Surgeon: Dr. Michael Bense MD FRCSC
Clinical Director Bense Medical Aesthetics: Kristine Feaver-Noseworthy, RN, CPN(C), OA

iLIDLIFT™

100% Blade-Free Cosmetic Eyelid surgery (Blepharoplasty) for those who suffer from droopy, wrinkled eyelids

Before iLIDLIFT™ After iLIDLIFT™

Before iLIDLIFT™

AfteriLIDLIFT™

Before iLIDLIFT™

AfteriLIDLIFT™

Old Technique: Traditional Blepharoplasty with a Blade

Cosmetic eyelid surgery (blepharoplasty) is a procedure that is usually performed with a steel blade and which designed to remove fat--usually along with excess skin and excess muscle from the upper and lower eyelids. Both upper as well as lower eyelids can be operated upon at the same time or on separately. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may even interfere with your vision.

A Traditional Blepharoplasty, will however not remove or treat crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows, unless combined with or followed up later with other procedures (see below). It is also not the treatment of choice for festoons or so called ‘malar bags’.

Malar bags are a difficult problem to treat. Options that I have found useful include laser resurfacing with lower eyelid surgery and in some cases directly excising the malar bags. Direct excision seems to work the best but may not be a good option in someone your age. It does leave a scar which is usually better than the bag itself but does take several months to heal and for swelling to resolve. In some cases in younger people with minimal malar bags, a resurfacing laser, such as a CO2 laser, can be used, sometimes 2-3 treatments, to get the desired results.

New Technique: iLIDLIFT™ is a 100% blade-free laser eyelid operation that combines the following surgical procedures:

• Blade-free, CO2 laser Blepharoplasty
• Peri-ocular skin resurfacing and skin tightening with:
  o Blade-free Erbium laser (1 session) or
  o Blade-free ProFractional laser treatments (3 sessions)
• Botox Cosmetic Browlift
• iLIDLIFT™ is frequently combined with:
  o Full face ProFractional laser treatment to remove facial wrinkles and spots
  o Brow lift using the “Threadlift” technique
  o Facial fillers to enhance cheeks, lips and other areas

iLIDLIFT™

Description

iLIDLIFT™ is a procedure that make your eyes and aging face look nice and fresh. Your eyes look bright and alert which in turn reduces the effect of a sagging jaw line or neck. Today therefore, most people preferentially opt for the laser iLIDLIFT™ instead of a full face lift. This gives a long lasting improvement in looks with lower cost, less discomfort, lower risk, less pain, and less inconvenience than a facelift.

If you're considering eyelid surgery, this information will give you a basic understanding of the procedure-when it can help, how it is performed, and what results you can expect. It can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask Dr. Bense about anything you don't understand.

How is iLIDLIFT™ performed?

The Bense iLIDLIFT™ Laser Blepharoplasty is performed with the CO2 laser and the skin resurfacing is performed using Erbium laser technology. This procedure has revolutionized cosmetic surgery for eyelids and the face. This exciting technology allows for excellent cosmetic results in upper eyelid blepharoplasty and transconjunctival lower eyelid blepharoplasty. Enhanced surgical visualization is permitted by a relatively bloodless field, resulting in a more precise and rapid surgical procedure.

Our laser technology seals small blood vessels and lymphatics as you operate. This results in significantly less post operative bruising and swelling than seen in a Traditional Blepharoplasty.

Upper iLIDLIFT™ Advantages over Traditional Blepharoplasty:

1. More precise with less trauma to tissues
2. Little or no bleeding.
3. Eyelid anatomy is easily identified.
4. Less surgical time.
5. Rapid patient recovery.
6. Most important - very little or no bruising after the surgery, thus less swelling
7. Results are far more pleasing because of wrinkle treatment and skin tightening

Lower iLIDLIFT™ (Transconjunctival) Advantages over Traditional Blepharoplasty

• Very precise, fairly quick, easy procedure compared to conventional surgery where much of the time is spent finding the bleeders and cauterizing them.
• No visible skin incision is made.
• Less irritation and trauma to the eyelid is required because of less traction on the eyelid.
• Fewer complications.
• Less likely to change the shape of the lower eyelid.
• Very low incidence of post operative bleeding and bruising.

