Top-Rated Chicago Eyelid Surgeon, Dr. Mohammed Alghoul

Dr. Alghoul Explains Eyelid Surgery

As time goes on, our eyes begin to lose their youthful appearance. In this introductory video, Dr. Alghoul explain types of eyelid surgeries and treatments, including non-surgical eyelid rejuvenation, and what to expect during consultation.

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Outside factors, including hereditary traits — such as the lack of a distinct upper eyelid crease, often referred to as “monolids” — and certain lifestyle habits, such as sun overexposure or smoking, can compound these aesthetic concerns with the eyelids.

Thankfully, Dr. Mohammed Alghoul, a talented plastic and reconstructive surgeon with Northwestern Plastic Surgery, offers a wide variety of eyelid surgery treatment options, from cosmetic blepharoplasty (eyelid surgery) to reconstructive eyelid repair, that can improve aesthetic and medical concerns related to the eyes, for a rejuvenated, refreshed and happy appearance.

Upper Blepharoplasty (Upper Eyelid Surgery)

Upper blepharoplasty is cosmetic surgery of the upper eyelid. This procedure is indicated when there is excess skin in the upper eyelid fold drooping over the lash line and obscuring the crease and the eye-shadow space. This redundant skin, or hooding, results in a tired look and hides the upper lid crease, which is an important sign of beauty. It can also obstruct the upper field of vision at an advanced stage.

Upper blepharoplasty is cosmetic surgery of the upper eyelid. This procedure removes the excess skin in the upper eyelid that droops over the lash line therefore covering the crease and the eye-shadow space. This redundant skin, or hooding, results in a tired look and hides the upper lid crease, which is an important sign of beauty. As the skin droops over the lash line at an advanced stage it can also obstruct the field of vision. In other words, patients start complaining that they cannot see objects that lie above them or to their sides.

Upper blepharoplasty restores the youthful contour of the upper eyelid and creates a refined crease. The excess skin is removed along with some fat, and the crease is sometimes repositioned. The procedure is designed differently and personalized to each individual depending on their features and goals. For example, the procedure varies from trimming skin only, to removing skin and some muscle and fat, to removing skin and adding fat. Brow lift can be combined with upper blepharoplasty in certain cases. Lifting the tail of the brow helps improve the skin hooding on the outer side of the upper lid area (also know has temporal hooding).

Goal of the Procedure:

It opens and brightens the eyes and improves symmetry. It restores a refreshed and youthful look of the eyes and re-creates a well-defined upper lid crease.

What does the procedure involve?

It involves removal of the excess skin in the upper eyelid and sometimes contouring of the fat. This is done through carefully designed incisions to create a well-placed and symmetrical crease. Excess fat is removed when present, or re-arranged in patients with hollowed upper eyelids. Fat grafting (fat injection) can be added to the procedure when hollowing is present and it can also help add volume to the brows.

Where is the incision placed?

The incision is designed so that the resulting scar falls over or forms the new crease. The scar heals very well in the upper lid and is hidden in a natural line.

Are there any non-surgical options?

There are no other effective treatments for excess skin of the upper eyelids and surgical removal remains the best treatment option.

Is a brow lift needed with an upper blepharoplasty?

Not necessarily. You can always have upper blepharoplasty done alone with excellent results. Lifting the tail of the brow can complement the results. The degree of droopiness of the tail of the brow varies among patients, therefore a brow lift is not recommended for everybody.

Is upper blepharoplasty the treatment of choice for a droopy eye?

It depends on what is causing the upper lid to droop. There are three components to this problem, a droopy brow, excess skin in the upper lid, and a droopy upper lid. Those factors can occur alone or in combination. Upper blepharoplasty only treats the excess skin component. A droopy upper eyelid (ptosis) requires repair of the upper lid and this, if present, can be treated at the same time. [see ptosis repair]

What is the recovery time?

Upper blepharoplasty is performed as an outpatient procedure under local anesthesia and sedation. Minimal bruising is common after surgery and usually resolves within a week. Swelling is also common and causes heaviness in both upper lids but resolves gradually over one to two weeks. Skin sutures are removed in the office after seven days. You may engage in light activity on the following day of surgery. Return to normal activity and going back to work, may take up to a week. Abstaining from exercise is recommended for the first two weeks after the procedure. To shorten your recovery time, it is advised to avoid your usual intensity exercise for 4 weeks from the time of surgery. Lighter exercise can be performed starting at 2 weeks from surgery.

Where is the procedure performed?

If Dr. Alghoul is only doing your upper eyelids, then the procedure can be performed in the procedure room in the office. If you are having other surgery performed in addition to upper blepharoplasty (lower blepharoplasty, brow lift, or facelift), then the procedure is done in the operating room at Prentice Women Hospital or 900 N Michigan Surgery Center.

Is upper blepharoplasty covered by insurance?

Upper blepharoplasty may be covered by your insurance if you have significant hooding obstructing your field of vision. A visual field test and a letter dictated by your doctor are usually required. Our staff will help you through this precertification process.

What is the cost of upper blepharoplasty?

The cost of the upper blepharoplasty starts at $ 2,500. The procedure is performed under local anesthesia and moderate sedation.


Lower Blepharoplasty (Lower Eyelid Surgery)

Lower blepharoplasty is cosmetic surgery of the lower eyelid. It is one of the most frequently performed cosmetic procedures and it aims to rejuvenate the lower lid and upper cheek areas. In a nutshell, the procedure removes or redistributes the fat and trims the excess skin to get rid of the bags and tighten the droopy skin of the lower eyelids. Dr. Alghoul is a highly specialized Chicago Plastic Surgeon who specializes in cosmetic surgery of the eyelids and he personalizes this procedure to each patient to achieve the best aesthetic results.
When planning lower blepharoplasty (eyelid lift), Dr. Alghoul evaluates not only the lower eyelids but also the entire area around the eyes. A 3D photograph of the patient helps him clearly visualize the skin topography of the lower lid and cheek support. It also allows him to compare sides for symmetry. Several aspects of the eyes’ features are examined, including the shape of the eyes, the strength of the muscle around the eye (orbicularis oculi muscle), the laxity of the lower lid, the excess skin and the lines responsible for the dark circles. The cheek volume and bony support are also examined as they both play a critical role in the success of the operation.

Goal of the Procedure

The ultimate goal of lower blepharoplasty is a smooth lower eyelid that blends seamlessly with the cheek; and almond-shaped eyes.

Who is a good candidate for lower blepharoplasty?

Males and females with undesirable features of the lower eyelid/cheek area like bags, skin wrinkles, deep lines and dark circles.

How much skin and fat are removed?

There is a big misconception that the more skin and fat removed from the lower eyelid the better. On the contrary, taking out too much skin and fat can cause problems with hollowing of the lower lid and serious complication with eyelid position. Dr. Alghoul follows a balanced approach to lower eyelid surgery. The amount of skin and fat removed are dictated by each patient’s anatomy and specific features. Fat removal is always conservative and in many cases none of it is removed, but rather redistributed to enhance the volume of the area between the eyelid and the cheek.

What is a “tear trough” deformity?

A “tear trough” deformity is a line under the eye that starts from the inner corner of the lower lid (toward the nose) and extends outwards, separating the lower eyelid from the upper cheek. It looks like a depressed area under the eye if you’re looking at someone’s face from the side. It results from fibrous attachments between the skin and orbicularis muscle and the underlying bone. These attachments are known as the “retaining ligaments” of the face. The one responsible for the tear trough deformity is known as the orbitomalar ligament. This line or groove is responsible for the dark circles under the eye. This line is made worse when there is a fat bag immediately above it as this arrangement creates a peak and valley effect. We all have this line or groove under the eye to a variable degree. It is definitely more prominent in some people compared to others and it always worsens with age.

 A mild tear trough can be camouflaged by adding volume to the area immediately adjacent to it. Hyaluronic acid hydrogel fillers and fat grafting are both acceptable methods to add volume.  More severe ones, especially those that are associated with fat bags on top, are more successfully treated with lower blepharoplasty. The tight adhesions causing the deep line are released and fat is moved across that area from the eyelid to the cheek, creating a smooth transition and eliminating the peak and valley effect. As an experienced facial plastic surgeon in Chicago, Dr. Alghoul is pleased to offer all of these treatment methods.

Where are the incisions made for lower blepharoplasty?

This all depends on the type of technique performed. There are two types of lower blepharoplasty, transcutaneous and transconjunctival. In transcutaneous blepharoplasty, the incision is made immediately under the lash line and extends to the corner of the eye. The incision heals nicely and leaves an inconspicuous scar. This technique allows muscle and skin tightening and more control of fat contouring. In transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and no muscle cut is made. If there is skin excess, a separate skin incision is made under the lash line and the skin is trimmed. Each approach has its advantages and limitations. Dr. Alghoul will discuss with you in detail which approach will be best for you.

How long do the results last?

Results are long lasting. You will continue to age normally; however, the lower lids continue to look good and a repeat surgery is rarely needed. A tear trough correction is usually permanent.

What is the recovery time?

Lower blepharoplasty is performed as an outpatient procedure under general anesthesia. Bruising is common after surgery and usually resolves within a week. Swelling is also common and resolves gradually over two weeks. Skin sutures are absorbable. You may engage in light activity the day after surgery. Return to normal activity and going back to work, may take up to 1-2 weeks. Abstaining from exercise is recommended for the first two weeks after the procedure. To shorten your recovery time, it is advised to avoid your usual intensity exercise for 4 weeks from the time of surgery. Lighter exercise can be performed starting at 2 weeks from surgery. Wearing sunglasses during the day and reading glasses can camouflage the swelling around the eyes.

Where is the procedure performed?

Surgery is performed in the operating room either in the main hospital or at a surgery center.

Is lower blepharoplasty covered by insurance?

No. Lower blepharoplasty is a cosmetic procedure and is not typically covered by insurance plans in the U.S.

How much does lower blepharoplasty cost?

Lower blepharoplasty cost starts from $3,000 when it is done under sedation and averages $6,000 when done in the operating room under anesthesia. Cost may change depending on the surgery and additional adjunct procedure.

Who gets a “tear trough” deformity?

We all have this depression or groove under the eye to a variable degree. It is definitely more prominent in some people compared to others and it always worsens with age.

Are there alternatives to surgery?

A mild tear trough or depression can be camouflaged by adding volume to the area immediately adjacent to it. More severe ones, especially those that are associated with fat bags on top, are more successfully treated with a lower blepharoplasty. Hyaluronic acid hydrogel fillers and fat grafting are both acceptable methods to add volume. As an experienced facial plastic surgeon in Chicago, Dr. Alghoul is pleased to offer all of these treatment methods.

Where are the incisions made?

For a lower blepharoplasty, an incision is made immediately under the lash line and extends to the corner of the eye. The incision heals nicely and leaves an inconspicuous scar.

How long do the results last?

Results are long lasting. You will continue to age normally; however, the lower lids continue to look good and a repeat surgery is rarely needed. A tear trough correction is usually permanent.

Droopy Eyelid (Ptosis) Correction

This condition describes the inability to adequately open or elevate the upper eyelid. It is also known as “ptosis.” It can affect either one or both eyes. It’s caused by weakness in the muscle that opens the upper lid or, more commonly, detachment of the muscle from the lid. Patients often present with a sleepy or tired appearance, especially when both eyes are involved. It is not uncommon for patients who present for correction of upper lid hooding to have a concomitant droopy eyelid. Dr. Alghoul uses specialized techniques to re-attach the muscle to the lid and reposition the crease.

The procedure improves the contour of the upper lid and brightens the eye. Upper blepharoplasty and ptosis repair are often performed together as a combined procedure.

What is the difference between a droopy eyelid and upper eyelid hooding?

A droopy eyelid is unable to fully elevate to a normal height because of a problem in the function of the lid itself. Upper lid hooding is simply related to overhanging excess skin. These two conditions can co-exist. It is not unusual for upper blepharoplasty and ptosis repair to be performed together at the same time.

What to Expect

Droopy eyelid or “ptosis” repair is an outpatient procedure performed under local anesthesia and sedation. Upper lid swelling occurs immediately after surgery, but as the swelling resolves over a two-week period the upper lids gradually start to take their new position. You may engage in light activity on the following day of surgery. Return to normal activity, including exercise, may take one to two weeks.

 

Correction of droopy eyelids may be covered by your insurance. A visual field test and a letter dictated by your doctor are usually required. Our staff will help you through this precertification process.

Eyelid Repairs

Prior lower eyelid surgery may cause excessive scarring of the lid and distort the shape of the eye. As the scar tissue pulls the lid down, it exposes the white under the eye and causes unnatural rounding of the lower lid corner. In more severe cases the lid shows the inside red lining. These changes are known as either lower lid retraction or ectropion, depending on the severity. In addition to being aesthetically unpleasing, lower lid ectropion causes functional problems like inability to completely close the eye, tearing and irritation.



To repair a lower lid ectropion, the scar tissue has to be completely released to elevate the lid to its normal position and the lid is fixed and tightened using specialized sutures to restore the natural shape of the eye. Sometimes, skin or cartilage grafts are used to give the lid additional support and prevent scar tissue from pulling the lid down again.

Dr. Alghoul uses very specialized and detailed techniques to repair eyelid complications. Depending on the complexity of the repair, additional surgery may be recommended to refine the cosmetic results.

Eyelid Reconstruction

Removal of skin cancer or a mole on the eyelid requires closure of the resulting defect to preserve the function and appearance of the eye. Dr. Alghoul uses the knowledge and skills acquired during his oculoplastic training to meticulously repair or re-build the missing segments of the eyelid. Cancer excision is frequently performed by a dermatologic surgeon using Moh’s surgery. The repair is performed immediately after the excision. Depending on the size of the defect, a flap, graft or eyelid sharing procedure may be required.

What does surgery involve?

The eyelid is a delicate yet very complex and unique structure. Reconstructing or repairing an eyelid defect after skin cancer removal or trauma requires very specialized techniques. The complexity of the repair depends on the location of the defect and the amount of tissue missing. Small defects can be directly closed. Larger defects often need burrowing tissue from adjacent areas.

What to Expect

Surgery is usually performed on the same day of cancer removal under local or general anesthesia, depending on the complexity of the repair. Sometimes a staged approach is required where a second operation is needed in two to three weeks. Generally, swelling and bruising are to be expected in the first two weeks of surgery. Lubricating eye drops and ointment are used in the first few weeks.

Common Questions About Eyelid Surgery

Blepharoplasty is a surgical procedure that improves the shape of the eyelid. It involves removal of excess skin and fat and some degree of lid tightening. The goal of the procedure is to smooth the appearance of the upper and lower eyelids and give them a more youthful look.

How is the procedure performed?

The procedure is performed through an eyelid incision. The incision is hidden in the crease of the upper eyelid and just under the lash line of the lower eyelid. Lower blepharoplasty can also be performed through an incision hidden on the inside of the lid. The fat bags are either trimmed or repositioned and the excess skin is removed.

Is there much scarring with a blepharoplasty?

Scarring with blepharoplasty is very minimal. The eyelid skin is the thinnest in the body and it heals very well leaving thin inconspicuous scars.

At what age is blepharoplasty performed?

Blepharoplasty can be performed in different age groups. Unlike facelift which is done in mid-age and beyond, blepharoplasty can be done at a younger age. Undesired features of the upper and lower eyelids can start appearing in the early to mid twenties. It is not uncommon for individuals in their late twenties and thirties to develop lower eyelid bags or dark circles under the eye.

Will a blepharoplasty rid me of my eye wrinkles?

Blepharoplasty results in significant improvement of eye wrinkles, especially the deep lines. Fine lines and wrinkles, on the other hand, may only partially improve. Fine lines are better treated with skin resurfacing using a laser.

What should I expect postoperatively?

Bruising and swelling last for approximately 2 weeks. Bruising is worse when fat grafting is combined with blepharoplasty. Lower eyelids usually take longer to recover than upper eyelids. Lower eyelid swelling significantly improves after 2 weeks, however residual mild swelling closer to the lash line may persist for another 2 weeks. The eyes may feel dry and irritated during the first 2 weeks especially when both upper and lower lids are done together. It is recommended to use artificial tear eye drops to keep the eye moisturized during that period. An ointment containing antibiotics and steroids is also used at bedtime with lower eyelid surgery to minimize irritation.

You can cover your eyes with sunglasses for the first two weeks when the swelling is noticeable. After that light makeup can be used and you can engage in social activities. You can start exercising in two weeks doing only 50% of your routine workout and go back to 100% in 4 weeks.

When will my stitches be taken out?

Stitches are removed 7 days after surgery.

When will I be able to see the results?

You will be able to see results towards the end of the first week after surgery. The results will continue to refine over the following two months.

What are the risks involved with blepharoplasty?

Risks of the procedure are minimized by using a very meticulous technique. You should discuss the details and potential risks of the procedure with your surgeon prior to surgery.

What is Asian blepharoplasty?

Approximately 50 percent of Asians do not have an upper lid crease.
Asian blepharoplasty is a term used to describe upper blepharoplasty to create an upper lid crease. The procedure involves marking where the ideal crease should be, making an incision along the markings, rearranging the upper lid fat and then closing the incision creating a crease. There are other techniques that rely mostly on external sutures to create a crease.

Contact Dr. Alghoul

If you’d like to schedule a consultation with Dr. Alghoul to discuss your eyelid rejuvenation or reconstruction treatment options, please call (312) 695-3654 or contact us via email.