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Eyelid Surgery (Blepharoplasty)

One of the first areas of the face to exhibit signs of aging is the area around the eyes. Under-eye bags and sagging upper eyelids that come with age can be corrected through cosmetic eyelid surgery, also known as blepharoplasty. This relatively minor cosmetic surgery procedure can refresh the appearance of the face and leave it looking years younger. Use the information provided below to learn more about eyelid surgery cost, benefits, and potential risks.

What is Blepharoplasty?

Cosmetic eyelid surgery dramatically improves the appearance of tired, droopy eyes. This is accomplished by removing excess skin and pockets of fat from the upper and lower eyelids. Many patients combine blepharoplasty with alternative treatments such as brow lift to eliminate drooping eyebrows, and various cosmetic dermal fillers to treat crow’s feet.

Blepharoplasty Candidates

Not everyone is an ideal candidate for eyelid surgery. The right candidate will understand that eyelid surgery is performed exclusively to remove under-eye bags, correct puffy upper eyelids, and restore vision that is obscured by excess skin and fat in the eyelids. Unfortunately, the presence of certain ophthalmic and medical conditions can exclude one from having the blepharoplasty procedure performed. Read on to learn who is an ideal candidate for blepharoplasty, as well as blepharoplasty pre-operative instructions.

Aesthetic Considerations

Ideal candidates for blepharoplasty include those patients who have:

  • Puffy upper eyelids: the procedure can smooth the appearance of under-eye bags or puffiness.
  • Tired looking eyes: Eyelid surgery can address the features that cause you to appear older and more tired than you truly are.
  • Excess upper eyelid skin: surgeons can tighten and remove extra eyelid skin.

Eyelid surgery candidates should be:

  • At least 18 years old: Most candidates are over 35, but if droopy or baggy eyelids are common in your family, you might be an ideal candidate at a younger age.
  • In good physical and mental health: Though a minor surgical procedure, there are different eyelid surgery risks for potential patients to consider. The ideal candidate for blepharoplasty will take these risks into consideration when making a final decision regarding the surgery.
  • Realistic: Patients should be realistic in their expectations concerning the outcome of the procedure.

Visit the DocShop gallery to view more eyelid surgery before and after photos.

Photo credit: Vincent R. DiGregorio, MD

Medical Considerations

Even those who seem like ideal candidates for eyelid surgery can be prohibited from undergoing the procedure due to specific medical or ophthalmic conditions that may elevate the risks involved in the surgery. Glaucoma and dry eye are two such ophthalmic conditions that can be complicated or aggravated by any form of surgery on the eyelids.

Other medical conditions that may exclude a person from eyelid surgery include hyperthyroidism (e.g., Graves' disease), cardiovascular disease, diabetes, and high blood pressure. Lack of proper orbital anatomy – or the insufficient structure to support the procedure – can also exclude one from eyelid surgery. The condition of bone and adjacent supportive structure can have an affect on a person’s suitability for the procedure.

In order to ensure a safe, successful, satisfying eyelid surgery (blepharoplasty) procedure, it is imperative that you prepare yourself properly in the weeks before the procedure. Consult with your surgeon regarding the best ways to prepare for your approaching surgical procedure, and adhere to them closely.

The Consultation

If you are considering eyelid surgery, your first step should be to contact a surgeon to schedule an initial consultation. During the consultation, your surgeon will work with you to establish realistic expectations about the results of your blepharoplasty procedure and discuss the cost of eyelid surgery. The surgery will be explained in great detail so as not to leave any question or concern you have unaddressed. Depending on your needs and your surgeon’s observations, additional facial procedures such as a brow lift or chin implants may be recommended.

Your surgeon will also arrange to view your comprehensive medical history to decide if you are in satisfactory condition for eyelid surgery. The surgeon must be made aware of conditions such as high blood pressure, heart disease, and bleeding disorders, as these can increase the risks associated with blepharoplasty. Previous eyelid surgeries and refractive surgeries such as LASIK are also crucial to know about, as they can affect the risk of complications. Your surgeon may also ask for medical clearance from your general physician and, depending on your health, request laboratory testing.

