Cosmetic Eyelid Surgery: What It Can and Can't Do

By Lawrence M. Korpeck, MD

Published on August 01, 2006

One of the first places we show age is around the eyes. The skin surrounding this area is the thinnest on our body and the sockets that nature designed to protect the eyes encourage the skin to stretch, muscles to weaken, and excess fat to gather above and beneath the lids. Some people -- depending on skin type, genetic makeup, and lifestyle --get the droopy upper lids, sagging eyebrows, and bags below the eyes sooner than others. Nevertheless, the result is the same -- the person looks sleepy and sometimes dissipated, regardless of the way he or she feels.

These unfortunate effects of age can be frustrating, and many people will be bothered by the way their eyes look. Unfortunately, in some cases makeup fails to hide the imperfections around the eyes. For many people, however, eyelid surgery or 'blepharoplasty' can successfully take away the tired look and make the patient look refreshed, without changing the character of the eyes.

Cosmetic eyelid surgery, or blepharoplasty, is among the most common procedures for men - almost one fifth of all blepharoplasty patients are male, according to the American Society of Plastic Surgeons.

How it's Done

Traditionally, surgeons performed the procedure by removing fat, and sometimes skin and muscles, from the upper and lower lids. Today, the trend is to remove less fat and to reposition the remaining fat where it was when the patient was younger. This allows a more natural and youthful look with less hollowing out of the eyes. For the lower lid, the surgeon makes the incision beneath the lashes, where it is hidden by the eye's natural crease. Alternatively, the incision can be made from inside the lower eyelid, so that there is no visible scar. The upper lid incision is made at the natural fold at the back of the lid. Once the fat and skin are removed, the surgeon carefully lifts and places the skin, suturing it in these natural creases. The incisions fade and become invisible.

Benefits and Limitations

Most patients can expect to look refreshed and more energetic following their blepharoplasty. The surgery results in a cleaner look, takes away any obstruction caused by drooping upper lids, and firms and smoothes the lower lids. However, eyelid surgery will not take away crow's feet and other wrinkles around the eyes, unless the wrinkles are part of the skin being removed. Eyelid surgery will not lift droopy brows, smooth furrowed lines above the nose, or completely eliminate dark, discolored skin (circles) beneath the eyes.

The following individuals may need to steer clear of certain eyelid procedures, including blepharoplasty:

• Those with abnormal blood coagulation
• Those taking aspirin or products containing aspirin, high doses of vitamin E or any other herb that might thin the blood
• Those with abnormal blood pressure
• People with medical problems of the eye, specifically corneal problems
• People with dry eyes
• People with thyroid disease

Consult with a qualified physician if you believe you may fall under one of the situations listed above.

In addition to surgical procedures, there are many other options available that treat the area around the eyes. The CO2 Laser can be used to decrease the discolored dark skin from under the eyes. BOTOX Cosmetic for the frown lines and crow's feet, and/or a non-ablative laser resurfacing for the fine lines can be done in conjunction with the upper and lower eyelid surgery. With these new, less invasive techniques the downtime is minimal and the patient usually can go back to work within one week.

Dr. Lawrence Korpeck is board certified by the American Board of Plastic Surgery. He is a distinguished fellow of the American College of Surgeons and is an active member of both the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery. Dr. Korpeck is also a member of the North American Lipoplasty Society.