Disadvantages of Upper and Lower iLIDLIFT™

• Very expensive equipment not generally available in general hospitals.
• Technically challenging to surgeons not thoroughly experienced with laser surgery. The surgeon requires extensive hands-on laser training with several unfamiliar laser technologies.

Complications from iLIDLIFT™

Remember that each individual is unique; therefore each post-operative recovery may be slightly different than discussed with you. Each eyelid surgery places incisions with a special surgical laser above the eyelids in the natural fold of the eyelids. Even though this is done with a specialized surgical laser, these scars will be red for a while and swollen, then gradually change into a pink color, assuming more normal skin color over several months. A feeling of numbness may occur about the eyes. This is usually temporary, turning normal after several months. Bruising and swelling occur to some degree in each eyelid procedure with 80% of the swelling gone in the first 8 weeks.

Complications and imperfect results are not common but they can occur. The goal of this specialized treatment is improvement, not perfection. Complications are really uncommon but can occur with any type of surgery. These may include:

• Bleeding, an uncommon collection of blood underneath the skin
• Infection
• Nerve damage causing temporary loss of feeling of the eyelid
• Asymmetry of the eyelids (they don't look exactly the same to the patient), and
• Abnormal drooping of the eyelids can all occur.
• Double or blurred vision for a few days
• Temporary swelling at the corner of the eyelids
• Slight asymmetry in healing or scarring
• Tiny whiteheads may appear after your stitches are taken out
• Some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent.
• Ectropion: a pulling down of the lower lids. In this case, further surgery may be required.

Please remember that Blepharoplasty surgery, whether done traditionally with a steel blade or using laser technology as in iLIDLIFT™, is not simply eyelid surgery, but orbital surgery. This should never be misconstrued as a simple procedure. This misconception has led to a number of unfortunate results that are difficult to correct. Those who have failed to understand the orbital intricacies and negative effect that it can have on the life of a patient usually will have challenges beyond what they anticipated.

Unacceptable results after any Blepharoplasty are often the inevitable consequence of poor preoperative planning.

Causes of BAGGY EYELIDS

There are many causes of baggy eyelids and only rarely will a patient just have one issue with their eyelid region or surrounding areas. A patients’ satisfaction depends on the surgeon correcting all components responsible for the deformity. The more common causes of baggy eyelids include:

• Dermatochalasis
• Blepharochalasis
• Hypertrophic orbicularis muscle which may involve the upper and or lower eyelids
• Protrusion of intraorbital fat can cause unsightly fat prolapse in two zones of the upper eyelid areas and in three zones in the lower eyelids.
• Brow droop causes hooding of the upper eyelids and lateral fullness of the upper eyelid. Even after an upper blepharoplasty is done, hooding of the upper eyelid can be present unless the droopy brow problem is addressed separately with a brow lift.
• Festoons of the orbicularis oculli muscle gives loose muscle hammocks in the lower eyelids extending to the cheeks and are not generally repaired by a blepharoplasty surgery. To correct this problem, direct surgery to the involved orbicularis muscle might be required or laser resurfacing over the festoon or other such treatments.

The Best Candidates for iLIDLIFT™

Introduction

The iLIDLIFT™ Laser Blepharoplasty procedure can enhance your appearance and your self-confidence, but results vary from patient to patient. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. Your expectations should be in line with anticipated results generally seen in the majority of such patients. Do not assume for example that any blepharoplasty procedure will cure your crow’s feet or your festoons unless combined with additional procedures like skin resurfacing and so forth.

The best candidates for eyelid surgery include:

• Men and women who are physically healthy
• Psychologically stable
• Realistic in their expectations
• Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

A few medical conditions make any type of blepharoplasty more risky:

• Thyroid problems such as hypothyroidism and Graves' disease
• Significant dry eye problems
• High blood pressure
• Other circulatory disorders, cardiovascular disease, and diabetes.

