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Eyelid Surgery (Blepharoplasty)

What is a Blepharoplasty?

A blepharoplasty (Eyelid Lift) restores a refreshed, rested and rejuvenated appearance to the eyes, specifically addressing extra skin and lower eyelid bags that occurs with aging. Blepharoplasty can improve the appearance of the Upper Eyelids, the Lower Eyelids, or both Upper and Lower Lids, making you look more rested, bright-eyed and alert.

Patients seeking blepharoplasty notice that their eye area displays Features of Aging Eyelids: Loose or sagging upper eyelid skin produces additional upper lid folds and creates overhang of the eyelid skin, disturbing the natural contour of the upper lid. In some instances, excess drooping eyelid skin can even impair vision. Excess fatty deposits around the eyes appear as puffiness in the upper or lower eyelids, creating a tired, mad or sad appearance. Extra skin and fine wrinkles can form in the lower eyelid, and puffy bags can develop beneath the eyes.

In extreme cases, “Festoons” can develop (enlarged puffy bags of skin) in the lower lids; this condition is usually genetic and requires skin excision. Extreme droop or curving out of the lower eyelids, called Ectropion (creating “show” of the sclera, the white portion of the eye) can also be corrected by blepharoplasty.

A blepharoplasty will not address dark circles beneath the eyes, fine lines or “crow’s feet” (natural laugh lines that extend outwards from the eyes). Dark Circles occur with loss of volume in the lower lid region that occurs with age; when light shines through the skin, the darker Orbicularis Oculi muscle is visible beneath as a dark circle. Fine Lines occur with loss of collagen and elastin over time, and “Crow’s Feet” are in fact deeper wrinkles that form naturally with age from continual contraction of the orbicularis oculi muscle. These conditions are treated using complimentary non-surgical methods such as injectable fillers, Botox and individualized skin care. Please visit our Minimally Invasive Procedures and Medical-Grade Skin Care sections to learn more.

Blepharoplasty will also not correct drooping eyebrows or chronically contracting forehead muscles that are actually a result of “brow ptosis” (forehead droop). The forehead will be specifically examined at your consultation together with the eye region. A Brow Lift may be recommended together with a blepharoplasty, or on occasion in place of eyelid surgery, especially if a blepharoplasty has previously been performed.

Eyelid surgery will treat the above features of aging to produce a Brighter and Refreshed look to the eyes. It should not change your appearance or make your eyes look unusual. The best facial rejuvenative procedures are not immediately obvious to others, but brightening of the eyes will be apparent to all. Beautiful, Subtle and Natural Results are the goal in blepharoplasty, without looking “done”, “surprised” or different.

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Who is a Good Candidate for Eyelid Surgery?

Good candidates for a blepharoplasty include adult men or women who are healthy, fit and emotionally stable, with features of the aging eyelid as described above. Some candidates for eyelid surgery may also have some degree of Brow Ptosis (forehead droop) and actually are also candidates for a Brow Lift together with surgical rejuvenation of the eyes.

Smokers, patients with high blood pressure, cardiovascular disease or diabetes, and individuals who are psychologically unprepared for surgery are not good candidates for blepharoplasty. Individuals with diseases of the eye such as dry eyes, glaucoma or a history of detached retina may not be good candidates for surgery. Remember to tell your surgeon about a history of vision disorders or LASIK surgery. Patients with an overactive thyroid (Graves disease) or “exophthalmos” (bulging of the eyes) are at higher risk of complications from blepharoplasty and should avoid cosmetic eyelid surgery.

A blepharoplasty can be an extremely rewarding and empowering experience, but should be done at the right time and for the right reasons, by a Board-Certified Plastic Surgeon. Candidates for eyelid surgery should be emotionally stable, have the support of their surrounding friends and/or family members, and be fully educated about the procedure they are contemplating. Learn more about Preparing for Plastic Surgery in our Preoperative Instructions section.

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What Are the Different Types of Eyelid Lifts?

Each blepharoplasty technique, used in the right setting, has outcomes that are consistently reliable and long-lasting. Surgical eyelid rejuvenation creates a refreshed and relaxed appearance to the eyes, a smoother contour to the lower eyelid skin, and a more rested and youthful look overall. The eyes will appear less sad, tired or angry.

At your blepharoplasty consultation, your entire eyelid and forehead area will be examined both at rest and with facial muscle animation. The particular blepharoplasty surgical technique recommended will depend on your skin quality and elasticity, the position of your eyebrows, amount of excess upper or lower eyelid skin, the presence of bags or festoons, and the condition of your forehead and eyebrow position.

An upper lid blepharoplasty, lower lid blepharoplasty, four-lid (also known as “quad”) blepharoplasty or nonsurgical rejuvenation of the eyelids may be recommended to you specifically, or in combination. Details of your surgical procedure will be individually tailored to treat your particular features of aging and your unique anatomy.

