Cosmetic Gallery - Joseph Walrath, MD

Numerous patients and their surgical results are shared below. All of patients enjoyed significant cosmetic benefits; some procedures were covered by insurance because they were undertaken to improve visual function.

Patient #1 (Preoperative). This patient complained of heavy upper lids. He also had a brow configuration (with the inner portions pointing downwards) that evoked an expression of anger.

Patient #1 (Postoperative, a few months). He underwent an upper blepharoplasty combined with medial direct brow lifting and medial M-plasty.

Patient #2 (Preoperative). This patient complained of heavy upper lids, eyebrow asymmetry, and some circles beneath the lower lids.

Patient #2 (Postoperative, 2 months). She underwent cosmetic temporal browlifting, right medial internal brow / corrugator release, bilateral upper blepharoplasty and bilateral lower transconjunctival blepharoplasty, with skin pinch removal.

Patient #2 (Postoperative, 5 months).

Patient #3 (Preoperative). This patient has visually significant upper lid droop, as well as cosmetic complaints of eyebrow asymmetry and ‘puffy’ lower lids.

Patient #3 (Postoperative, 3 months). The same patient after upper lid internal ptosis repair, upper blepharoplasty, right brow elevation, and lower blepharoplasty. Insurance covered the internal lid lift portion of the procedure.

Patient #4 (Preoperative). This patient has visually significant upper lid droop, giving her a tired appearance.

Patient #4 (Postoperative, 1 month). The same patient after upper lid external ptosis repair and blepharoplasty. Insurance covered this procedure.

Patient #5 (Preoperative). This patient complained of puffy lower lids.

Patient #5 (Postoperative, 6 w). The same patient after cosmetic lower blepharoplasty.

Patient #6 (Preoperative). This patient had upper lid droop that was affecting his vision. He was also concerned about tissue “bags” in the lower lids.

Patient #6 (Postoperative, 1 month). The same patient after bilateral upper lid ptosis repair and 4 lid blepharoplasty. The lower lid surgery was performed on the inside of the lower lid (“transconjunctival)”.

Patient #7 (Preoperative). This patient complained of a retracted left upper eyelid, making the left eye appear to bulge.

Patient #7 (Postoperative, 1 month). The same patient after left upper lid retraction repair. Insurance covered this procedure.

Patient #8 (Preoperative). This patient has visually significant upper lid droop, giving her a tired appearance.

Patient #8 (Postoperative, several months). The same patient after upper lid external ptosis repair and blepharoplasty, as well as cosmetic open forehead lifting with the incision in front of the hairline. Unfortunately, a melanoma was detected in the left lower lid during the first postoperative period, and the entire lower lid was lost. The eyelid was reconstructed with advanced techniques. The patient is depicted after: bilateral upper lid lift, bilateral upper blepharoplasty, pretrichial brow lift, reconstruction of the lower lid using the inner layers of the upper lid, and skin grafting.

The hairline incision is invisible.

Patient #9 (Preoperative). This patient complained of upper lids obscuring his vision, as well as lower lid bags.

Patient #9 (Postoperative). The same patient after 4 lid blepharoplasty, direct brow lifting, and left upper lid ptosis repair.

Patient #10 (Preoperative). This patient complained of upper lids obscuring her vision, as well as lower lid bags.

Patient #10 (Postoperative). The same patient after 4 lid blepharoplasty and upper ptosis repair, now 4 months after surgery.

Patient #11 (Preoperative). This patient complained a heaviness of the upper lids and desired Asian blepharoplasty.

Patient # 11 (Postoperative). The same patient after Asian blepharoplasty, now 1 month after office surgery.

Patient #12 (Preoperative). This patient complained a heaviness of the upper lids as well as some age-related changes in her lower lids.

Patient # 12 (Postoperative). The same patient after 4 lid blepharoplasty, now three months after surgery. In addition, an “internal” brow lift performed with the upper blepharoplasty procedure, utilizing the same upper eyelid incision, and leading to subtle brow elevation and enhanced brow definition.