Planning Your iLIDLIFT™ procedure

The initial consultation with your surgeon is very important. Dr. Bense will need your complete medical history, so be sure to inform your surgeon if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

Prior to surgery, you will have a complete eye examination by Dr. Jon Bense, an optometrist affiliated to Bense Medical Aesthetics. He will test your vision and assess your tear production. You should also provide to him any relevant information from any previous visits to other ophthalmologists or optometrists about possible pre-existing eye disorders, and a record of your most recent eye exam.

You and Dr. Mike Bense should carefully discuss your goals and expectations for this surgery. You'll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

Your surgeon will explain the techniques and anaesthesia he or she will use, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery. MCP will cover simple and conventional excision of droopy skin if you can prove that drooping upper lids interfere with your vision. Dr. Bense does not perform this procedure under MCP, as the NL government does not cover any surgery, regardless of its merit or need, unless it is performed in a hospital.
Don't hesitate to ask Dr. Bense any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing For Your iLIDLIFT™

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.

Types of Anaesthesia

Eyelid surgery is performed under local anesthesia--which numbs the area around your eyes--along with oral sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. A mild sedative like Ativan and Valium is often given to relax patients.

THE iLIDLIFT™ Laser Blepharoplasty procedure

This procedure usually takes 60-120 minutes to perform, depending on the extent of the surgery. In a typical procedure, Dr. Bense makes laser incisions following the natural lines of your upper eyelids, in the creases of your upper lids. In the lower lids no external incisions are usually made unless extra skin is to be excised or additional tightening of the lower eyelid is required to help prevent droopiness of the lower eyelids. A lid crease is usually created about 10mm above the upper eyelid margin in women and at about 8mm height in men. If someone wishes to have a lower or higher placed lid crease, simply ask Dr. Bense prior to surgery.

The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, Dr. Bense separates the skin from underlying fatty tissue and muscle using laser technology. Excess sagging skin and muscle is trimmed at this time, and then the excess herniated orbital fat is carefully trimmed using the Erbium laser technology which seals blood vessels immediately. The incisions are then closed with a very fine running suture which we remove after 7 days.

In the lower eyelids, Dr. Bense usually removes the three pockets of herniated fat beneath your lower eyelids. Typically Dr. Bense therefore performs a transconjunctival laser blepharoplasty (TCLB) from the inside of the lower eyelid. No suture-line is visible and no sutures are used. In this procedure the incision is made inside your lower eyelid with a laser beam, leaving no visible scar.

Dr. Bense does not usually remove excess skin in the lower eyelids unless really necessary when excess laxity of the skin requires this extra step be done. This is therefore more commonly performed in older clients with very elastic, stretched skin. Here, excess skin is trimmed in a sub-ciliary incision below the lash line. This can be combined with a lateral tarsal strip procedure when excess lid laxity causes the lower eyelid to roll outwards.

In cases of simple excess laxity of the lower eyelids without excess skin, a lateral support suture is usually added to the TCLB to improve results.

In the iLIDLIFT™ procedure, lower or upper iLIDLIFTS™ are combined with resurfacing of the lower eyelid skin for a perfect result. Botox is likewise injected into the eyelids to help elevate the upper eyelids and brows.

After Your iLIDLIFT™ procedure

After surgery, we will lubricate your eyes with ointment and topical antibiotic ointments. No bandages are used. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can control any discomfort with the pain medication prescribed. If you feel any severe pain, call us immediately.

We will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising for up to 48 hours after the surgery. (Bruising varies from person to person and generally lasts anywhere from one week to two weeks or more). For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision. You will be applying special hydrating ointments to your skin around your eyes for several days as well.

We will follow your progress very closely for the first week or two. The stitches will be removed a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.

Getting Back To Normal

You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week. By then, depending on your rate of healing and your instructions, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a sun block when you go out.

Dr. Bense will probably tell you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.

Your New Look

Healing is a gradual process, and your scars in your upper eyelids may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. The resurfaced skin around your eyes will generally heal within a week and look perfectly normal in a month or so.

On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.

Lovely Results

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