Facelift Neck lift Frankfurt, Germany on of the best Plastic Surgeons and finest addresses for deep plane facelift techniques, Dr Bianca Knoll

Blepharoplasty and Oculoplastic Eyelid Surgery in Frankfurt, Germany

A blepharoplasty is one of the procedures associated with oculoplastic surgery.  What is oculoplastic eyelid surgery? This may be a real “EYE – OPENER” to you! Oculoplastic eyelid surgery is a specialized field in plastic surgery, that is focused on the periorbital region, this means the eyelids, eyebrows, orbit (eye socket), and adjacent areas like the forehead and cheeks. Oculoplastic surgery involves reconstructive measures after trauma, cancer surgery as well as aesthetic surgery. Oculoplastic surgery encompasses more than a blepharoplasty.The periorbital region is very sensitive to small discrepancies in normal form. These changes can readily be perceived by others, therefore precise technical detail and appropriate treatment plans are required. Minimal changes in eyelid, eyebrow position and shape may influence the perception you have of yourself and others have of you. This is easy to understand, as the eyes and the area around it, are so important in displaying perceived emotions.

The eye region, unfortunately starts to show its age as early as the mid to late 30’s. The most common complaint of patients seeking rejuvenative eye surgery is they look “tired” even though they retain their normal inner energy. A patient often seeks to reestablish the balance between the more youthful “inner” self and the “outer” facial image they present to the public. Studying this topic, we found that variations in eyebrow contour, drooping of the upper eyelid, and wrinkles may be conveying facial expressions that don’t necessarily match how patients are feeling. Optimally, these subtleties must be taken into account when a surgical plan is being developed.

Read the full article in the New York Times 5/28/08

Knoll B, Attkiss K, Persing J.
The Influence of Forehead, Brow and Periorbital Aesthetics on Perceived Expression in the Youthful Face
Plast Reconstr Surg. 2008 May;121(5):1793-802
Click here to read full scientific paper

Upper Blepharoplasty or Upper Eyelid Surgery

Looking „tired“ is the most common complaint of patients seeking an upper blepharoplasty. But rarely this is related to skin/fat excess of the upper eyelid alone. A commonly practiced surgical blepharoplasty technique is the removal of skin, its underlying muscle (orbicularis oculi) and fat. Unfortunately, this option does not always correct the “tired” look, quiet often the patient will be left with a „hollowed out“ appearance and an A-deformity of the upper eyelid. The patient looks operated, and different, but not necessarily better. After the initial swelling has subsided, the patient’s type appears to have changed. However, this is what most patients are not looking for after having undergone an upper blepharoplasty. An upper blepharoplasty should restore the age related changes, resulting in a rested, youthful appearance, not alter your appearance type.

Blepharoplasty and eyelid surgery can make all the differences in perceived emotions, especially when combined with other facial surgeries. Yale trained, board certified plastic surgeon Dr Knoll in Frankfurt Germany

Age Related Changes of the Upper Eyelid Region

During the aging process the natural support structures of the forehead become weaker, and many patients loose volume of the subpalpebral fat pad (fat just below your eyebrows) resulting in excess skin of the upper eyelid. This is why we are trying to rise our eyebrows with our forehead, leading to horizontal lines of the forehead.Frequently, there is, an additional weakness of the lid elevator muscles (eye-opener muscles; i.e Mueller’s muscle and levator muscle). As with everything else in our bodies, these muscles are affected by the aging process and they stretch out and weaken with time. This means if the weakness of the lid elevator muscles are not being supported, one still will be perceived as looking tired, despite having had a traditional, older technique upper blepharoplasty procedure done. Assessing if and which of the lid elevator muscles is affected, and conducting the appropriate procedure is a highly specialized necessary element in fully correcting the “tired look” .

A “tired look” may also be associated with a droopy eyebrow and forehead which may require additional surgical or non-surgical procedures. Many important entities need to be assessed carefully pre-operatively in order to perform the appropriate and most effective surgical procedure.

Am I a Candidate for an Upper Blepharoplasty?

Most patients seek an upper eyelid surgery for the following reasons:

  • Looking “tired” and/or “sad”
  • Excess skin obscuring the natural upper eyelid fold (i.e. pretarsal crease) – women often have difficulties applying eye make-up
  • Loose, excess upper eyelid skin impairing your peripheral vision

If you have any of these concerns, and are a healthy person, you are most likely an excellent candidate for an upper blepharoplasty procedure.

