While mild eyelid surgery complications such as temporary swelling, dry eyes, and bruising are common and generally dissipate on their own, all efforts must be done to avoid serious problems such as infection, abnormal crease position, vision loss, and poor healing.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, explains his guidelines to avoid eyelid surgery complications.
- Preoperative exam and consultation
Proper patient selection is crucial to achieve predictable results from eyelid surgery or any other form of facial plastic surgery. In general, people with serious and uncontrolled medical issues are poor candidates; the same is true for individuals with unrealistic goals and expectations or those who exhibit body dysmorphic disorder, psychosis, and other similar “problems.”
Certain eye conditions such as dry eyes and reduced blink reflex are also considered risk factors.
The idea is to attain one’s optimal health and beef up the body’s ability to self-heal before the operation. Aside from proper nutrition and regular exercise, preparation will also entail avoidance of aspirin, platelet inhibitors, NSAIDs, and heparin products for 2-3 weeks prior to surgery because they inhibit clotting.
But even large doses of green tea, vitamin E, ginseng, ginkgo biloba, and other herbal supplements are known to affect healing, thereby these should not be used several weeks prior to surgery.
- Proper execution of the surgery
Experienced facial plastic surgeons have a deep understanding of the anatomies to avoid unnecessary trauma and increased bleeding. For this reason, a prudent patient will only choose a qualified doctor with proper board certifications and extensive experience in eyelid surgery.
The patients can also do their part to avoid or at least minimize risk of eyelid surgery complications. First and foremost, they must be aware of the signs of severe vision loss, hematoma, infection, and other serious problems.
Studies have suggested that most complications following an eyelid surgery can be treated by prompt intervention.
The patients should also stick to their doctors’ specific postop instructions. According to surveys, severe loss of vision and other serious complications are linked to bending over, performing rigorous activities too soon, and failure to control hypertension.
Meanwhile, elevating the head, limiting one’s activity, and keeping the postop swelling at a minimum (e.g., with frequent application of ice packs) are known to reduce the risk of bleeding and its subsequent complications.
Facelift with cheek implants. Is it always necessary to combine the two procedures?
First and foremost, facial aging is not just about the loose skin and deep wrinkles, hence pulling and tightening the skin tissue does not always work as a stand-alone procedure if the goal is to achieve a more youthful and “refreshed” appearance.
Renowned Los Angeles plastic surgeons suggest that a multi-level approach works for many patients desiring to achieve a more youthful countenance. For this reason, facelift with cheek implants (or any other form of “volumizers”) has become a routine procedure.
A standard facelift rejuvenates the lower eyelid, mid face, jaw line, and upper neck by lifting the saggy skin and tightening the facial muscles. If needed, it will also reposition the saggy cheek fat pads, leading to a more angular or heart-shaped face, which is an improvement from its previous boxy appearance.
However, not everyone has sagging cheek fat pads. Naturally thin and “athletic” patients may lack facial fat, which can be compensated by cheek implants, dermal fillers, or structural fat grafting. It is important to note that the ideal volumizer will depend on two key variables: their goals and their underlying anatomies.
While dermal fillers injection could provide the same effects as cheek implants, their results only last four to six months, thereby they require regular touch-ups which in the long run will cost more.
Fat grafting is another alternative to cheek implants, although its results is highly variable because each surgeon has his own preferred technique. But basically this involves collecting donor fat from one area of the body, processing it to remove the biomaterials such as blood, and then re-injecting it into the recipient site.
Simply put, cheek implants are the ideal choice for someone seeking a more predictable and permanent solution for hollowed-looking mid face. Nowadays, most of them are made of solid silicone that can be easily extracted should the patients are not happy with the initial results.
Some patients may avoid or at least postpone facelift by filling in the cheeks with implants, fat graft, or dermal fillers, depending on their ultimate goals and expectations.
By filling in the hollowed cheeks, one of the leading Los Angeles plastic surgeons Dr. Tarick Smiley says it may soften the laugh lines, decrease the downturn of the mouth, minimize the hollowness of the lower eyelid, and provide some “lifting effect.” For this reason, some people choose to have cheek implant surgery and then wait for a few years before they resort to a more extensive procedure usually in the form of facelift, he further explains.
As long as the cheek implants have been properly secured onto the bone, a facelift in the future will not be able disrupt them, he adds.
Breast lift with auto augmentation accomplishes the same goals as the standard technique, i.e., correct soft tissue laxity and reposition the downward pointing nipple-areolar complex.
But unlike the standard technique, breast lift with auto augmentation provides more fullness in the upper poles of the breast with the patient’s own tissue. In the past, the only option to achieve this look and correct the deflated appearance was to position an implant in the “pocket.”
Instead of using synthetic implants, doctors are able to deliver more fullness in the upper pole by creating a pocket behind it where the lower pole tissue is pushed upward, with its blood supply intact to avoid healing problems.
Despite the reasonable safety of breast implants based on clinical findings and surveys, using the patient’s own tissue offers a myriad of benefits such as more natural feel and look, avoidance of implant-related complications (e.g., rippling and bottoming out), and lower risk of infection since no synthetic material is introduced in the body.
