Plastic Surgeon Explains The Fastest Way to Look Less Tired

Speaker 1 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today I have Dr. Kiersten Riedler. She's back in the studio to give us an overview of eyelid surgery. Now, eyelid surgery is also called blepharoplasty, if you're fancy. And it's the fifth most popular procedure in the United States for plastic surgery. But you probably wouldn't know it and that's because it isn't the most obvious thing once someone has had it done. So, Dr. Riedler, what do people look like after eyelid surgery when it's done well?

Dr. Kiersten Riedler (00:52):
So after eyelid surgery, after they've healed, which can take months to heal fully, but usually within a few weeks, people might notice that they look more refreshed or well rested. They look a little bit younger. So it's often fairly subtle results, but things where people might look at you and say, "Oh, you look good. What did you do? Or did you get some more sleep?"

Monique Ramsey (01:19):
So what are the most common reasons that people come to you? What are the things that they complain about when they are thinking about eyelid surgery?

Dr. Kiersten Riedler (01:29):
So often patients come to me for eyelid surgery because they are starting to notice age-related changes in their eyelids that make them look either tired, old, or sad, when they don't feel tired, old or sad. And so eyelid surgery can treat various issues in the upper and lower eyelids, such as loose or sagging skin that might create folds or wrinkles and make the upper eyelids appear kind of heavy. Fatty deposits that might make the upper and lower eyelids look puffy. Under eye bags and just excess skin and wrinkles.

Monique Ramsey (02:15):
What causes eyes to look older, tired? Is it just that extra amount of skin or the puffiness or all of the above?

Dr. Kiersten Riedler (02:22):
Well, it really varies from person to person. Every patient is going to have different age related changes. It can be changes in the skin, fat, muscle and/or bone that cause these changes in the appearance. So it's always a very individualized treatment. And so evaluating each person's specific changes is important, but generally the excess skin or sagging skin, is very commonly an issue, especially in the upper eyelids. That can be just because the skin is losing elasticity, but it can also actually be related to the eyebrow drooping and then causing the excess upper eyelid skin to fold over itself. And then fat can be an issue in the upper and lower eyelids, more commonly in the lower eyelids. There's a hammock called the orbital septum in the lower eyelids that holds the fat in your eye socket. And so as that weakens with age, the fat in your eye socket can start to bulge out and then that can make your lower eyelids look really puffy. That can also happen just, usually to a lesser extent, in the upper eyelids as well.

Monique Ramsey (03:49):
Now you mentioned the brow. How would somebody know, like if I pulled up on my own brow or if you're at home and you're trying to do your own diagnosis. How would you know if a brow lift would be more appropriate or the eyes, or do you sometimes do a combination?

Dr. Kiersten Riedler (04:06):
Yeah. So patients with concerns about the upper eyelids might be a good candidate for a brow lift or an upper eyelid surgery, or both. It depends on a few different things that I look at during the consultation. One of those is just the brow position. So the normal brow position is either at or above the brow bone. So if the brows are positioned below the brow bone, that indicates that you'd probably benefit from a brow lift. And then other things that I look for are there's something called Connell's sign, which is an upper eyelid skin fold that extends beyond the eyelid, into the crow's feet area. And that's a sign that your brows are drooping and that excess skin would actually be best treated with a brow lift. That doesn't mean that you wouldn't benefit from upper eyelid surgery as well, but when the excess skin extends that far, typically a brow lift would be beneficial as well.

Monique Ramsey (05:10):
Because a brow lift, isn't the incision sort of from ear to ear, like a headband or could it be just the temples or?

Dr. Kiersten Riedler (05:17):
Well, yeah, so that's another complex topic as well.

Monique Ramsey (05:21):
Sorry.

Dr. Kiersten Riedler (05:22):
No, it's okay. There are a lot of different techniques for brow lift and it can be from ear to ear, or it could be endoscopic with a few small incisions in the scalp, or it could be a temporal brow lift that involves incisions on the side of the scalp to lift more of the lateral or the side part of the brow.