The incisions are 90% healed and barely visible. The next sequence of photos shows a close-up view of the incision, with a marked up photo highlighting the path of the incisions.

Patient #13 (Preoperative). This patient complained a heaviness of the upper lids and also wanted lower blepharoplasty.

Patient # 13 (Postoperative, 3 months). The same patient 3 months after upper blepharoplasty and lower blepharoplasty with: 60% fat transfer / 40% fat reduction, open subciliary approach, canthoplasty.

Patient #14 (Preoperative). This patient complained of drooping upper lids, and also wanted her lower lids to look more youthful.

Patient # 14 (Postoperative, 3 months). The same patient after bilateral upper lid ptosis repair and blepharoplasty, as well as lower blepharoplasty, open approach, with 100% fat transfer and canthopexy.

Patient #15 (Preoperative). This patient complained of excess tissue on both upper lids, as well as puffy lower lids. Additionally, she had ptosis (true eyelid droop) on the right side, making her eye look a little smaller on that side.

Patient # 15 (Postoperative, 5 months). The same patient after bilateral upper blepharoplasty, transconjunctival lower blepharoplasty, and right upper lid internal ptosis repair

“Cosmetic Reconstruction”

Dr. Walrath operates on a significant number of patients who have endured complications from previous upper and lower lid blepharoplasty. Dr. Walrath has expertise in fixing these complications and has recently written articles on the subject.

Patient #1 (Preoperative). This patient complained of a “small eye” on the right due to improper eyelid anchoring during cosmetic surgery.

Pre: small eye on right due to prior surgery

Patient #1 (Postoperative). The same patient after proper eyelid anchoring on the right.

Post: one month postoperative result after correction of lid anchoring on right

Patient #2 (Preoperative). This patient complained of irritation in the left eye preoperatively. The left eye, pictured below, has lost it’s normal attachments to bone. The “white triangle” of the eye can be seen, and it is small compared to the other side.

Patient #2 (Postoperative, 1 month). Afterwards, reanchoring the eyelids increases the amount of eye that can be seen from the side view. Not only does sharpening this angle improve the appearance of the eyes, but the eyes can now close properly.

Patient #3 (Preoperative). This patient could not close his eyes after cosmetic lower eyelid surgery followed by two revisions. The eyelids were simply anchored too superiorly at the outside corners — this interferes with upper eyelid closure, as can be seen in the bottom picture during attempted lid closure.

Patient #3 (Postoperative). The same patient after lower lid reconstruction using a drill-hole for eyelid anchoring laterally, as well as a collagen spacer in the lower eyelids. The lower eyelids are now higher centrally, and the anchor position of the lids is lower at the outside edges. He can now close his eyes.

Patient #4 (Preoperative). This patient had cosmetic upper blepharoplasty that left her right upper lid drooping.

pt-2-preop-ptosis-r-after-outside-blepharoplasty

Patient #4 (Preoperative). After repair.

Patient #4 (Preoperative). This patient had prior lower lid surgery with fat injections. That surgery left her with both lids too low. The outer corners of the lids tended to droop as well, leading to a “sad” apperance. There is additional bulk in the right lower lid due to fat injection.

Patient #4 (Postoperative, 1 month). The same patient after release of scarring in both lower lids, placement of lower lid implants, removal of some injected fat on the right, and reanchoring. Notice that there is much less “white” of the eye visible. There is no white visible beneath the colored iris. The outer corners do not droop down.

Direct preoperative and postoperative comparisons for each side are seen below:

Right lower eyelid: pre / post

Left lower eyelid: pre / post

Disclaimer: Please note that each patient heals differently. Note that every single photo on this website is from a patient of Dr. Walrath’s. These represent personal surgical results. Some surgeons have used photos on these webpages in the past without permission, when counseling their patients, for their own benefit. If that has been your experience, kindly contact Dr. Walrath.