Dr. Kahana has specialized training and experience in cosmetic oculofacial plastic procedures, with a focus on the eyelids, forehead and midface. For optimal aesthetic results, Dr. Kahana believes that cosmetic procedures must be nuanced and customized to the patients desires, needs, and unique anatomy. The key to achieving outstanding aesthetic results is careful pre-operative planning. Once the plan is set, it must be executed properly, followed by appropriate aftercare. Dr. Kahana and his team are committed to your care, with exceptional attention to detail and a creative, customized approach.
An important consideration in all eyelid surgery is the presence of dryness of the ocular surface. If you have dry eyes, please share that with Dr. Kahana and his team. We will utilize a special biomicroscope – a “slit lamp” – to perform an evaluation of the eye surface. If your ocular surface is dry, we can initiate treatment prior to any surgery. Such treatment is usually covered by insurance and is essential to healthy eyes and good vision. The ability to fully evaluate the eyes when performing a cosmetic eyelid surgery evaluation is a strength of ophthalmic plastic surgeons, who have completed training in both ophthalmology (i.e. eye surgery) and oculofacial plastic surgery.
Excess upper eyelid skin is very common, and can lead to an undesirable saggy, tired appearance. Removing excess skin from the upper eyelids (i.e. upper eyelid blepharoplasty) is the most common of all facial cosmetic surgeries. Additional considerations for optimal eyelid crease and contour include proper incision choice, selective fat debulking, and eyelid crease reformation. Each patient is unique, and these considerations will be discussed at your pre-operative evaluation.
It is also critical to avoid removing too much skin: the upper eyelid requires a minimum of 20 mm of vertical skin in order to properly blink and close. If too much skin is removed, the eye will become dry and irritated, and the eyelid will appear unnatural. This often happens when a surgeon confuses eyelid and brow skin and misses the presence of significant drooping of the brows. It is important to discuss with your surgeon how the upper eyelids and brows interact, and how upper eyelid rejuvenation may require addressing the brows as well.
Another potential issue is a weakness of the eyelid opening muscles, which leads to a true “droop” of the eyelid, or “ptosis” (pronounced ‘toe-sis’). If this is present, it makes the eyelids look sleepy, and will need to be addressed. This surgery is sometimes covered by insurance if it covers the visual axis.
Dr. Kahana has a full arsenal of tools at his disposal and will provide a customized plan of care.
Lower eyelid “bags” are a common cause of concern, since they make the eyes look swollen and tired. The bags are actually a protrusion (i.e. herniation) of orbital fat pushing forward into the eyelid. This happens as a result of tissues stretching over time, as well as gravity. In addition to fat herniation, lower eyelid bags often also involve laxity of the skin and eyelid tendons, as well as drooping of the cheek fat pads (“midface ptosis”). Deep hollows around the eyes accentuate the fullness of the herniating orbital fat pads, making the eyelids look even worse.
Properly addressing lower eyelid bags is among the more complex and challenging of all cosmetic oculoplastic procedures. There are many nuances, and complications are common – particularly eyelid retraction in which the lower eyelid gets pulled down, causing eye irritation and an abnormal appearance. Avoiding complications requires proper pre-operative planning as well as good surgical technique and execution; this is true for all surgeries, but is particularly true for lower eyelid surgery.
Dr. Kahana has extensive experience in the treatment of lower eyelid bags, including a variety of surgical technique to provide a customized approach for achieving the desired results.
Forehead drooping can cause the eyebrows to rest on the eyelids, causing a feeling of heaviness and making the brow-eyelid complex appear crowded and tired. Forehead drooping can also lead to increased wrinkling of the forehead, as you try to compensate by raising your brows to help open your eyelids. These wrinkles can severely age the face. A forehead lift will elevate the brows and restore them to a more natural youthful position, which will open your upper face and help you look younger and more rested.
There are several approaches to forehead surgery, and the right choice varies by anatomy and patient needs. Some techniques for forehead lifting can result in elevation of the hairline, whereas other techniques can lower the hairline. Different techniques can utilize the hairline and hairy part of the scalp to hide incisions. This surgery is frequently performed in combination with upper eyelid blepharoplasty, but not always.
Dr. Kahana is well versed in multiple techniques for forehead elevation, and will create with you a customized plan to address your needs.
Dr. Kahana has unique expertise in elevating the midface to restore a youthful appearance to the cheek area. This expertise was developed over the course of many years taking care of patients with complex injuries and tumors around the eye and patients with facial paralysis. After many years of performing these surgeries for patients with complex medical needs, Dr. Kahana has adapted the techniques to patients with cosmetic concerns related to cheek descent. Midface surgery is frequently performed alongside lower eyelid cosmetic surgery to address the anatomic issues and enhance the results.
Dr. Kahana has a multi-planar approach to face lift surgery, utilizing incisions around the ears and at the outer corners of the eyes to tighten the underlying myofascial tissues, improve the definition of the jaw line, and restore a youthful appearance to the mid- and lower face. Sometimes excess skin is removed; however, the goal of face lift surgery is not to remove skin but rather to tighten the deeper connective tissues. The goal is a natural, youthful appearance, while avoiding a “pulled” look or a “pixie ear” deformity around the ear lobes.
Avoiding bleeding complications and injuries to nerves are key aspects of safe face lift surgery, and Dr. Kahana’s techniques prioritize avoiding complications. If you have cosmetic concerns relating to your jaw line or facial drooping, we might be able to help you with a less invasive surgery, lower risk of complications and quicker recovery.
Chemodenervation agents such as Botox® are commonly used to treat dynamic wrinkles of the forehead and around the eyes. Dynamic wrinkles are wrinkles that form when you move your muscles, as opposed to static wrinkles, which are present all the time. Chemodenervation works for dynamic wrinkles, but not for static wrinkles, which benefit from surface treatment such as lasers and peels.
In Dr. Kahana’s opinion, successful, natural results from Botox® treatment require nuance. Chronically “freezing” the face is not only unnatural, depriving you of facial expressiveness, but will eventually lead to atrophy and thinning of the muscles, which can lead to premature aging. Before initiating treatment, Dr. Kahana will perform a complete evaluation of your forehead and periocular dynamic wrinkles to develop a customized plan for your needs.
Before laser resurfacing, revealing damaged cheek skin with hyperpigmentation, and the 3 and 9 days post CO2 laser resurfacing. The damaged hyperpigmented skin looks fresh and rejuvenated. And that’s just 9 days after 1 treatment. Typically, 3 treatments spread over several months provide an optimal result. Skin resurfacing using a fractionated CO2 laser is truly the gold standard, and we are fortunate to be able to offer this treatment to our patients, alone or in conjunction with other procedures.
This is a woman presenting with complaint of eyelid skin folds. She actually has a normal amount of eyelid skin, and significant brow ptosis causing pseudo-dermatochalasis. She underwent a forehead lift. “After” photo is at 6 months.
Patient underwent bilateral upper and lower eyelid cosmetic blepharoplasty. Post op is at 6 months.