Monique Ramsey (05:45):
Okay. Sorry to derail this over to brows, but I just thought that though, is sort of interesting. So now where are the incisions made for an eyelid lift?

Dr. Kiersten Riedler (05:54):
So for the upper eyelids, the incision's made within the natural eyelid crease. And for the lower eyelid, the incision can either be made just below the lower lash line, which is also well hidden, or it can even be made on the inside of the lower eyelid if skin removal isn't required. But all of the incisions for eyelid surgery are designed so that the scars are well hidden in the natural creases.

Monique Ramsey (06:20):
And so if you're doing the incision on the inside of the lower eye, that means you're not taking out skin. It's more about the fat and the muscles?

Dr. Kiersten Riedler (06:29):
Yeah, typically that's more about the fat and the muscles. Exactly.

Monique Ramsey (06:34):
So how long does it take maybe for those scars to heal and be not noticeable?

Dr. Kiersten Riedler (06:42):
So the sutures are in place for typically about a week and then the incisions will be kind of pink for up to six months, maybe. But typically, I would say within about four weeks or so, they're not very noticeable.

Monique Ramsey (07:03):
What's the usual age of someone who's thinking about having their eyes done?

Dr. Kiersten Riedler (07:09):
So I've seen patients, really all ages from their 20s to their 90s, but I would say the average age is probably in their 50s. The eyelids and the brow area tend to be one of the areas that ages earliest. And so it tends to be patients who maybe aren't as concerned about their lower face yet, but their upper face is starting to bother them sooner.

Monique Ramsey (07:42):
Now, if you do this when you're younger, let's say you had this done and you're 34. 34 years old, you get your eyes done. Is this something that you would have to maybe repeat again later in life?

Dr. Kiersten Riedler (07:54):
So yeah, eyelid surgery can be repeated later in life. The results, they don't go away, but everybody continues to age. So depending on how you age after surgery and what age you were at the initial surgery, I would say if you're 34, there's a decent chance that you might be looking to have another eyelid surgery later in life. Just depends on the patient.

Monique Ramsey (08:21):
Now, if the problem that the patient is having is just, let's say, hollowing under the eyes or dark circles, could you just get filler to fix that?

Dr. Kiersten Riedler (08:32):
So that's a good question and a common question. It depends on the specific problem. So dark circles can be either from the fact that you have a lot of blood vessels under thin skin in your lower eyelids. And that unfortunately can't really be fixed surgically or with filler. The best treatment for that is under eye concealer. But if the dark circles are related to hollowing that's causing shadowing, then filler may be a good option. If there's a bulge from fat, kind of pouching out and then that causes a depression below it with hollowing and darkening there, really surgery's going to be a better option. I mean, sometimes a little bit of filler can be placed there to smooth the transition between the lid and the cheek, but it really just depends on the specific findings in each individual patient.

Monique Ramsey (09:36):
Now, how long does eyelid surgery take?

Dr. Kiersten Riedler (09:40):
So it takes one to two hours, depending on which eyelids are being treated, or if all of the eyelids are being treated.

Monique Ramsey (09:48):
And what would somebody look like immediately after surgery?

Dr. Kiersten Riedler (09:53):
So immediately after surgery, there's some sutures in place. And then generally, you're going to have swelling and a little bit of bruising for, I would say at least a week and then the sutures come out. The swelling does take some time to go away. I would say, you'll look swollen for about two weeks. And then by three or four weeks, you're going to have a little bit of residual swelling, but when people look at you, they won't necessarily notice it.

Monique Ramsey (10:25):
Oh, you would probably notice it more on yourself than...

Dr. Kiersten Riedler (10:28):
Yeah, definitely.

Monique Ramsey (10:29):
than somebody else. Now what other procedures could be combined with eyelid surgery?

Dr. Kiersten Riedler (10:36):
Brow lift is a common one. As we discussed earlier, sometimes upper eyelid concerns are best addressed with upper eyelid surgery or brow lift or both. So that's a really common one. That transfer is another adjunct procedure that can be very helpful to restore a youthful appearance in patients who have hollowing of the upper or the lower eyelids. And then faces don't age in an isolated manner, so often patients with eyelid aging have other signs of facial aging that they may wish to improve. And so eyelid surgery can be combined with any of the other aging face procedures that we perform like brow lift, face lift, neck lift, lip lift, fat transfer and skin resurfacing.

