This patient underwent cosmetic brow and lid surgery to help improve her appearance. She also had volume loss along her midface and cheeks. Surgery was performed to help improve her brow position and shape through an endoscopic brow lift, and her lids were addressed through upper and lower lid blepharoplasty. In order to address her volume loss though, she underwent fat grafting to allocated areas along her cheeks and midface. The result is natural but certainly shows an improved appearance to her cheek and midface.
Preoperative Diagnosis: Brow ptosis, upper and lower lid aging changes, volume loss to midface and cheeks.
Procedure performed: Endoscopic brow lift, upper and lower lid blepharoplasty with fat repositioning, lower lid chemical peel, fat grafting to midface and cheeks
Surgeon: Christopher Zoumalan, MD. Oculoplastic Surgeon.
Location: Beverly Hills, California
This patient presented with a left lower lid ectropion, where the eyelid was everted out. It was resulting in many ocular symptoms including tearing, red eyes, and discomfort. He also had loss of volume in his midface, which is commonly seen with aging. A standard ectropion repair alone would likely improve the lid position, but performing a midface resuspension at the same time helps provide added “support” for the lid while it heals. He underwent an ectropion repair along with a midface resuspension (aka lift) to help keep the lid stabilized and in a better position after surgery. His lid has remained stable as seen in his post op photos taken six months after surgery.
Preoperative Diagnosis:Left lower lid ectropion.
Procedure performed: Left lower lid ectropion repair and midface resuspension (lift).
This patient had significant lower lid ectropions, where the position of the eyelid is directed outward and away from the eyeballs. This results in tearing and constant irritation. He underwent lower lid ectropion repair and a midface lift to help keep his eyelids positioned as best as possible after surgery.
Preoperative Diagnosis:Bilateral lower lid ectropions.
Procedure performed: Bilateral lower lid ectropion repair and midface lift.
This patient had prior surgery to both lowerlids which as resulted in lower lid retraction and difficulty closing her lids. She underwent eyelid reconstructive surgery in order elevate her lower lids to a more anatomically normal position. A canthoplasty (lid resuspension) with a hard palate graft (taken from the roof her mouth) was used to help keep the lower lid in a new position. A midface lift was also performed to elevate her midface and to allower her lower lids to be resuspended and supported at a more anatomically appropriate position.
Preoperative Diagnosis: Lower lid retraction
Procedure performed: Lower lid retraction using a hard palate graft, canthoplasty, and midface lift
This patient had a severe right-sided facial nerve palsy (weakening of her facial nerve) leaving her unable to close her lids when she tried to blink. Her right eye was very irritated and needed to be addressed.
Postoperative photograph taken 1 montha after surgery. She underwent a complex surgery which included placing a gold weight in her upper lid to help her close her lid better. In order to help elevate her lower lid, she also underwent a midface (SOOF lift) and lid resuspension, hard palate posterior spacer graft, and canthoplasty.
I prefer to use a hard palate graft in cases of moderate to severe retraction; I find that they provide exceptional long-lasting results in lower lid retraction. She did well post operatively and was symptom free and her eye continued to be healthy.
This patient suffered a very severe facial nerve palsy where her whole left side of her face was paralyzed. She couldn’t close her lids well and lower lower lid was retraction.
Preoperative Diagnosis: Left lower lid retraction from facial nerve palsy and difficulty closing left eye.
She underwent a midface lift and lid resuspension to help elevate her lid to help her close her eyelids more appropriately. A posterior spacer graft was also used in the lid retraction repair. After the surgery, she was able to close her lids better and her symptoms had all resolved.
Procedure performed: Left lower lid reconstruction using canthoplasty and tissue graft to lower lid as a posterior spacer.
However, in people that undergo eyelid surgery and also midface volume atrophy, complementary fat grafting can achieve incredible results as well as a subsitute to a traditional midface lift. In selected patients, fat grafting along with a blepharoplasty can result in an incredible improvment in the midface soft tissue volume as seen below in this patient.
This particular patient was unhappy about her tired appearance and the bags under her lower lids. You can see in the preop side profile how she had deficient volume in her midface which was addressed well with volume augmentation using complementary fat gafting
Side profile demonstrating hollowing of the midface preoperatively and an improvement after undergoing a lower lid transconjunctival blepharoplasty with complementary fat grafting to the lower lids and midface. The midface volume loss that the patient had preoperatively was sufficiently addressed by periorbital and midface fat grafting.
All before and after pictures displayed are real patients who have consented to having their pictures published on our site. Individual results will vary with each patient and Dr. Christopher Zoumalan does not guarantee any outcomes of procedures shown. All pictures are meant for reference and illustrative purposes only.