Upper Eyelid Surgery and Recovery

An upper blepharoplasty is commonly performed as an one day procedure under local anesthesia or slight sedation. Each blepharoplasty procedure needs to be personalized to the patients unique needs and goals. A variety of techniques will be used, including skin removal, restoring lid levator function, fat repositioning, or restoring volume by lipofilling (fat transfer) . The ultimate goal will be to obtain a refreshed, natural-looking appearance that is consistent with your appearance at a younger age. The recovery of an upper blepharoplasty is rather quick, and most patients return back to work after 1 week. However, the individual healing and recovery process can vary from patient to patient. To learn more about upper blepharoplasty and other eyelid procedures, schedule a consultation with Dr Bianca Knoll in her Frankfurt office.

Augmentation Upper Blepharoplasty

Augmentation upper blepharoplasty describes a surgical technique restoring missing volume below the eyebrow and / or of the non-movable upper eyelid by lipofilling (fat transfer). Micro- and nano fat grafting techniques can be used to restore the age related volume loss in these areas. A small amount of fat will be harvested under local anesthesia, from an inconspicuous area, processed, and injected in the area where it is missing. New technologies allow very precise placement, similar to a filler injection. Unlike HA fillers, the transfer of vital fat cells will not only replenish lost volume, it has also been shown to be regenerative and to improve the overlying skin quality and texture. Advantages that HA fillers do not have.

Asian Eyelids

Asian upper eyelids have some unique anatomical characteristics. They often present with an upper eyelid fullness which is due to a more anterior insertion of the levator aponeurosis. This causes the intraorbital fat to protrude more than in caucasians. If desired this can be corrected through an upper blepharoplasty incision in which an upper eyelid crease can be created by re-inserting the elevator aponeurosis (the muscle system that opens the upper eyelid). The eye will appear more open and fresher. Some patients wish to reshape the fold of skin between the eyelid and the nose referred to as an epicanthal fold. This can easily be corrected under local anesthesia.

Lower Eyelid Surgery

The age related changes of the lower eyelid are very characteristic. Achieving an excellent, long lasting and natural appearing result following a lower eyelid blepharoplasty surgery can be challenging. Surgical techniques in correcting sagging or bulging lower eyelids has also undergone a tremendous evolution. More than 20 years ago it was established that lower eyelid fullness is a herniation (bulging due to a weakness of a restraining layer) of intraorbital fat (fat inside of your orbit), and not an age related fat overgrowth. Older blepharoplasty procedures emphasized fat excision rather than correcting the herniation. This can result in or exaggerate enophthalmos (sunken in eye) and create a hollowed out, skeletonized (excessively aged) look after having undergone a blepharoplasty. Instead of creating a rejuvenated look, the exact opposite can develop.Recognizing this, surgeons developed during the 80’s the so-called “septal reset” (the septum is the restraining layer of the orbit which holds the fat in its normal position.) or “arcus marginalis release” and its variations. No fat is removed with those blepharoplasty techniques. Both blepharoplasty techniques were a big step forward addressing some of the age related features of the lower eyelid. However, there are some age related changes that are not or not sufficiently addressed by these lower blepharoplasty techniques, like the support of the weakened orbital septum, the skeletonization of the infraorbital rim (lower bony border of the orbit) and the depressed malar (cheek) eminence. Dr Knoll avoids fat resection during a lower blepharoplasty and instead, comprehensively reshapes the eyelids and cheek to achieve a natural youthful appearance and corrects even severe lower eyelid bags. The tear trough and the transition of the lid cheek junction will nicely blend in. Most complex lower blepharoplasty techniques require support of the lateral canthal tendon, either in form of a canthopexy or canthoplasty. A canthoplasty is used to stabilize the current shape of the lower eyelid, whereas a canthoplasty can additionally alter the shape of the lower eyelid. The superior results obtained with this technique, has been recognized internationally by the plastic surgeons community. This technique has withstood the test of time for several years and provides long lasting results.

Click here
Read the full article about this technique.

Persing J, Knoll B, Shin J.
The Shade Procedure – for Lower Lid Deformities
Plast Reconstr Surg, 2008, 121(4):1398-404

Am I a Candidate for a Lower Blepharoplasty?

Patients seeking a lower blepharoplasty are usually looking for improvement of:

  • The lower eyelid bags
  • Excess skin of the lower eyelid and/or “crepe paper“ like lower eyelid wrinkles
  • Dark circles of the lower eyelid
  • Visibility of the infraorbital rim (lower bony ridge of your eye socket)
  • Tear trough

In advanced lower blepharoplasty techniques adjacent aging anatomical areas are taken into account as well. This includes for example the deflation (fat and volume loss) and mild sagginess of the cheek, prominent lateral bony ridge of the orbit, and the adjacent temples.

