WITH AN EYE ON THE FACE – TAKING EYELID FAT
So this is a little vignette about a woman and some unfriendly face work, and specifically eyelid work. I’m a plastic surgeon so I get to talk about such things, presumably because I know about such things.
I am having dinner, one night, at the Brentwood Bar and Grill, one of Steve Wallace’ places. The food is great as usual. I see this grinning woman heading my way, so I stand up only to get shrink wrapped in a great, I mean really nice, hug, and a sweet smack on the mouth. This I like very much, but I have no idea who she is, or judging from my power outage, who she was.
Clearly her approach hinted of a past of some intimacy. So I tap dance, like it says in the dopey human’s handbook, since none of the more mature options appealed to me. After some initial fumbling, she drops a remark, that happily, gave it all away. I won’t bore you with details of our very excellent relationship, partly because I don’t talk of such things, but mostly because it’s not my point.
WHO WAS SHE
The reason she was unrecognizable, was in some really bad work done to her face, and especially to the frame of her eyes. The aging frame to the eyes is the most important problem in the aging face…period. In my world, if you don’t get the eyes right you don’t get the face right. If you don’t get the eyes right, you lose all the romance and poetry.
So even before I tumbled to who she was – and I mean “was”- I saw her eyes. The Empress was wearing no clothes, and as usual, no one, probably, said a word… to her.
I loved this woman once, and still do, so I was really more than annoyed. Just wanted to tear off the table cloth and fix it right there. I am restrained in this, by an otherwise loose sense of propriety.
IT’S ABOUT THE WORK
I love the work I do, and bad work is all so unnecessary, even when done by someone poorly trained. Los Angeles, where I work, has some really good plastic surgeons, any one of whom could have done a great job with her face, while sleeping. And of course, I was annoyed she did not come to me, and slightly annoyed at myself for feeling that way, but I understood.
We kissed and made a lunch date, but I could not get her face out of my mind. This brings me to the blepharoplasty (eyelids). In this case, it’s about the fat, that’s in the eyelid. The surgeon trimmed the fat away. In other places this is just fine, but in the eyelids it is usually tantamount to robbery. Aging and scaring are the twin Moriartys of my life. Neither one is anything I am disposed to assist in any way. Aging does a very nice job in removing the fat from the eyelids – all except the Medial fat in the upper lids, and the Lateral fat in the lower lids. So why do it surgically, and before its time. Ya sure there are always exceptions.
REVERSE THE CAUSE
The idea is to do what all medical care demands: find the cause and reverse it. Presently we don’t do this really well, in a lot of things, but for eyelid fat, just tuck it back whence it came and tighten the retaining wall, (Capsulopalpebral Fascia), and you got it. There’s much more to do, of course, but that’s for another time.
By the way, we are talking eyelids not eyes, and the procedure is called a blepharplasty: the “plasty” means to form, and the “bleph” means eyelid, and “procedure” means operation. More important(ly), it’s not even just about the eyelids, it’s about framing the eyes – a concept new to many, but the basis of the work I do.
THE WORKING FRAME
Here’s how the frame works. The upper eyelids belong to the brow, and not so much to the lower eyelids. The lower lids belong to the upper cheek (Malar). The edge of both lids belong to the eyes themselves. The Crow’s feet area belongs to the Temple. The inner angle of the eye, (Medial Canthus), belongs to the root and side of the nose, and the Tear Trough. The critical outer angle (Lateral Canthus) belongs to a world of it’s own. Well you get the idea.
In the early days days of cosmetic plastic surgery, the bar was not so high. For the eyelid operation, you took a little skin and some fat, and you were done… of course, you have to close, first. The problem is not the detail work. All plastic surgery is about detail work. Everything is about detail work. It’s the surgeon in the details, not the devil, unless perhaps the surgeon….that’s another story. So it’s not about the operating room, It’s about the plan, the design of the operation. You can do a wonderful operation but if it’s the wrong operation, it’s the wrong operation.
THE AMNESIC DISCONNECT
In the past, trimming away eyelid fat was all the rage in the past. It lasted as long as it did, because of something I’ve known as the amnesic disconnect. The bad effects of removing eyelid fat are not seen right away, but a few years down the line. This is much the same as any delayed effect. Just flush Glass-Steagall and a few years later you get a depression. Eyelid age earliest in the face, so a good deal of time has gone by since the fat removing eyelid operation. So the hollowed eyelids seen later are put down to aging, which of course is always a co-conspiritor, and the fat trimming operation gets a pass. It continues to be done. Most of the time this is a bad thing.
Thanks for listening
Keep those cards and letters coming