However, breast lift with auto augmentation is only suitable for patients whose preoperative breast size is at least a full B cup. Simply put, there should be a sufficient amount of tissue in the lower breast pole to be repositioned towards the upper pole.
Women with insufficient breast tissue may have to resort to implants if they want to achieve more fullness in their upper poles. According to studies, these devices have an average lifespan of 10-15 years, thus most patients will require a revision or two down the road.
If implants are going to be used simultaneously with breast lift, the consensus is to select a conservative size to avoid sagging recurrence and telltale signs of the surgery, such as visible rippling, implant displacement, and cantaloupe-shaped breasts.
Regardless of the surgical maneuvers used during a breast lift, it is important to reshape the tissue, as opposed to rely on skin tightening alone. It is important to note that skin settles over time due to the effects of aging, weight loss, pregnancy, and even gravity.
Nowadays, most Los Angeles plastic surgeons use some kind of internal sutures to support the new breast contour and possibly minimize the tension on the skin, which in turn prevents wound dehiscence (breakdown) and poor healing.
While the breast will continue to age, the effects of breast lift can last for many years, assuming that the patient is able to maintain a healthy weight, avoid pregnancy, and stick to a healthy lifestyle.
Brow lift for young patients, i.e., aged between 20 and 35, is quite uncommon since the procedure is primarily designed to lift the sagging brow and correct the horizontal forehead creases and “11” lines between the brows, which are age-related problems.
However, some young people are born with lower eyebrow position that could make brow lift a possible option. Nonetheless, most plastic surgeons would recommend non-surgical or “temporary” solution to at least give them an idea of how much elevation that would suit them before resorting to a more permanent surgery.
Photo Credit: Ambro at FreeDigitalPhotos.net
Botox injection, which could be a good alternative to brow lift, is not just used to elevate the saggy brows; in the hands of a great injector it can also reshape the brow in a way that it “respects” the patient’s underlying anatomies and gender, according to California Surgical Institute website.
The effects of Botox can last four to six months, so the patient must accept that she requires regular maintenance to preserve her appearance.
Whether brow lift or Botox is used, the goal is to create gender-appropriate results. In general, female brow appears higher than the bony rim of the eye socket and is more arched compared to male brow.
Male brow, meanwhile, typically lies at the same level or even slightly lower than the bony rim of the eye socket.
Just like Botox, brow lift not only elevates the saggy brow, but also reshapes them in a way that the results look natural and proportionate to the rest of the facial features. However, a good number of patients only require the lateral part of their brow, or “tail end,” to be lifted.
Only a small number of patients experience significant medial/inner brow descent, as suggested by some Los Angeles plastic surgeons who advocate the use of temporal brow lift in which a small incision behind the hairline is used to lift the tail end of the brow.
Proponents of this minimally invasive technique suggest that it is an ideal brow lift for young patients who generally require a conservative elevation of their brow’s tail end, which in turn could also minimize the fullness in their upper eyelid thus leading to a more rejuvenated appearance.
To determine the most viable option, any form of facial rejuvenation procedure entails proper patient selection, honest discussion between the surgeons and patients, and comprehensive physical exam.
The Brazilian buttock lift consultation is a two-way process that allows the patient to scrutinize her doctor’s qualifications and experience, and at the same time permits the surgeon to determine one’s candidacy based on her anatomies, health, and cosmetic goals.
During consultation, the patient must share her medical information and her immediate family’s, cosmetic goals, and any reservation. She must be honest and thorough especially when it comes to her medical history, lifestyle, use of medications—including recreational drugs, diet pills, contraceptives, vitamins/supplements, alcohol, and tobacco products.
Any drug that is known to thin the blood, such as aspirin and NSAIDs, tobacco and smoking cessation products, and supplements known to inhibit normal clotting must be avoided 2-3 weeks before surgery to minimize risk of complications.
Meanwhile, a prudent surgeon will listen carefully to his patients, especially their cosmetic goals and expectations so he can offer solutions and make them realize not just the benefits, but also the downsides and limitations of Brazilian buttock lift.
In essence, Brazilian butt lift is a buttock augmentation via fat transfer/graft. It starts with liposuction of two or more donor sites before the collected fats are processed to remove unhealthy cells and other debris prior to re-injection.
Simply put, the surgery’s result will heavily rely on the amount of donor fats. For this reason, thin patients who expect large augmentation will not achieve their desired look.
Aside from the amount of donor fat, a prudent surgeon should also explain the other limiting factors such as tight skin and smaller preoperative buttocks. He can assess other variables that can affect the results through a physical exam.
To promote good communications, many surgeons use before-and-after photos of their actual work. Ideally, their picture gallery should show different body types—e.g., slender, big framed, short, athletic, boxy, pear shaped, etc.—to help patients communicate their goals and set realistic expectations.
A surgeon with extensive before-and-after photos that reveal impressive results despite that some of these involved difficult cases can show his level of expertise and a great deal of experience.
To further promote good patient-doctor communications, some Los Angeles plastic surgeons offer 3D computer imaging technology that takes a person’s image from different angles to come up with the “before” photos, which can be digitally altered to show the possible results.