Eyelids | Dr. Forley
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Archive for the ‘Eyelids’ Category


Sunday, July 29th, 2018

A common complaint of patients is that they look tired but don’t feel tired. This is often the result of bulging fat pockets in the lower lid combined with a tight attachment of the skin at the junction of the lower lid and the cheek known as the tear trough. It is frequently one of the early signs associated with the aging process. Dr. Forley approaches this concern with both a non-surgical and a surgical option. Camouflage of the bulging fat can be achieved with the use of an injectable hyaluronic filler at the tear trough to aid in blending the transition across the lid-cheek junction. Although this can improve early changes, the fundamental cause of the problem remains unaltered. An advanced surgical technique that Dr. Forley utilizes to treat this issue involves releasing the attachment of the tear trough below the eyelid from the inside so that there is no external scar. At the same time, the fat from the lower lid is repositioned to extend across the lid-cheek junction. This changes the orientation of the fat so that the bulging is reduced in conjunction with filling the depression below the lower lid. This procedure is known as a transconjunctival fat transposition lower blepharoplasty. During your consultation, Dr. Forley will discuss the options that would work best in your individual situation.


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Saturday, March 31st, 2018

As the aging process progresses, facial veins may appear more visible. The area around the eye, known as the periorbital region, is a frequent site for visible veins. These can become quite prominent and detract from the aesthetics of the eye. They are difficult to conceal and are a frequent complaint of patients concerned about their appearance. Fortunately, a safe and effective treatment option exists with the Ellipse Nordlys Nd:YAG laser. This device uses a specific wavelength of light that is absorbed by the red blood cells found within veins. The resulting heat that occurs results in the eventual elimination of blood flow through the veins due to the collapse of the vessel walls. The veins will disappear when blood doesn’t flow through them. The deeper veins remain untouched so there is no functional effect when treating the superficial veins. Minimal discomfort is associated with this rapidly performed treatment. One or more laser sessions may be required depending on the extent of the problem.

45 year old female 4 months following laser treatment of periorbital vein

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Thursday, December 21st, 2017

The aging appearance of the eye is often a combination of a progressive descent of the brow, heaviness of the upper eyelid, and a baggy appearance of the lower eyelid. The individual contributions of each of these factors varies from patient to patient and each of them can be addressed separately or in a combined procedure.

The key factor in treating the eye area is making the correct diagnosis so that the appropriate procedures are performed. If the problem is a low-lying brow, removing upper eyelid skin can make the brow appear even lower. Conversely, trying to correct upper eyelid skin redundancy with a brow lift will result in excessive brow elevation and a surprised look.

The aging lower eyelid is often a combination of prominent fat pads and a depressed lid-cheek junction or tear trough that creates a circle under the eyelid. Removing fat in the setting of a deep tear trough leaves that problem uncorrected or may even make it appear worse.

This patient example demonstrates a patient with a low-lying brow that creates a heavy appearance at the junction of the brow and the upper eyelid. The lower eyelid has a moderate amount of fat excess and depression of the lid-cheek junction that creates a tired appearance.


Treatment of the aging eye with an endoscopic brow lift and a fat transposition lower blepharoplasty

The patient underwent an endoscopic brow lift and a fat transposition blepharoplasty of the lower eyelid. The brow lift was performed using specialized instrumentation introduced through small incisions within the scalp and enabled a correction of the heavy appearance of the upper eyelid, in this case, without any skin excision. The lower eyelid was improved by releasing the tear trough ligament and draping the excess lower eyelid fat across the lid-cheek junction to fill the depression. This procedure is distinct from more traditional fat removal procedures of the lower eyelid. The combination of surgical procedures resulted in a more youthful and rested appearance that appears natural.




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Sunday, August 20th, 2017

The Ellipse Nordlys is a state of the art device with multiple light and laser based treatment options for effectively managing various conditions. Superficial veins around the eye and temporal region are a frequent complaint that can be very visible and difficult to conceal due to the thin skin in this region. Treatment with the Nordlys Nd:YAG laser can reduce or eliminate the veins by using a specific wavelength of light to deliver energy that is absorbed by the red blood cells contained within these vessels. The energy is converted to heat which is transmitted to the inside surface of the vein. This results in eventual collapse and sealing of the veins so no further blood flow occurs. The lack of blood flow is what makes the veins gradually disappear. There are plenty of deeper veins in this area so eliminating the superficial ones that are visible is not a problem. There is minimal discomfort and the treatment only takes a few minutes. Frequently one treatment is sufficient but additional treatments may be indicated depending on the response of the veins.

