Cosmetic Procedures

Injectable Fillers

Lines and wrinkles are part of the ageing process, but everyone wants to retain their youth and look their best. There are some new treatments available that can help. Here are two of the treatments Dr. Hawes recommends:

Restylane® is made of hyaluronic acid, a completely natural substance that already exists in the human body. Hyaluronic acid provides volume and fullness to the skin. It works nicely in the lips, nasolabial folds, and to fill hollow areas below the eyes (tear trough deformities). More about Restylane®

Sculptra™ injections have been called a "liquid face lift." Sculptra™ (Injectable Poly-L-Lactic Acid) is a relatively new product in the United States, but more than 150,000 people in over 30 countries worldwide have been treated with Sculptra™, under the trade name New-Fill™, for a variety of facial volume and contour deformities. It was approved in Europe in 1999 to increase the volume of depressed areas, particularly for the correction of skin depression, including skin creases, wrinkles, folds, scars, and eye rings or tear trough deformities. While results are not immediate and take several months to develop, this filler does provide more long lasting effects.

Photographic examples in two patients >

Botox® for Wrinkles and Worry Lines

Botox® or botulinum toxin is a drug administered by injection into a muscle. It works to block the messages sent from nerves to muscles. It is useful in decreasing forehead worry lines or "crow's feet" lines at the outer corner of the eyes. The patient pictured below has forehead worry lines suitable for Botox® treatment. The injection does not completely eliminate these lines, but does decrease contraction of the muscles that make the lines more prominent with a frown. The effect normally lasts for 3–4 months. The exact cost varies depending on how many units of Botox® are used. Other areas can also be treated, such as forehead horizontal lines or crow's feet at the outer corner of the eyes.

Botox® enters nerves and blocks release of the messenger substance which causes nerves to make muscles contract. Botox® is a registered trademark of Allergan, Inc. Dr. Hawes never uses or recommends any grey market botulinum toxin.

Blepharoptosis or Droopy eyelid

This patient [top] had a droopy left upper lid, as seen in the first photo below. She is seen after surgical repair performed from the inside of the eyelid (lower photo). Sometimes the lid is too high or too low following this surgery, and further operations may be needed.

In another patient, Dr. Hawes performed ptosis repair and upper blepharoplasty on each side. Preoperative view is on top and the postoperative view on the bottom

Eyebrow and Forehead Lift

Many patients who complain of heavy upper eyelids actually have low eyebrows. Drooping of the forehead and brow allow tissue to come down onto the eyelid and weigh down the lids.

Shown here is such a patient preoperative in the first photo and following an endoscopic (small incision) brow lift combined with an upper blepharoplasty (second photo below). The brow surgery was done without shaving any hair and by means of 5 small incisions carefully placed on the scalp and temple.

Another patient who had a brow lift combined with an upper blepharoplasty is seen at right. The first photo is preoperative and the lower photo is postop. Notice how the brow position is more even in the postop photo, while she still has a natural look.

Upper Blepharoplasty

Blepharoplasty surgery has changed. Years ago, the emphasis was more on debulking the lid, which often left the patient with a hollowed out or "skeletonized" look. The current emphasis is more on recontouring the lid to give it a more youthful shape with preservation of muscle and fat. An example of a patient who had an upper blepharoplasty performed by Dr. Hawes is seen in the following photos. The first picture shows the preoperative view and the second or lower photo shows the postoperative result. Dr. Hawes is using a CO2 laser to perform the surgery in most cases. The laser tends to cause less swelling and bruising in most cases, although the long term results are the same whether the laser is used or not.

Lower Blepharoplasty

The patient pictured below had a lower blepharoplasty (removal and/or repositioning of puffy and redundant tissue) performed by Dr. Hawes. The first photo shows him prior to the surgery and the lower photo is following the operation. Further revision surgery is sometimes needed to achieve the best final result.  Dr. Hawes performs such revisions when the patient desires them and the timing is correct. The second set of photos show  pre and postoperative side views.