Upper Lid Blepharoplasty

Upper eyelid blepharoplasty makes an incision within the natural fold of the upper eyelid, extending from the inner upper lid slightly past the outer upper lid crease to fall in a natural “laugh line” or existing crease. Because the incision follows the natural contour of the upper eyelid, it is inconspicuous and fades with time to be nearly invisible, particularly when wearing makeup. Skin is removed from the upper lid, fatty deposits may be repositioned or removed, eyelid muscles can be tightened and the upper lid is given a refreshed and more youthful appearance.

Lower Lid Blepharoplasty

Lower lid blepharoplasty may be done using an incision below the lower lid lashes (“subciliary” method) or within the internal lining of the lower lid (“transconjunctival” approach). The method used to rejuvenate the lower lids depends on your anatomy, the amount of excess lower eyelid skin, and the presence of bags or festoons.

“Subciliary” Lower Lid Eye Lift

A subciliary lower lid blepharoplasty rejuvenates the lower eyelid through an incision made just below the lower eyelash line. Through this incision, excess skin of the lower eyelids is removed and underlying fat and/or muscle is repositioned or removed as necessary. The subciliary incision heals nearly imperceptibly and is hidden beneath the eyelashes of the lower lid.

“Transconjunctival” Lower Lid Eye Lift

A transconjunctival blepharoplasty makes an incision inside the lower eyelid, hidden within the “conjunctiva”, the thin membrane that lines the lower lid. The transconjunctival approach is used only to redistribute or remove excess lower lid fat and correct lower eyelid conditions but does not permit removal of excess lower lid skin.

Four-Lid “Quad” Blepharoplasty

Surgery of the upper and lower eyelids is commonly called “quad” or four-lid blepharoplasty. The lower lids may be addressed by either the subciliary or transconjunctival incisions.

Nonsurgical “Liquid Eye Lift”

A nonsurgical option that can achieve modest rejuvenation of the eye area involves the use of Botox and Injectable Fillers to fill in depressions, deep creases or hollows above or below the eyes. Gentle elevation of the outer aspect of the brow can be achieved by selectively relaxing muscles around the eye, giving the eyes an overall refreshed look. Nonsurgical procedures have the advantage of improving the appearance of the eye region both at rest and with animation, and can last for many months to a year or two. Please visit our Minimally Invasive Procedures section to learn more.

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What Really Happens During a Blepharoplasty?

Please see our Preparing for Surgery section to learn about what happens in the operating room on the day of surgery.

A blepharoplasty is performed in the operating room under intravenous sedation (also known as “twilight” anesthesia) plus local anesthesia or under general anesthesia plus local anesthesia or for optimal comfort, control and safety. As for all facial Plastic Surgery, eyelid procedures are done under surgical “loupe” magnification to enable ultimate precision and meticulous attention in surgery.

The method used for your blepharoplasty procedure will depend on your anatomy, the degree of skin excess and amount of bulging fat and/or muscle in the upper and lower lids. All incisions used for eyelid surgery are designed to be well concealed within the natural structures of the eyelid region.

Following injection of local anesthesia containing epinephrine (which minimizes bruising), delicate eyelid skin is separated from the underlying tissues, and excess fat or muscle is repositioned or removed as necessary. Tiny blood vessels are meticulously cauterized to avoid bleeding during and after surgery. Excess skin is trimmed, the remaining eyelid skin is redraped without tension, and incisions are closed using very fine sutures that will be removed a few days to a week after surgery.

When you awake from your blepharoplasty, your eyes may be blurry from protective ophthalmic ointment applied to the eyes during surgery. You will be comfortable; eyelid surgery is not normally painful. Pain medication is prescribed for you to take after surgery as needed. You will have cool packs over your eyes that you can continue at home for a few days. Blepharoplasty is usually performed as an outpatient procedure and takes 1-2 hours depending on the details of surgery.

Initial healing after a blepharoplasty may include some eyelid swelling, bruising, tearing, eye irritation, light sensitivity or dry eyes that is controlled with medication, cold compresses and lubricating ointment. Blepharoplasty incisions tend to heal very well with excellent quality scars due to the delicate nature of eyelid skin and robust blood supply of the face.

As mild swelling and any bruising subsides, visible improvements of the eyelid procedure will appear over a few weeks. The results of a blepharoplasty will reveal a smoother, more defined eyelid, and brighten the eye region for a more youthful and refreshed appearance. It takes several months up to a year for the final results to be evident and for incisions to fade maximally.

