90% of our attention is focussed on the eyes when viewing someone’s face. They are the most important feature of the face, and Dr. Neurohr treats the eyes with unique and special care. The orbit is the area of the face where the eyes are located, and the peri-orbita refers to the structures around the eyes, such as the eyebrows, the eyelid skin, the eyelid crease, and the eyelashes. It also refers to structures beneath the skin which contribute to the appearance of the eyes, such as the muscle fibers, the fat pads, and the bone that forms the eye socket. Eyelid aesthetics are related to the visual interaction of all these structures to the viewer, and aging changes of the eyes directly impacts the appearance of an individual. They look different. Aging eyes causes an identity change in that person. A term called the aesthetic oval describes the periorbital aging process. It is defined as an oval shape bordered on the top by the eyebrow, and on the bottom by the visual convergence of where the lower eyelid meets the cheek. When the pupil centers that oval, a youthful appearance results. When the oval moves lower on the cheek, an aged appearance results, and if the oval is moved too high, a surprised or weird appearance results. Dr. Neurohr is adept at recognizing the specific periorbital structures involved in causing those changes in the context of the patient’s inherent anatomy. In other words, he restores the more youthful appearance of the eyes by correcting the structural changes that aging had created.
Upper eyelids typically develop redundancy of the skin, and the underlying fat pads often bulge causing distortions of the appearance of the eyes. Sometimes, the skin actually obstructs the visual field of the patient. Often, the eyebrows droop, and the nice curvature from the upper eyelid to the eyebrow flattens, creating the “hooded” effect of aging. Dr. Neurohr selectively identifies the issues, and communicates clearly with each patient about what the problems are. Then, he discusses treatment options with them. Surgery of the upper eyelid, called upper lid blepharoplasty, involves much more that removing skin and fat, and then sewing it up. Dr. Neurohr carefully designs incision patterns which result in a scar that looks like the patient’s natural eyelid crease. Skin for removal is always measured while the patient is sitting up to allow for the pull of gravity, and this is tested by a pinch maneuver during surgery to make sure that there is enough skin left so the patient’s eyes will close normally after surgery. Fat pad removal is a sculptural exercise in Dr. Neurohr’s hands. “Hollowed out” upper eyelids don’t look young, they look over operated! So, he contours the fat to maintain the full shapes of youth, while trimming the unattractive bulges. Actually, he will often perform fat graft injections to the upper orbit and beneath the eyebrows to restore the soft tissue fullness to that area if it has been thinned by atrophy of aging. Dr. Neurohr has great experience with periorbital fat grafting, and has been a pioneer in this field since 1990. Closing the upper eyelid skin after surgery is crucial to achieving an excellent result. Dr. Neurohr is remarkable because he makes the effort to use a meticulous, intercuticular suture technique, in each case, to accomplish perfect approximation of the skin edges, and facilitate folding of the upper eyelids precisely at the crease when the eyes open to minimize the risk of a visible scar.
Dr. Neurohr is an expert in performing upper lid blepharoplasty on Asian patients, and he is one of the few aesthetic plastic surgeons who operates on upper eyelids to correct ptosis, which is drooping of the actual eyelid. He has extensive knowledge of the anatomic structure and function of the eyelid which he deems indispensable to understanding aesthetics as well as providing the roadmap to reconstructive success.
Lower eyelids tend to develop “bags” as they age, and dark circles form beneath them, making the person look tired. The thin skin of the lower eyelids covers a muscle beneath it which is responsible for squinting and closing the eyes. Over time the skin loses elasticity and begins to bunch and wrinkle. The collagen in the skin becomes more brittle and fractures, leaving the skin with permanent lines and creases. The crepe skin becomes redundant. At that point, only surgery can correct the problem. Dr. Neurohr has spent untold hours studying and perfecting lower eyelid surgery, lower lid blepharoplasty. He understands the importance of lower eyelid support, and the preservation of eyelid shape. He performs the lower blepharoplasty operation to restore normal anatomic relationships of the lower eyelid. His design for skin removal hides the scar either inside the eyelid, or just beneath the eyelashes, and the pattern of skin removal is made to only take out the excess, not to distort the eyelid shape! The fat bags under the eye are reduced, if necessary, but not too much. They result from a hernia in the membranes between the orbital rim and the back side of the eyelid. Dr. Neurohr is one of the few surgeons who actually repairs this hernia to restore anatomic integrity to the lower eyelid, and inherent youthful shape. Usually, soft tissue thinning, atrophy, accompanies aging changes of the lower eyelids where the cheek meets the lower lid. Dr. Neurohr prefers to improve that problem with injectable fat grafting. It is a very delicate procedure which requires much precision, and Dr. Neurohr has been refining this technique with superb results since 1990.
His extensive experience and artistic insight allows him to exercise great judgement in individualizing his techniques to satisfy the needs of each patient. Sometimes that means more complicated, reconstructive procedures; sometimes that means a very simple procedure; and sometimes that means no procedure at all. Lower blepharoplasty can be a very treacherous operation. It can also be an incredibly rewarding operation, and seasoned, veteran surgeons like Dr. Neurohr know the gravity of choosing wisely to assure each patient the best possible result.