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Interviewer: It's a pretty common question. How do you fix droopy eyelids? Dr. Eric Cerrati is the Director of Facial Plastic Surgery at University of Utah Health. Dr. Cerrati, first of all, what usually brings patients to you looking for an eyelid procedure? What are some of the common themes?
Dr. Cerrati: I would say the most common thing across the board is that patients say that they feel or look tired, especially when they look at themselves in the mirror.
Interviewer: Got you. And you have a procedure that can do that. Now, is it something that you can do without surgery, or is surgery always involved?
Surgical and Nonsurgical Options to Fix Droopy Eyelids
Dr. Cerrati: So there are actually a lot of different options. There are nonsurgical options, in which case you put filler underneath the eye, you can do laser procedures to tighten the skin under the lid, and then there's a whole arsenal of surgical procedures, where we tighten the muscle underneath, we remove some of the skin, and we lift the brows, all giving a more rejuvenated or rested appearance.
Interviewer: How would you decide what is best for a particular patient?
Dr. Cerrati: It starts with the patient's concerns and what their question is. This is actually more common in males than you would think. It's very common that patients come in and just say they look tired and their colleagues are commenting, both male and female.
Another common complaint that patients will say is that it's affecting their vision, in which case the droopy eyelids can actually block some of their peripheral vision. If that's the case, we could actually send them for an objective visual field test is what we call it. They have the test. Depending on how they perform, there are certain insurance criteria and if they meet that criteria, insurance will actually cover the procedure.
Interviewer: So you can get rid of the tired look and also improve your vision, which is fantastic. It's a safety thing, really.
Dr. Cerrati: Exactly.
Interviewer: You know? And just a quality of life thing as well. So you have a conversation with them. You try to find out what their needs are as far as then determining which one of these procedures you're going to go with. How often is it possible that somebody could do nonsurgical?
Treating Droopy Eyelids without Surgery
Dr. Cerrati: It's difficult to say. I would say people that have more on the mild side of findings we can treat it nonsurgically.
Botox
Botox, which is actually common medication that we use, that you think of smoothing wrinkles on the face, but you can actually use the push/pull of muscles on the face to actually create a brow lift to give a more rested appearance to the brow. Some other nonsurgical options include, for the brow, using Botox to elevate the brow.
Fillers
Really not much you can do for the upper eyelid skin, but the lower eyelid you can place filler in the tear trough to help provide some volume to the under eye, which gives them more of a rested appearance, and also doing a laser procedure to tighten the skin underneath the eyelid.
Topical Creams
As far as topical creams and those sorts of things, they do help slightly. I wouldn't say it would give the patients a long-lasting result that they're really looking for when they come to my office.
Interviewer: And when you talk about long-lasting results, how long could somebody expect this to continue to be what they want it to be?
Dr. Cerrati: So obviously, we can't stop the aging process, so it continues. But I would say for eyelid and brow revisions, usually you're talking several, several years down the road, 10-plus years.
Interviewer: And then where, if it is a surgical option . . . I'd imagine the nonsurgical happens in your clinic. What about the surgical options? Tell me more about that.
Surgery to Fix Droopy Eyelids
Dr. Cerrati: So the surgical options are performed either up at the main hospital, the University Hospital, or out at one of the satellite offices. When I consider eyelid rejuvenation, you have to consider the brow and the eyelids kind of as one unit. And so, if the brows are ptotic or have fallen down some, addressing the brow can create a very significant improvement in the appearance.
So if the brow is being done, usually I perform that under general anesthesia, and then the upper lids, if we're coupling that with the brow, again under general anesthesia. If it's just the upper eyelids, we can actually do that in the clinic setting just under local anesthesia. It takes maybe 45 minutes to an hour. And then the lower lids are a little bit more involved. I tend to do those back in the operating room.
Recovery from Eyelid Lift Surgery
Interviewer: Got you. And what kind of recovery time are we talking about? I'd imagine it varies because it sounds like the approaches vary.
Dr. Cerrati: So I tell everyone it's about a one-week recovery. At one week, all the stitches come out. Most of the bruising has resolved. Still taking it easy as far as activity-wise, but one week you're pretty much recovered and back to your normal day-to-day activities.
Interviewer: Do people generally choose not to go to work for that one-week period while they're healing?
Dr. Cerrati: Depending on what their job is, yes.
Interviewer: See if they can work remotely and maybe do that?
Dr. Cerrati: Exactly.
Interviewer: Got you. And you mentioned insurance covered it if it was a sight thing, so that's pretty good.
Dr. Cerrati: If insurance feels that the findings affect your peripheral vision, they will actually cover both the brow lift and the upper blepharoplasty or upper eye lift.
Choosing a Surgeon for Eyelid Surgery
Interviewer: Tell me about how the skill and experience of the surgeon can make a difference in the outcome when it comes to this type of procedure. I mean, you do it. You also have some very talented colleagues that do it. How would somebody choose the person that they want?
Dr. Cerrati: So there's a team of surgeons, and with every surgeon, there's a team that works around them to help provide the best care here at the University. For brows, I tend to use an endoscopic approach, which is incisions hidden way back in the hairline, so that way, really minimizing the amount of scarring or any incisions on the face.
The eyelid incisions are hidden right in the natural creases of the eye. And again, all of this is tailored to the specific patient's needs and the skill the patient takes, in both aesthetics and shorten the recovery time.
Interviewer: And how could a patient make sure they're picking the surgeon that's right for them?
Dr. Cerrati: So the most important thing is the in-person consultation. It's important to come meet your surgeon, discuss with them kind of what you're hoping to achieve. You can look at some before and after pictures. And if you feel comfortable with the surgeon, that's the most important thing.
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