Asian Blepharoplasty

The anatomy of the Asian eyelid is different from the anatomy of the Caucasian lid. One important difference is that the tissue layers fuse at a lower point in the Asian lid than in the Caucasian lid. This often results in a fuller appearance to the Asian upper lid, with the eyelid crease being lower or not present at all (sometimes termed a "single eyelid"). Check out an informative web site on this subject.

Dr. Hawes has had considerable experience performing blepharoplasty surgery on Asians. Below is a photograph of a patient he operated seen pre-op in the first photo and post-op in the lower photo.

Mid Face Lift

The patient seen in the photo below had puffy lower eyelids and some mild sagging of the mid-face (area from the lower lids to the upper lip). She is seen in the first photo prior to the surgery and in the second photo after a blepharoplasty of the upper and lower lids (see descriptions above) combined with a mid-face lift. The lower lid and cheek surgery was all done from the inside of the lid to hide the incision. Notice the subtle recontouring of the cheek to make it more smooth.

Laser Resurfacing

The CO2 laser has gained popularity as an effective treatment for wrinkles. Dr. Hawes usually does resurfacing of the area around the eyelids in conjunction with upper and lower blepharoplasty (see descriptions above). The laser vaporizes the most superficial layer of the skin, leaving the deeper skin intact. A new top layer of skin then grows back and the new layer has fewer wrinkles. This treatment has gotten much easier for patients with the use of fractional laser resurfacing. Dr. Hawes uses the Lumenis Encore fractional laser, which allows healing of the skin in about 6 to 7 days. The treated area needs to be covered with a healing and lubricating medicine such as Aquaphor during this period. The skin may be red after the treatment and it is important to use sunscreen and all the other medications prescribed by Dr. Hawes.

Active FX

Secondary Repairs after Previous Blepharoplasty

Blepharoplasty is a very common operation, and the vast majority of patients have a good result. However, the outcome is not always perfect, even when the original surgeon did the best job he or she could. Dr. Hawes has seen hundreds of patients in referral from other doctors (general plastic surgeons, facial plastic surgeons, other oculoplastic surgeons) with complications from blepharoplasty surgery, and he has also encountered some of these problems in his own patients.

One such patient (top) who had lower lid retraction and persistent swelling of the surface of the eye after a blepharoplasty done by a general plastic surgeon is seen in the first photo at right and then following surgical correction as performed by Dr. Hawes in the second photo. The swelling is still not completely resolved in the right eye in the postoperative photo.

A more subtle problem is seen in the patient pictured at right. She is a patient referred to Dr. Hawes for treatment of a sagging left lower lid following a previous blepharoplasty surgery by a facial plastic surgeon. She has chronic soreness and dryness of her left eye months after waiting for the lids to heal. The second or lower photo is following revision by Dr. Hawes to raise the lower lid and cheek. The surgery was done on the inside of the lid to avoid a visible scar.

Complications of blepharoplasty may include:
  • asymmetry
  • difficulty closing the lids
  • dry eye syndrome
  • loss of vision or blurry vision
  • double vision
  • ectropion or lid turned outward
  • lid retraction or lid pulled downward
  • chemosis or swelling of the eye surface
  • scarring
  • webbing or folds of the skin (usually at the inner corner of the upper eyelid
  • lid crease problems
  • droopy lid
  • lacrimal gland prolapse (causes fullness of the upper lid laterally)
  • hemorrhage
  • dissatisfaction
  • excessive/inadequate fat removal
  • excessive/inadequate skin removal

Complications from blepharoplasty do not always require surgery and often tend to improve with time.

Recommended Skin Care Products: SkinCeuticals

Dr. Hawes has found a line of skin care products that is scientifically based. He personally uses these products and will recommend appropriate ones to you after he examines you.

Visit SkinCeuticals for more information or to purchase products.