38 year old female 8 months after Nd:YAG laser treatment of veins

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Sunday, April 19th, 2015

The junction between the eyelid and the cheek, also known as the “tear trough”, is an area of the face that makes us appear tired and older when it starts to deepen. It is caused by the anatomic relationship of the eyelid and cheek with bulging eyelid fat and an adherent ligament or fibrous band accentuating the depth and visibility of the tear trough. Frequently, associated shadows that are created will make it appear worse.


A more rested, youthful appearance is achieved when the junction between the eyelid and cheek is blended. The use of injectable fillers is an effective, non-surgical way to improve the area by camouflaging the depth of the tear trough through the placement of Restylane® or BELOTERO BALANCE®. Fat grafts can also be used to effectively conceal the depth of the tear trough. Treating the cause of the baggy appearance, however, requires a surgical approach that handles not only the bulging fat but the tear trough ligament that defines the junction between the eyelid and the cheek. The procedure, known as transconjunctival fat transposition blepharoplasty, involves an incision on the inside of the eyelid through which Dr. Forley releases the tear trough ligament from its bony attachment. The junction between the eyelid and the cheek is then filled with the fat of the lower eyelid to create a youthful, natural, well rested appearance. Any excess fat is removed to enhance the final outcome. A long lasting result is achieved with this technique which can be combined with other procedures to reverse the signs of facial aging.


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Tuesday, July 23rd, 2013

LATISSE® (bimatoprost ophthalmic solution) 0.03% is a prescription treatment for inadequate eyelashes. It was first introduced by Allergan in 2001 as a glaucoma medication to treat increased pressure in the eye. Patients began to report that they were seeing longer, fuller, and darker eyelashes as a side effect of using the medication. LATISSE® was judged safe and effective for eyelash lengthening by the FDA in December 2008 following the outcome of a clinical study.

Courtesy of ALLERGAN © 2011 Irvine, CA

Courtesy of ALLERGAN © 2011 Irvine, CA

How it Works

LATISSE® is believed to work by increasing the length and number if hairs during an extended eyelash growth phase. It is a once-nightly treatment that is applied topically to the skin at the base of your upper eyelashes using an applicator brush followed by blotting of any excess fluid. https://www.latisse.com/HowToApply.aspx

The results are gradual and will be evident within about 4-8 weeks with full growth present by 16 weeks of regular use. Continued use is necessary to maintain the results.

Side Effects

Although side effects are uncommon, those that may occur are skin darkening, eye irritation, dryness, and redness of the eyelids. Increased brown pigmentation of the iris in people with green or hazel eye color has been reported as a rare but permanent change that may develop if the drops are applied directly into the eye. Any differences in the appearance of the eyelashes between each eye would resolve if you stop using LATISSE®.

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Friday, December 30th, 2011

Men have become an increasingly common presence in the plastic surgeon’s office. Competition in the workplace and the prevailing youth culture have combined to create a desire for self-improvement that may not have seemed as important 15 or 20 years ago. The minimal downtime procedures performed today make their acceptance amongst busy professional men and women very high. The most frequent non-surgical procedures men are having done in our office are BOTOX® Cosmetic, injectable fillers, and Ultherapy®. Surgery often is performed to treat baggy eyelids, excess neck, hip, and tummy fat, and gynecomastia or male breast enlargement.


BOTOX® Cosmetic

Botox® Cosmetic provides a non-surgical way of reversing the crow’s feet, laugh lines, and frown lines produced by the underlying contraction of facial muscles. “Also known as Bro-tox, Botox is one of the most popular non-surgical cosmetic treatments for men” say Philadelphia dermatologist, Dr. Ringpfeil. It works by enabling a smooth skin appearance as a result of blocking the muscle contraction and overlying skin wrinkling produced by nerve impulses. The untreated muscles will allow for normal facial expression to remain unaffected. The treatment lasts from 4-6 months and is performed 2-3 times per year to maintain youthful appearing skin.

Injectable Fillers

Injectable dermal fillers composed of hyaluronic acid, such as JuvedermUltra and Ultra Plus, Restylane®, and Perlane® are indicated in the treatment of folds, wrinkles, or hollowing that results from facial aging. “By adding volume, wrinkles and folds appear smoother and facial contours appear more youthful” says Dr. Forely. The duration of effect is up to 12 months.

48 year old male before treatment

48 year old male before treatment

6 years following ongoing treatment with Restylane®

6 years following ongoing treatment with Restylane®

Another filler we offer is Sculptra® Aesthetic. This product is composed of poly-L-lactic acid (PLLA), an injectable biocompatible material that stimulates the production of the skin’s own collagen. The natural appearing restoration of youthful facial contours is made possible by the skin thickening that results from the gradual deposition of the new collagen. Generally a series of 2-3 treatments at 6-week intervals are necessary to achieve the desired effect. The youthful appearance that results from the treatment can last up to 3 years at which time maintenance treatments can be utilized.