As a component of Scar Therapy, it is important to minimize direct sun exposure to the eyelids and face not only during healing, but as a life-long behavior to help maintain your rejuvenated appearance and to minimize future “photo-aging” (sun damage). Dark sunglasses will help to protect the delicate skin of the eyes during healing and promote comfort to the eyes after surgery.

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How Long Will the Results of a Blepharoplasty Last?

A blepharoplasty lasts forever, giving your eyes a rested and more youthful appearance that will endure in the long term. However, you will continue to age as appropriate after any type of facial Plastic Surgery. In the future, you will still appear younger than if you had not had your procedure, but you will never appear too tight, “overdone” or abnormal.

Maintaining excellent Skin Care, exercising smart sun avoidance and some Non-Surgical Rejuvenative Procedures can often prolong the results of your blepharoplasty. Long-term follow up with your surgeon will enable ongoing assessment of your results both in the short-term and over many years to come.

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Can other Surgical Procedures be Done Together with a Blepharoplasty?

A blepharoplasty by itself makes improvements to the eyelid region but does not specifically address the brow, the mid-face, cheeks or the neck and jaw line. A complete facial examination will be done at your consultation to elucidate which surgical option(s) will best achieve your goals and most accurately treat your specific features of aging.

A blepharoplasty is often complimented and further enhanced by a variety of Complimentary Facial Plastic Surgery Procedures, including a:

  • Brow Lift (Forehead Lift) to gently lift and refresh the brow, helping to create a more youthful appearance to the eyes and enhance the results of a blepharoplasty.
  • Facelift to smooth wrinkles and correct aging in the cheeks, mouth region and mid-face.
  • Neck Lift to rejuvenate the jaw line, lift the “jowls”, remove crepe-like neck skin and restore a well-defined and youthful neck.
  • Otoplasty or Earlobe Correction to help balance the face and rejuvenate or repair aged or stretched-out earlobes.

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Are Non-Surgical Treatments Part of a Blepharoplasty?

Complimentary Non-Surgical Procedures are very commonly added to a blepharoplasty to increase its effect. Pre-treatment of the face with nonsurgical, minimally invasive techniques or specialized skin care regimens can promote the best aesthetic outcome of blepharoplasty surgery.

Nonsurgical procedures that may accompany an eye lift include:

  • Minimally Invasive Procedures such as Botox, fillers, lasers and other skin treatments to compliment and enhance blepharoplasty results.
  • Medical-Grade Skin Care to adequately prepare the skin of the eyelids and face for surgery, assist in the recovery of the skin during the healing period, and in the long term, extend the results of surgery.
  • Medi-Spa Services to compliment facial Plastic Surgery and further pamper and rejuvenate the eyes, forehead, face, neck and décolletage (cleavage area).

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What is the Recovery After an Eyelid Lift?

After any type of facial surgery, some swelling and bruising is expected. Initial eyelid asymmetry from swelling or an uneven appearance can occur and will normalize as healing progresses. After approximately two weeks, obvious signs of surgery such as puffiness or discoloration should dissipate.

Sleeping with a few extra pillows to elevate the head can help speed the resolution of postop swelling. Strict sun avoidance and the regular use of sunblock of at least SPF 30 are vital to prevent permanent “hyperpigmentation” (darker color to the skin and incisions) and sunburn. Wearing makeup over sunblock is permitted at a week postoperatively and should continue as part of your morning beauty routine. Products that are recommended for postoperative skin protection are available at our office as part of our Medical-Grade Skin Care regime.

Sutures will be removed in the office approximately a week after surgery. Please see our Postoperative Instructions section and Special Instructions for Facial Surgery for additional information pertaining to recovery from a blepharoplasty.

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What Are Potential Risks and Complications of Blepharoplasty Surgery?

When you are considering any type of surgery, you should be fully educated about potential risks and complications. Please see our Preparing for Surgery section to learn about general risks and potential complications, Special Considerations for Facial Plastic Surgery, and our section on Postoperative Instructions for additional information pertaining specifically to blepharoplasty surgery.

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Before and after eyelid surgery results will be reviewed during your consultation.

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As women Plastic Surgeons, we intimately understand how an individual’s looks and their feelings about their appearance can influence self-image and self-esteem. At your blepharoplasty consultation, your surgeon will spend a great deal of time with you to get to know you personally and take a complete medical history.

Your facial bone structure, underlying skin composition, eyelid skin thickness, texture and elasticity, bagginess to the lids, eyebrow position, hairline, extent of facial wrinkles and folds will be carefully examined. Taken together, this information will be used to formulate an individualized plan to address your unique features of aging and your specific aesthetic goals. Your Plastic Surgeon will select the surgical technique she feels will obtain the best outcome for you and that offers the lowest potential risk.

We will explore in detail your reasons for seeking a blepharoplasty, and if you are an appropriate candidate for surgery, your options will be described in detail.

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA