The surgeon’s eyelid surgery before and after photos can shed light on his artistic skills, which play a critical role in any facial plastic surgery. Hence, a prudent patient should insist to view this material before scheduling her surgery.
The before and after photos should have no classic surgical stigmata such as skeletonized eye socket, abrupt lower lid and cheek transition, unnatural height of the upper lid, retracted skin lid, and visible scar.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video demonstrating a patient who has had upper and lower eyelid surgery to correct age-induced skin and soft tissue laxity. To achieve a more natural and more youthful result, he combined the procedure with fat transfer.
Lower Eyelid Surgery with Fat Transfer
The idea of fat transfer, also referred to as fat injection and structural fat grafting, is to create a smooth transition between the lower lid and cheek. Occasionally, a lower lid-alone approach can create or worsen the appearance of tear trough, a problem best avoided when fats are injected beneath the skin to serve as padding.
While the superficial fat beneath the lower lid skin tends to shrink with aging, the deeper fat behaves differently: It becomes more prominent and saggy, leading a crescent-shaped bulge. Hence, the right surgical maneuvers reverse these age-induced effects.
The deeper lower lid fat is often removed or reduced during surgery to correct lid herniation or “bagginess.” This is typically followed by fat injection beneath the skin to create a smooth lid-cheek transition.
To further create a smooth lower lid and eliminate the crepe-like appearance, during surgery Dr. Smiley removed a small amount of excess skin with the use of a thin incision placed very close to the lower lash margin. This is expected to heal into a thin scar that is invisible at a conversational distance.
Upper Eyelid Surgery
The patient also received upper eyelid surgery to eliminate the hooding and fullness of the lid-brow complex.
“I placed the incision inside the new skin fold to hide the scarring,” Dr. Smiley said in the video.
The incision allowed Dr. Smiley to remove the excess skin and fat that was causing the “heaviness” and drooping of the upper lid. However, he made sure that sufficient fat pad would remain after surgery to avoid the skeletonized appearance, which in any way does not look youthful.
The skin excision aspect was also done in a highly meticulous manner to preserve “normal blink” and to ensure that the “new” upper lid would have a height that is consistent with the patient’s facial feature, gender, and race. For instance, female Caucasians often have a lid crease height that is between 8 and 12 mm; this generalization does not apply to men and other ethnicities.