Ultherapy® is a new type of non-surgical treatment that uses ultrasound energy to safely lift and tone the skin without any downtime. The ultrasound image on the viewing screen allows Dr. Forley to see precisely the level at which the ultrasound energy is being delivered. Ultherapy® apparatThe deep layers of the face and neck that have lost their elasticity and firmness over time are targeted by the heat-producing sound waves. Although one treatment is frequently all that is needed, more significant facial and neck sagging may require an additional treatment after 3-6 months. The duration of results can vary but you can generally expect up to 2 years of benefits from Ultherapy®.


Blepharoplasty (Eyelid Surgery)

Eyelid Surgery 75 year old male before

75 year old male before surgery

Eyelid Surgery 2 years following upper and lower

2 years following upper and lower eyelid surgery

Loose, sagging, bulging tissues of the eyelids can make the eye appear smaller and lead to others asking if you are tired or stressed. Blepharoplasty or eyelid surgery removes excess loose skin and fatty tissue that produces sagging and heaviness of the upper or lower eyelids. The eye appears larger, less tired, more open, and brighter.

Liposuction (Neck, Hips, & Abdomen)

Liposuction is a contouring procedure that removes bulges to achieve a more aesthetic blending of body outlines. The type of physical appearance men desire can be counteracted by age, heredity,lack of exercise, and poor eating habits. Long lasting results are achieved when surgery is combined with a program of fitness and nutrition. Liposuction removes excess localized fat deposits through tiny incisions using small tubes or cannulas. The overlying skin contracts to fit the new profile. Areas such as the neck, hips and abdomen are the most often targeted areas for men.

Liposuction Before


Liposuction 6 months after liposuction of the hips

6 months after liposuction of the hips

Gynecomastia (Chest)

Gynecomastia 36 year old male before

36 year old male with gynecomastia

Gynecomastia 8 months after gynecomastia surgery

8 months after gynecomastia surgery

Excessively large male breasts, known as gynecomastia, can produce a feeling of self-consciousness about body image that can inhibit lifestyle choices and daily activities. In most cases, the glandular and fatty tissue enlargement of the male breasts begins during puberty. It is usually a benign condition, but can be associated with hormonal abnormalities that may need additional evaluation. Gynecomastia procedures improve the large breast size by reducing the volume and prominence of the breast fatty tissue using liposuction and directly removing excess glandular tissue via an incision at the lower edge of the areola. Skin excision is rarely necessary as it will generally retract during the healing phase. In addition to the improved appearance, patients also find they are comfortable participating in social or sports activities that they were either unable or unwilling to do before surgery. During your consultation Dr. Forley will discuss and recommend those options that he feels will give you the best result.

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Sunday, April 17th, 2011

The first signs of aging in the face often occur around the eyes and are typically described as baggy lower eyelids.  Multiple factors contribute to this appearance including a pattern of sun exposure, lack of sleep, alcohol use, poor diet, and stress.  Sometimes it’s simply unlucky anatomy that results in the eyes appearing hollow and prematurely aged even in your thirties.  This can lead to a weary appearance with prominent circles under the eyes known as “tear troughs”.  The tear trough disrupts the smooth transition from the lower eyelid to the cheek which we visually associate with a rested, more youthful look.   Replacing the lost volume under the eyelid masks the tear trough and produces a younger, refreshed appearance that, in many cases, can postpone the need for a more invasive surgical procedure.

Tear trough at lower eyelid/cheek junction

Tear trough at lower eyelid/cheek junction

Restylane® is an injectable dermal filler commonly used to restore volume in the tear trough.  It is composed of hyaluronic acid, which is naturally present in the skin, and has been proven to last up to 12 months in clinical studies.   During the treatment, small droplets of filler are injected deep along the tear trough and then gently massaged into place.   The most common side effects of the procedure are short term bruising and swelling.

Fat grafting is a minor surgical procedure, performed under local anesthesia that can also be used to achieve correction of the tear troughs.  Fat cells are obtained using liposuction from a donor site such as the hip or abdomen and specially processed to concentrate the cells prior to injection.  While fat grafting offers a long-lasting solution to volume loss and can last for years, there are some limitations to the procedure.  The injected fat has to develop a blood supply from the surrounding tissues for it to achieve long-term survival and may require additional treatments to achieve the desired correction.

Blending of lower eyelid/cheek junction after treatment

Blending of lower eyelid/cheek junction after treatment

These techniques and procedures apply to more than just the tear troughs.  Just as volume depletes from the under eye, it also diminishes and migrates in other areas of the face.  Dermal fillers and fat grafting can also be used to treat volume loss in the mid-face and cheeks to assist in restoring smooth contours and a youthful appearance.

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