Upper and Lower Blepharoplasty

By Dr. Brian Peterson

Published on January 31, 2011

Blepharoplasty, or surgery of the eyelids, is a common plastic surgery procedure. Plastic surgeons tend to address the upper eyelids and lower eyelids separately, but often do procedures on both.

All aesthetic plastic surgery is performed to address the effects of aging. Like it or not, a significant proportion of the population is concerned about their appearance and will go to the extent of having surgery to reverse the effects of aging.

With time and gravity, the position of our eyebrows descends and this adds to the accumulation of skin in the upper eyelid. Additionally, eyelid skin is very thin and prone to stretching. Add in the normal changes of collagen and elastin, which gives skin its integrity, and eventually you end up with a significant mount of excess skin in the upper lids. This may progress to the point that it can interfere with your vision.

The lower eyelid is different. Excess skin is not normally a problem, but lower eyelid puffiness or bags develop, giving people a tired appearance even when they are well rested. These "bags" are actually collections of fat that become more apparent as tissue in the lower lid relaxes and allows the fat to sag forward.

"Crow's feet," or lines that develop around the eye, are made worse by smiling and facial animation. They are a result of the loss of a portion of the fat, so that the action of the underlying muscle has a more pronounced and permanent effect on the skin.

Many creams, superficial treatments with lasers, BOTOX® Cosmetic, and filler substances have been developed, and can effectively treat the early stages of aging. However, after the age of 50, they are of limited benefit and surgery is really the only treatment that will provide patients with desired results.

The focus of upper eyelid blepharoplasty is to remove the excess skin, redundant muscle, and any excess fat to give a brighter, more youthful appearance to the eye. The incision is hidden in the natural crease of the upper lid, and with time, becomes virtually invisible. During lower eyelid surgery, the surgeon removes excess fat, tightens the surrounding muscle, and removes any excess skin.

Normally, blepharoplasty is performed under deep sedation. The operation can take one to two hours to perform, depending on what is being done. These procedures are done on a day care basis, with the patient going home the same day. Bruising and swelling are a normal result of the surgery, and take up to three weeks to resolve. Stitches are removed on the fifth day after surgery, and make up can be worn after this time. The eyelids have diminished feeling for the first few weeks, but it will eventually return.

In severe cases where visual field loss can be demonstrated, the Medical Services Plan may cover the costs associated with surgery. As always, consult a board certified plastic surgeon for more detailed information.

Dr. Brian Peterson is a Kelowna plastic surgeon that offers eyelid surgery and other facial rejuvenation treatments to patients.