). This approach can have a powerful rejuvenative effect as it redistributes volume, smoothens the contours of the region and improves aging hollowness. The traditional approach that most surgeons adopt (transcutaneous incision) is a subtractive form of surgery that can lead to functional and aesthetic complications such as eyelid malposition, dry eye and rounded eyelid corner.

In this perspective a combined approach (bilamellar surgery) that addresses lower eyelid fat through a hidden transconjuctival incision and excess skin through a conservative skin incision, represents the foundation of Dr Papageorgiou’s surgical approach to the lower eyelid. This incorporates preserving the integrity of the orbital septum (a structural component of the eyelid) and the function of the orbicularis muscle.


Preserving the masculine aesthetics

Male blepharoplasty is a delicate yet transformative aesthetic procedure aiming to rejuvenate the face. Due to the intrinsic anatomic and aesthetic characteristics of the eyelids, male blepharoplasty requires a unique approach aiming to rejuvenate the eyelids without altering the key masculine features of the most expressive part of the face. The objective is to enhance the natural features of the eyes and restore a youthful, rested and pleasant aesthetic to this area.

Dr Papageorgiou with his specialist expertise in eyelid surgery and male facial aesthetics employs minimally invasive techniques customised to the individual needs of the patient. The balance of knowing how much skin and fat to remove/preserve is attributed to his artistic skills and expertise as an Oculoplastic surgeon. Dr Papageorgiou performs the Augmenting Blepharoplasty, where the fat pads are preserved or repositioned to enhance the 3D contours of the area and above all avoid the deep-set or hollow appearance often seen in male patients undergoing blepharoplasty.

Additional elements like face asymmetry, tone of the eyelid structure and position of the eyebrows are critical in optimising the final aesthetic outcome and must be taken into consideration during the pre-operative assessment. Dr Papageorgiou employs 3-D photography which is a powerful tool in assessing the aging changes and helps customise the surgical plan.

The procedure is usually performed under local anaesthesia or sedation (twilight anaesthesia) and has a fast recovery time. Energy based devices (Infrared Lasergenesis, Ultherapy) or Hyaluronic Acid layering can further enhance the final aesthetic outcome.


How are Asian eyelids different from Caucasian eyelids?

Asian eyelids are unique as the eyelid crease is quite different from the Caucasians’ in terms of length, shape and height. Although about half of the Asian population does have a fold in upper eyelid area, the other half does not. The former type is traditionally called the “double eyelid” type where the actual eyelid height is higher, exposing more of the eye.

The difference is anatomical and relies on the degree of the attachments of the levator muscle on the eyelid skin. In Asians the levator muscle inserts either very low (with partial or low creases) or not at all so that no crease is visible. In addition the weak insertion of the muscle allows the eyelid fat to be placed at a lower position, making the eyelid to appear fuller and the eyelid opening narrower.

While facial attractiveness does not necessarily relate to the eyelid shape and fold, many Asians desire the double eyelid crease, as it gives an overall impression of a larger appearing eyelid opening. Known as “Asian double eyelid surgery” a blepharoplasty procedure can be performed to create a natural-looking crease. The goal of double eyelid surgery is not to westernize an Asian face, but to create a better defined crease and enhance the overall appearance of the upper face.

What type of procedures are used to treat Asian eyelids?

Two types of procedures are available to rejuvenate Asian eyelids: partial incision and incisional surgery. The partial incision which relies on the use of sutures is minimally invasive and potentially reversible but the permanence of this procedure is questioned and it cannot address anatomic aspects like prominent fat or epicanthal folds. This procedure is best suited for younger patients where the upper eyelid skin is relatively thin, with thin orbicularis muscle and eyelid fat.

The incisional surgery is a delicate but powerful procedure where the incision line is hidden in the newly created eyelid crease. The technical demands and details of this procedure rely on the design of the new crease as well the technical skills required for the incision to heal in a permanent but natural fashion. For a natural looking fold, the ideal amount of pretarsal show is 2-3 mm and this height is usually achieved by creating an incision at 7-10 mm above the lash line at the mid pupil. A small amount of fat and muscle is removed to allow stronger adhesion of the skin to the deeper tissues. A series of sutures are placed through the levator muscle to facilitate this creation.

What other aspects must be taken into consideration with Asian Blepharoplasties?

A series of additional aspects must be considered when performing double eyelid surgery like facial asymmetry, the position of the eyebrow, as well as the epicanthal fold, a web like skin fold that drapes over the inner corner of the eye. This fold can be a non-desirable ethnic trait as a wide fold can make the nose to appear even flatter further exacerbating the lack of definition of the nasal bridge usually encountered in Asian patients.

In carefully selected patients the epicanthal fold can be addressed with medial epicanthoplasty, a delicate procedure that softens the fold in the inner corner and further elongates eyelid leading to a softer and more open look. Dr Papageorgiou with his unique understanding of the Asian eyelid anatomy and his specialist expertise in eyelid procedures can achieve natural and predictive outcomes.

How does eyelid surgery (Blepharoplasty) in Asians differ from the eyelid surgery performed for Caucasians?

Although both treatments have the same objective in enhancing the definition of the upper eyelids, the Asian blepharoplasty primarily aims in creating a fold or crease in the upper eyelid that runs more parallel to the eyelid margin and blends with the normal skin( epicanthal) fold in the inner corner of the eye. The goal of Asian eyelid surgery is not to westernize an Asian face, but to create a better defined crease and enhance the overall appearance of the upper face.

How long does the procedure last and what is the anesthesia used for this procedure?

Although the duration of surgery can vary from patient to patient, typically it takes an hour and a half to perform eyelid surgery. Patients can return to their daily activities and working schedule within one week. The procedure is usually performed under local anaesthesia with mild sedation. With this approach patients experience fewer side effects and typically can be discharged home safer and quicker within a few hours following surgery.

What are the possible side effects related to Asian blepharoplasty?

As with any surgical intervention the procedure can carry some risks which are extremely rare and are usually minimized through careful pre-operative screening of the patient and choosing a fully qualified experienced plastic or oculoplastic surgeon.

Some patients can experience minor side effects like temporary eye irritation and blurriness, swelling, asymmetry of the eyelids and changes in tearing. These particular effects are usually temporary and settle in the first weeks after the operation, as the tissues recover from the procedure. Infection and bleeding are minimized through careful technique and antibiotic cover.