As an oculoplastic surgeon, I perform a great number of cosmetic eyelid surgeries in my practice in Denver. Between my partner Jerry Popham and myself, the number is staggering. One of the most critical elements of our practice is adapting and changing new techniques that are most able to give our patients better outcomes. One of the most important things to know is that every new technique is not always better. Any plastic surgeon in Denver or in the US for that matter have seen procedures in their practice come and go. What is at one point reveled as a game changing procedure or "fix all" procedure may not have the lasting power, lack of complications, or reliability to be permanently added to a surgeons repetoire. In blepharoplasty or cosmetic eyelid surgery there are some new trends that are taking over the field. This article serves to discuss some of the newer techniques, their benefits, downsides, and how we implement it in our practice. These four techniques are implemented in our practice. Hopefully educated patients can ask their surgeon about their technique and why they use each technique or variation.

Ptosis repair through an internal incision

When patients have drooping of their eyelids, causing their eyelids to be half shut a common additional procedure that is implemented is a "ptosis repair". Commonly the approach that is taken is through a skin incision and tightening of the eyelid muscle called the levator. An approach that is taking on more use is an internal tightening of a second muscle called the muellers muscles. The advantages is that the surgery through the inside of the eyelid is a little more predictable and the contour or shape of the eyelid tends to be nicer. Additionally, the skin technique involves waking the patient up and examining the eyelid position. The internal approach requires no patient cooperation. The internal approach is not always feasible on everyone with a drooping eyelid. This approach

Fat repositioning in the tear trough

Fat repositioning has been involved in eyelid surgery for approximately 10 years however only recently has it been taken on more regularly by ophthalmic plastic surgeons. In the past surgeons have removed fat from the abdomen and injected it into the tear trough at the same time of blepharoplasty. Other surgeons have used some of the fat that is removed from the eyelid and transferred it into other areas. Fat repositioning has the advantage of using the fat that is already being removed for another location. Two downsides of fat transfer: 1. healing takes longer 2. It is not 100% predictable. Transferring fat is more work and thus more bruising and swelling. Also, the fat can feel hard initially as it is healing. Transferring the fat is not 100% predictable. We can place it in areas to soften the appearance however, it does not guarantee that the tear trough will be smooth. Fillers may be needed in the future to completely smooth out the area.

Tetracycline or cautery to the festoons

Festoons are the swollen areas under the eyelid. These are commonly see in the cheeks. These can be shrunk with cautery or tetracycline injection. Cauterization of the festoons is performed in the operating room and takes about 30 minutes to perform. The tetracycline injection is given to the festoons in the office or operating room. Downsides of festoon treatment is that it takes a month for swelling to go down and multiple treatments may be needed. Of course the upside is that the swollen festoon is reduced.

Conservative fat excision in the upper eyelids

In the old days of cosmetic surgery, patients had eyelid surgery with excessive fat removal on the upper eyelids. The procedure has migrated to almost no fat removal of the upper eyelids except for the medial eyelid. This results in a more natural youthful appearance compared to aggressive fat removal . This is something to consider when discussing blepharoplasty with your doctor.

These are subtle newer additions to blepharoplasty that have taken hold over the recent years. In discussing blepharoplasty with your surgeon remember that there is no "one size fits all" for the procedure and each case is individualized. Find out before the surgery how the individual approach is being tailored to you. Best of luck.