Blepharoplasty

Cosmetic eyelid surgery, or blepharoplasty, is performed to enhance the appearance of the upper and/or lower eyelids. Also known as “eye lift” surgery, it aims to reduce drooping and excess skin, often creating a tired or puffy look. Patients are often surprised by the significant impact of this minimally invasive procedure, which makes them appear younger and more vibrant. The surgery involves modifying skin, muscle, and fat to achieve a rejuvenated look. Typical signs of aging in the upper eyelids include sagging skin and excess fat, while the lower eyelids may have excess skin or fat. Surgery can correct these issues, potentially improving vision in the upper eyelids and rejuvenating the lower eyelids. Candidates for eyelid surgery may have drooping eyelids, excess skin on the upper eyelids, under-eye bags, puffy lower eyelids, or asymmetry in eyelid position.

How We Do It Differently

For the upper eyelid, we utilize the tarsal fixation method, ensuring a long-lasting result that is functional and naturally dynamic when opening the eyes. We avoid the ‘postblepharoplasty’ look common after skin-only excision blepharoplasty, which can lead to stretched and thinned skin and a raised crease, causing the recurrence of ‘excess’ skin. We often combine blepharoplasty with fat grafting and brow ptosis correction to achieve a more elegant and natural result.

We use the transconjunctival approach for the lower eyelid, meaning no incision in your lower eyelid skin (unless skin excision is needed). We usually also fat graft the cheek/lower lid area to help sculpt this area. Depending on the looseness or drooping of the lower lid, Dr. Boonipat may suggest an additional procedure on the outer corner or lateral canthus of the eye. These additional procedures include canthopexy or canthoplasty. Canthopexy involves anchoring the outer corner of the eye to prevent further sagging, while canthoplasty is a more complex procedure involving extensive dissection and reshaping of the area.

FAQ: Blepharoplasty

Why is blepharoplasty performed?

Blepharoplasty is a rejuvenating surgical procedure for the upper and/or lower eyelids. Upper blepharoplasty involves removing drooping eyelid skin, repairing eye-opening muscles, and eliminating excess fat. Lower blepharoplasty corrects under-eye bags by repositioning or removing fat and skin and addressing sagging lower lids. Eyelid ptosis, caused by decreased collagen and elastin production, may require upper blepharoplasty or a brow lift. Ptosis can also result from detached muscle fibers or herniated fat, necessitating surgical repair. Identifying the cause of ptosis is crucial for surgical planning, with dry eye testing informing the procedure. Severe upper eyelid drooping may obstruct vision, potentially qualifying for insurance coverage. Lower eyelids also age, with thinning skin, descending tissues, bulging bags, and fluid accumulation. 

Am I a good candidate for eyelid surgery?

Blepharoplasty could be considered for individuals with: 

• Sagging or drooping upper eyelids 
• Upper eyelid skin surplus that partially obstructs peripheral vision 
• Excessive skin on the lower eyelids 
• Under-eye bags 

Additionally, blepharoplasty can be performed concurrently with other procedures, such as a brow lift, facelift, or skin resurfacing. 

What to Expect After Eyelid Surgery

Most patients report minimal discomfort post-surgery. Swelling varies among patients, depending on the procedure performed, with those involving fat and skin removal causing more swelling. Bruising typically subsides around the 1-2 week mark. Return to desk work is generally possible after 1-4 days. Driving can typically be resumed within 1-2 weeks. Gradual resumption of physical activities is recommended 2-4 weeks post-surgery.

Temporary Post-Surgery Effects May Include:

• Blurred vision due to applied lubricating ointment 
• Watery eyes 
• Light sensitivity 
• Double vision 
• Puffy, numb eyelids 
• Swelling and bruising akin to black eyes 
• Pain or discomfort 

Steps for Recovery:

• Administer prescribed eye drops or ointments. 
• Sleep with your head elevated higher than your chest for several days. 
• Apply cool compresses to reduce swelling. 
• Wear dark sunglasses for eyelid skin protection. 
• If necessary, use acetaminophen (Tylenol) for pain relief.

Avoid:

• Strenuous activities for a week. 
• Smoking. 
• Eye rubbing. 
• Contact lens use for about two weeks. 
• Certain medications or supplements that increase bleeding.

Follow instructions to return to the office for stitch removal if required.

What are the Risks of Eyelid Surgery?

Major complications are extremely rare. Some degree of asymmetry between the two sides is expected, but significant asymmetry is not anticipated as the surgery is performed with local anesthetics, allowing you to sit up and look at yourself during the procedure. There is always a chance you might need revision surgery. Minor eye irritation and temporary use of eyedrops may be needed. Your eye may need 1-2 weeks to adjust to the new eyelid position. You will still be able to close your eyes when you sleep. However, in cases of ptosis repair, there might be a period of 1-2 weeks where you need eye ointment while your eye slowly closes over time. Infection is very rare. Bruising is expected but usually minimal. Bleeding is very rare but can occur and might require another procedure. Blindness is exceedingly rare. The lower eyelid can have a more prolonged swelling time (3-4 weeks). Ectropion is a rare complication where the lower lid pulls down, exposing your eye and causing irritation. Further surgery may be needed if this occurs.

What is Ptosis?

A droopy eyelid can result from either a congenital weak eyelid muscle or muscle detachment from the tarsus, typically due to aging. Treatment depends on the cause: reattachment of the muscle if detached or strengthening/shortening the muscle to position the eyelid correctly at rest.

Cost

Please contact us about the cost as the exact procedure needed is tailored to your goals and anatomy. Insurance typically doesn’t cover eyelid surgery for cosmetic reasons, but it may cover corrective procedures in certain cases. Ptosis, a condition where a drooping eyelid affects vision, can qualify for insurance coverage. Ptosis may result from a weakened levator muscle, common in congenital ptosis in younger patients. Another cause is levator dehiscence from the tarsus, often occurring in older patients due to aging. A visual field test can assess the severity of ptosis and determine if insurance covers corrective surgery.

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