Blepharoplasty

Blepharoplasty, or eyelid surgery, can be performed on the upper or lower eyelids to rejuvenate the eyes and improve a tired appearance as “heavy” eyelids are often a sign of early aging.

Upper eyelid surgeries focus on removing skin redundancy with limited fat removal. Ptosis, or dropping of the upper eyelids, may be performed in conjunction to upper blepharoplasty. Lower eyelid surgery is focused on smoothing bags of protruding fat under the eyes, camouflaging the “tear trough,” improving dark shadows under the eyes, and removing excess lower eyelid skin if needed. As the eyes are considered to be the most engaging and important parts of your face, eyelid surgery can correct the aforementioned issues and give you a more youthful, refreshed, and alert look. Even though most blepharoplasty surgeries are considered cosmetic, upper eyelid surgery may be functional if the field of vision is partially obstructed from droopy upper eyelids.

Types of Blepharoplasty

Functional Blepharoplasty

Functional Blepharoplasty corrects eyelid issues that affect an individual’s field of vision. If the field of vision is diminished, the surgery would be considered functional surgery as opposed to cosmetic surgery and could be covered by your health insurance depending on your insurance plan. Removing excess skin and fat from the upper eyelids with possible correction of upper eyelid ptosis (droopy lid) improves the field of vision for driving, reading, and other visual activities. Other problems that can be improved using functional blepharoplasty include:

  • Irritation can result from folds of skin rubbing together on the upper or lower lids
  • Muscles in the forehead can become stressed and painful due to the effort required to use those muscles to lift sagging eyelids.

Cosmetic Blepharoplasty

Cosmetic blepharoplasty addresses eyelid problems that affect the aesthetics of the eyes and face to create a more youthful look. There are several issues that can be corrected through cosmetic blepharoplasty, which can give you a more youthful and rested appearance. Normal aging can cause skin to stretch and muscles to weaken in both the upper and lower eyelid area. This can result in:

  • Pockets of puffiness
  • Folds of excess skin
  • Bags under the eyes
  • "tear trough" hollow with dark shadow
  • Wrinkles under the eyes

Who is a Good Candidate?

A good candidate for upper blepharoplasty:

  • Loose or excess upper eyelid skin
  • Puffiness of the upper eyelid
  • Realistic expectations of what the procedure can and cannot accomplish
  • Non-smoker
  • No underlying eye disease or conditions (including dry eyes)
  • No other significant illness or disease that could be life threatening

A good candidate for lower blepharoplasty:

  • Loose or excess lower eyelid skin
  • Puffiness of the lower eyelid
  • "Tear trough" deformity with dark shadow
  • Can be away from computer work or sending text message for at least 7 days
  • Realistic expectations of what the procedure can and can’t accomplish
  • Non-smoker
  • No underlying eye disease or conditions (including dry eyes)
  • No other significant illness or disease that could be life threatening

How is blepharoplasty surgery performed?

Anesthesia

Upper eyelid surgery may be performed under local anesthesia (usually in the operating room with mild sedation) but may be performed in the office in certain patients. Lower eyelid surgery is performed in an operating room with mild sedation. Under sedation, the patient is considered to be awake but unaware of the procedure. In some instances, blepharoplasty is performed under general anesthesia with the patient fully asleep and unaware of the procedure (usually done in conjunction to other procedures such as rhinoplasty or facelift). Your surgeon will discuss the anesthetic options with you and recommend the best anesthesia utilized.

Details

Upper eyelid surgery is performed through an incision hidden in the upper eyelid crease. This allows for improvement in skin redundancy, fat removal if needed, and correction of eyelid position. The procedure takes approximately 45 to 60 minutes. Sutures are placed on the outside and removed 5 to 7 days after surgery.

Lower eyelid surgery may be performed through an internal incision, external incision, or both. External incisions just below the lash line (“subciliary approach”) are typically best to address and treat excess skin and correct lower lid malposition/laxity. This approach is more commonly utilized in older patients. Internal incisions (“transconjunctival approach”) through the inside of the lower eyelid may be utilized if fat herniation is the sole problem without skin redundancy/excess. This approach is commonly utilized in younger patients or patients with puffy eyelids only. Tear trough correction is performed by fat transposition or fat/soft tissue grafting as needed. The type of incision is determined by the underlying problem and hence customized to each patient. With our technique we place emphasis on precision, symmetry, scar concealment, and maximizing results without compromising function (such as dry eyes or difficulty closing the eye). All incisions are placed such that they are well hidden in natural folds of eyelid skin. The procedure takes approximately 60 to 75 minutes. For the internal (“transconjunctival”) approach, sutures are usually not necessary. For the external (“subciliary”) approach, sutures are removed 7 days after surgery.

Recovery Time

Once eyelid surgery has been completed on both sides, ointment and cool compresses are applied in the operating room. After awakening from anesthesia and assuring your comfort, you will be able to go home the same day.

After upper eyelid surgery, some bruising and swelling is to be expected that may persist for up to 2 weeks. It is recommended that you do not go to work for 5 to 7 days after surgery. Sutures are removed on day 5 to 7. Mild blurry vision is not unusual after eyelid surgery and usually lasts 1 week, sometimes longer. After 2 to 3 weeks, you may wear contact lenses again or apply eye makeup. If upper and lower eyelid surgeries are performed at the same time, the recovery time may sometimes take slightly longer.

After lower eyelid surgery, some bruising and swelling is to be expected for 3 to 4 weeks with gradual improvement. It is recommended that you do not go to work for 10 to 14 days after surgery. Sutures are removed after 1 week. Mild blurry vision is not unusual after eyelid surgery that usually lasts 2 weeks, sometimes longer. After 2 to 3 weeks, you may wear contact lenses again or apply eye makeup. In general, the recovery following the internal (“transconjunctival”) approach is usually quicker than the external (“subciliary”) approach.

Schedule your consultation to speak with us about eyelid surgery, your goals, and ways to give your eyes back their youthful look!