Upper & Lower Eyelid Blepharoplasty
UPPER EYELID BLEPHAROPLASTY
Eyelid skin is the thinnest skin on the body, and it is here that most people will show the signs of aging first. In the upper eyelid, the skin may get so loose that it hangs down over the lashes, making it impossible to wear make-up. To correct this drooping extra skin, called dermatochalasis, a blepharoplasty can be performed. This is a surgery which will remove the skin and some of the excess fat, and accentuate the lid crease so that you will have a platform to put make-up on. After liposuction, it is one of the most commonly performed cosmetic surgeries.
A blepharoplasty is an outpatient procedure which can be done with either straight local anesthesia, or with IV sedation. After consultation with the patient to determine the look they are trying to obtain, a new lid crease and excess skin are marked on the eyelid. Local anesthetic is then injected directly into the lid.
The excess skin and some of the underlying muscle is then removed. This can be done with a surgical blade and scissors, or with a laser. We use the UltraPulse CO2 laser to do the surgery. The laser will coagulate any blood vessels at the same time it is making an incision, so that there is minimal bleeding and therefore less bruising post-operatively. Most people have a prominent fat pad in the upper lid by the nose, so this is usually trimmed. The skin is then sewn back together with sutures.
After an upper lid blepharoplasty, there will be some bruising and swelling for several days. The eyes are NOT covered, so that you will be able to see. We have patients use ice over the lids for the first few days to help decrease swelling and bruising. There is usually little to no pain after the surgery, although some people may note some dryness of their eye which can cause a sandy sensation. This is easily treated with artificial tear drops. Contact lens use can usually be resumed after about 10-14 days.
Some patients may also have a ptosis, which is when the lid itself has fallen and is obstructing the vision. This is due to stretching of the levator muscle, which is the muscle responsible for opening the eyelid. If a patient has a ptosis, this can be corrected during the blepharoplasty procedure by tightening the levator muscle.
It is extremely important to evaluate the brow height before performing any upper eyelid surgery. If only a blepharoplasty is performed in a patient with a low brow, the brow may fall even further. This creates a very heavy appearance to the upper lid, and the patient can actually look worse. In these types of cases, the brow must also be lifted to give a rejuvenated appearance to the upper part of the face and eyelids. You can read more about this in the browlift section!
Many patients express the concern that they know people whose eyes look like they are popping out or who can’t close their eyelids after surgery. This can occur if too much skin is removed during the procedure. Although many patients will have some difficulty closing completely for the first few days due to the swelling, this will resolve over the first week or two. This is why it is important that you go to a medical specialist in facial or ophthalmic cosmetic surgery to have a blepharoplasty performed!
LOWER EYELID BLEPHAROPLASTY
The lower lids can be especially problematic, because the skin not only becomes thin and wrinkled, but the fat around the eyes can move downward into the lid to produce the swollen “bags”. These fat pads will create a dark shadow on the lid, and people will complain of the dark “circles.” This dark shadow is also called the tear trough.
In a traditional lower lid blepharoplasty, excess skin and fat are removed. While this initially produces a smooth contour to the lid, with time, most people will start to look hollow from the lack of fat, and the lid can start to look very hollow and dark again. In a newer technique called fat repositioning, instead of removing that fat, we reposition the fat over the cheek bone, to fill in the tear trough, smooth out the contour of the lid and decrease the appearance of the dark circles. It is much more rejuvenating to preserve the fat here than to remove it.
At ARC CLINIC, we have a CO2 laser which we use for this procedure. Using the laser helps to decrease bleeding and subsequent bruising and swelling. This surgery is usually done with IV (intravenous) sedation and local anesthesia. We make a small incision inside the lid to allow direct access to the fat pads, which can then be moved down into the tear trough. Once the fat has been repositioned, any loose skin is addressed. If there is a lot of excess skin, some of this can be excised with an incision that is directly under the lashes, and extending out in one of the wrinkle lines on the side of the eye. Laser resurfacing can also be done on the lids to help tighten and improve the texture of the skin. This is done with one of several lasers, depending on the degree of tightening needed, and the color of the skin.
There is little or no pain post-operatively, but the lower lids have a lot of blood vessels, so most patients will have bruising and swelling after a blepharoplasty. You will use ice packs over the eyes for the first 2-3 days, and then warm compresses. After a fat repositioning blepharoplasty you can expect a fuller, more youthful under-eye appearance.