Monique Ramsey (11:26):
Yeah. I was just about to ask about lasers. So do you ever have where you would do their eyelid lift and then also laser around the eyes at the same time?

Dr. Kiersten Riedler (11:37):
Yeah, so often we combine skin resurfacing, laser treatments with eyelid surgery, because the thin skin of the lower eyelid, especially the texture, changes with age. And so laser resurfacing can be very helpful to improve the skin texture in addition to treating the excess skin and fat.

Monique Ramsey (12:00):
So we have a new non-surgical treatment, which is actually an eye drop. An eye drop that you just drop into your eyes that helps your eyes look more open and it's called Upneeq. How does that work?

Dr. Kiersten Riedler (12:14):
So that actually works by activating one of the eyelid elevator muscles in your upper eyelid. And you drop it in your eye and it activates that muscle to contract and lift your upper eyelid a few millimeters and makes your eye look more open.

Monique Ramsey (12:35):
So that's kind of fun.

Dr. Kiersten Riedler (12:38):
Yeah. It is, because it's just an instant result, which is kind of exciting.

Monique Ramsey (12:43):
And it's, from what I've read, it's safe for everybody. Pretty much everybody can use it, which is nice. So for a temporary little lift.

Dr. Kiersten Riedler (12:51):
Yeah, for a temporary, yeah. It lasts about maybe eight hours or so.

Monique Ramsey (12:56):
Yeah. So we put all of our prices on our website and for eyelid surgery, the range is about seven to $10,000 and we have lots of financing options. And I think not everybody realizes that financing is really normal in our industry. A lot of patients don't know that or prospective patients, but that is a way to sort of have your cake and eat it too. Be able to have your eyelid surgery and then pay over time while you're enjoying the results of it. And our finance team is amazing at helping to figure out what's the best option for you. Now, does insurance ever cover eyelid surgery?

Dr. Kiersten Riedler (13:39):
No insurance does not cover cosmetic surgery. Lower eyelid surgery is almost always considered cosmetic and not covered by insurance. In some cases, if the upper eyelids are so heavy that they block your vision, insurance may cover upper eyelid surgery when it's done after specific testing and with somebody in your insurance network, who does that surgery.

Monique Ramsey (14:07):
Okay. So the last question is, is it possible to have a virtual consultation or do you see everybody in person or is it up to the patient?

Dr. Kiersten Riedler (14:21):
Yeah, I mean, it's up to the patient. So if you're interested in eyelid surgery, I would recommend calling our office and talking to one of our patient coordinators. They are very knowledgeable about the procedures we perform and they can schedule you for either a virtual or an in person consultation. I always like to see patients in person before surgery and even really before we schedule the surgery, because with a lot of facial procedures, especially eyelid surgery, nasal surgery, it's really important to see in person and feel and really evaluate the anatomy. But a virtual consultation, especially for patients who might not live locally, is always a great option as a first step too.

Monique Ramsey (15:14):
So if you're listening today, we want to ask you for a special favor. If you love the La Jolla Cosmetic Podcast, hopefully you've learned something from it. Or if it's helped you make a decision, please tell your friends, share it with your friends. And write a review of our show on Apple Podcasts or Goodpods or wherever you're listening. We love reviews and we want to hear from you or any topics you're wanting us to dive into. And if you have any questions, look in the show notes. We have links for how to schedule an appointment, for financing information, reviews, and then you'll find links to those before and after photos of all our surgeon's beautiful work. And it is helpful, I think, to see those before and after photos, to see what a person started with and how it ended up. So thank you Dr. Riedler. It was very fun to talk to you this morning and we will see you next time.

Dr. Kiersten Riedler (16:09):
Great. Thanks so much.

Speaker 1 (16:17):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @LJCSC. The LA Jolla Cosmetic Podcast is a production of The Axis. the axis.io.