A newsletter from David J. Levens, MD, FACS
Board-certified plastic surgeon
Please contact me for a free consultation with Dr. Levens.
Case Study: Facelift & Upper/Lower Eyelids
”After losing 30 pounds at age 58, my face looked like it had melted,” says Michelle, 60, of Coral Springs. “I’m not the kind of person who looks into the mirror all the time, but my face looked so fallen, I hated to look in the mirror at all. It was very depressing. My Mom felt so bad for me, she offered to pay for cosmetic surgery.
“I didn’t want to go to one of the large cosmetic surgery centers. I asked my primary doctor to recommend someone. He said Dr. Levens is the best plastic surgeon in the area. I checked his credentials online and liked the fact that he’d been voted #1 Cosmetic Surgeon several times and that he does charity work, especially the medical missions to Ecuador,” she adds.
Michelle recalls that when she met Dr. Levens and explained how unhappy she was with the impact her weight loss had had on her face, “he said don’t worry, we can fix that.” She underwent a traditional facelift and surgery of the upper and lower eyelids at the same time.
The results?
“I am over the moon,” she says. “The improvement is very obvious. “
Her favorite comments?
Several people who knew about the surgery, she says, have told her “whatever that cost, it was worth it!”
“When I went to a wedding/family reunion recently,” she adds, “people I hadn’t seen for a long time came up to me and said, 'You just never change…you still look like a "kid."'
Michelle says the whole experience was wonderful: “Dr. Levens and everyone on his staff were so warm and knowledgeable and helpful through the whole process. I couldn’t recommend them more.”
The procedures: It is not uncommon to have both a facelift and upper/lower eyelid surgery done at the same time. Simultaneous surgeries can produce some cost savings and eliminate the need for separate recovery periods. Here’s how the procedures Michelle had are typically performed.
Facelift: Dr. Levens makes small incisions within the hair at the temples, in the skin creases in front of and behind the ears, and within the hair behind the ears. (Location of incisions can vary). Then, he gently elevates the skin and deeper facial tissue. Next, the skin and deeper tissue are lifted very carefully in a generally backward and upward direction to reposition and retighten them in a more satisfactory location.
Recovery is generally quite rapid though actual recovery time varies. There is some tightness in the neck area immediately after a facelift. This early tightness is necessary to produce the best possible results long-term. Most of the tight feeling diminishes during the first 1-2 months after surgery. Areas of numbness can last for weeks or months.
There is typically bruising and swelling for 5-10 days. Patients can return to work and social activity in 10-21 days, but must avoid aerobic or strenuous activity for 14-21 days. Aerobic activity that increases the pulse over 100 also increases blood pressure, and could cause bleeding if resumed too soon after surgery.
Upper Eyelid Surgery: Upper lids that have become excessively full can often make the patient appear to be squinting. The surgical solution is to remove excess skin and fatty tissue. Incisions are made along the eyelid folds. Dr. Levens then removes fat and skin and closes the incisions with tiny sutures.
Lower Eyelid Surgery: To remedy under-eye “bags”, incisions are placed immediately below the eyelashes where they are inconspicuous or inside the lower eyelids, depending upon the specific patient. Fatty tissue which had caused a puffy look is removed and the incisions are closed. Resurfacing with a chemical peel or laser is sometimes used on the skin of the lower eyelid to help minimize fine lines and wrinkles, and to shrink excess skin. Often, Botox and/or fillers are also used to address crow’s feet and enhance the overall results of the eyelid surgery.
“The goal in eyelid surgery is to produce the most significant improvement possible within the bounds of utmost safety,” Dr. Levens notes. “ Removing too much skin and fat can create a skeletal look later on and in rare cases, can make it difficult to close the eyes properly.”
The vast majority of patients report that discomfort is minimal with eyelid surgery. There is some bruising and swelling for the first week or so, but after 7-10 days, most patients return to work and social activities, though strenuous activity should be avoided for 3-4 weeks. Sun exposure must be avoided.
For patients who don’t want or need surgery but do want to see some improvement in the eye areas, several non-invasive treatments can be very effective.
For “crow’s feet”, Botox® can be used to relax muscles which constantly contract when you smile or frown, thus reinforcing the wrinkles. Restylane®, Radiesse®, Juvederm™ or other fillers can be used to fill in persistent wrinkles. Neither Botox® nor fillers are permanent solutions and must be repeated after a number of months. When the wrinkles are particularly stubborn a combination of Botox and fillers as well as peels and lasers can be used. In rare cases, tiny muscles are cut to permanently relax the affected area.
For dark circles under the eyes, topical bleaching creams can sometimes minimize them sufficiently, but repeated treatments are needed to produce noticeable results. If topical treatment doesn’t do the job, vascular or pigment lasers can produce good results but again, multiple treatments are usually required.