What To Expect with Lower Eyelid Surgery and Recovery

Most lower blepharoplasty techniques are more complex and require general anesthesia. The recovery process (especially swelling) from a lower blepharoplasty takes longer than from an upper blepharoplasty. After your lower blepharoplasty you will have some swelling and bruising, which will gradually subside within the first days to weeks. The amount of bruising and swelling will vary from patient to patient, but Dr Knoll’s office will provide you with helpful pre and post-operative care information.

Dr Bianca Knoll and her staff will have your best interest at heart, and will do everything they can to have your surgery go well, and your recovery proceed smoothly, safely and with the least amount of discomfort possible. We are happy to provide you with further information about your blepharoplasty and answer your questions during your consultation in Dr Bianca Knoll’s office.

Book chapter:

Knoll B, Persing JA.
Blepharoplasty. In: Soft Tissue Surgery of the Craniofacial Region.
(pp 211-222) John Persing, Gregory Evans (eds). Publisher.Informa Healthcare Division of Taylor & Francis Group, LLC

Scientific Presentations:

Orbital Septum Reinforcement In Lower Lid Blepharoplasty – Knoll B
Teng E, Persing JA Section of Plastic and Reconstructive Surgery,
Yale School of Medicine, New Haven

19th Meeting of European Association of Plastic Surgeons (EURAPS), Madeira, Portugal, May 2008 

Orbital Septum Reinforcement In Lower Lid Blepharoplasty – Knoll B
Teng E, Persing JA Section of Plastic and Reconstructive Surgery,
Yale School of Medicine, New Haven

11th Congress of Italian and American Surgeons, Bologna, Italy, June 2008

Verstärkung des Septum Orbitale bei der Unterlid Blepharoplastik – Knoll B
Teng E, Persing JA Frankfurt, Germany and Section of Plastic and Reconstructive Surgery,
Yale School of Medicine, New Haven

21st Annual Meeting of the Society of Aesthetic Surgery Germany (GÄCD), Hamburg, Germany, October 2008 

Incisions and Scars of your Eyelid Surgery

In upper blepharoplasty or eyelid surgery, Dr Knoll will mark your natural lines, and will place the incision within those lines hiding the scar as much as possible.

In lower blepharoplasty or eyelid surgery the incision can be placed either from the inside (transconjunctival) or from the outside of your lower eyelid. The „outside“ incision is placed just below and along the lash line and smile lines. This allows additional skin removal which is not possible by choosing the „inside“ approach.

In both blepharoplasty techniques very fine sutures will be used for wound closure minimizing scar visibility.

Your Blepharoplasty Consultation

During your blepharoplasty consultation Dr Bianca Knoll will carefully listen to your concerns, examine you and thoroughly analyze your facial aging process and the underlying anatomy of your eyelids, eyebrows, forehead, cheeks, and temples. She will then discuss this with you, explain your available options, and present some of her before and after cases.

We are happy to provide you with further information about your different options of eyelid surgery and answer your questions during your consultation in Dr Bianca Knoll’s office in Frankfurt. We totally understand that it can be inconvenient for some of our out of town / or international patients, to come to Frankfurt, to get a first impression. For this reason Dr Knoll’s office offers the possibility of an online consultation. However, a virtual consultation has it’s limitations, and does not replace an in person consultation.

Eyelid Surgery Cost

Now that you understand that there is a broad variety of blepharoplasty techniques, it is easy to understand that it is difficult to provide any estimated cost without having examined and talked with a patient. The cost of a blepharoplasty may vary depending on the complexity, length of the procedure, or in combination with another procedure. Usually there are 3 different costs associated with a surgery: the surgeon’s fee, hospital fee, and anesthesia fee.Dr. Bianca Knoll’s office in Frankfurt will provide you with a detailed cost proposal including all these 3 different costs after your consultation. During your office consultation with Dr. Knoll you will be thoroughly examined, provided with information pertaining to your surgery, and cost associated with your individualized surgery plan. For these reasons a consultation in our Frankfurt office is strongly encouraged.

We understand that it can be impractical for some of our out of town/international patients to travel to Frankfurt for an initial consultation. For this reason, Dr. Knoll offers online consultations. By submitting a series of photographs, information about yourself and desired outcome, we can start to determine if you are a good candidate. Though a online consult starts the consultation conversation, it does have its limitations and does not replace the need to be seen in person for a traditional consultation to finalize plans for a procedure.

If you wish to have additional information or would like to schedule a consultation, please contact the office of Dr. Bianca Knoll, we will be happy to assist you.