The Weeks Prior to Surgery

In the weeks leading up to your blepharoplasty, it is important to cut down, if not eliminate, smoking and drinking alcohol. If you take vitamin E supplements, cease taking them in the weeks prior to your eyelid surgery. In addition, avoid gingko biloba and ginseng, as these are believed to prolong the bleeding after the surgery. For the same reason, aspirin or any medications containing aspirin or ibuprofen should also be avoided at all costs in the weeks leading up to the surgery. Be sure to ask your surgeon about acceptable alternatives to these drugs. Lastly, continue to take prescription and daily medicines as long as they have been approved by your surgeon.

The Day before Surgery

On the day before your eyelid surgery, make sure that you have the following items stocked at home:

  • Ice cubes
  • Clean washcloths
  • Clean bowl for cold water
  • Gallon-size Ziploc® bags (to make ice packs)
  • Sterile gauze pads
  • Bottle of acetaminophen
  • Bottle of artificial tears
  • Groceries for the week

You should also be sure that you have arranged for someone to take you to and from the place where your blepharoplasty will be performed. Finally, your plastic surgeon may have some specific instructions for you to follow the day before your surgery, such as abstaining from eating or drinking after midnight the day of your surgery.

The Day of Surgery

While the directions for preparing for eyelid surgery may differ somewhat from surgeon to surgeon, there are some general guidelines you can follow to help ensure the procedure goes smoothly. Before adhering to any of the following guidelines, check them with your surgeon.

  • Make sure to shower and shampoo before the procedure and to wash your eyebrows
  • Do not wear make-up or other cosmetics should not be worn
  • Leave false eyelashes, contact lenses, jewelry, and any other unnecessary accessories at home
  • Wear loose-fitting and comfortable clothing to your surgery
  • Talk to your surgeon to find out whether any prescription medicines or eye drops you regularly take may be taken the morning of your blepharoplasty

Arranging Transportation and After-Care

It is imperative that you arrange for someone to transport you home after your eyelid surgery. Make sure that you clearly understand your surgeon’s post-operative care instructions, as they are vital to a quick, comfortable, and safe recovery from blepharoplasty.

 

Visit the DocShop gallery to view more eyelid surgery before and after photos.

Photo credit: James P. Wire, MD

Upper and Lower Eyelid Surgery

Eyelid lift surgery is a relatively simple procedure that can take years off the appearance of the face. Upper eyelid surgery may benefit those patients whose upper lids have sagged low enough to reduce their field of vision. Lower eyelid lift surgery can be a very beneficial procedure for patients who wish to correct saggy or puffy lower eyelids. The eyelid surgery procedures involve the removal of excess tissue and fat to produce a more refreshed, youthful facial aesthetic. Some patients may undergo upper and lower eyelid surgery under local anesthesia, though general anesthesia may be used if requested.

Lower Eyelid Surgery

While upper eyelid surgery primarily involves the removal of sagging skin, lower eyelid surgery also involves the removal of fat deposits, which are more prevalent under the eye. Removing these deposits in conjunction with the sagging skin leaves a smooth, firm, younger-looking surface above the cheek. In addition, lower eyelid surgery allows the surgeon to transfer fat or dermal fillers to hollowed areas under the eye, leading to plump, healthy-looking skin where the face may have previously looked sunken in.

To perform lower eyelid surgery, the surgeon first makes an incision below the lower eyelashes; the incision is made carefully in a discreet place hidden from plain view. Excess fat, skin, and muscle are removed as the surgeon sees fit. Sometimes, the fat is redistributed in order to minimize puffiness and uneven swelling. If muscle laxity is an existing problem, this will also be corrected during surgery. The incision made to perform eyelid lift surgery heals quickly among the eyelid's surrounding natural creases.

Transconjunctival Blepharoplasty

For patients who have less pronounced under-eye bags, transconjunctival lower eyelid surgery may be an effective procedure. In these cases, simply removing pockets of fat without removing any skin is all that's required. Since this can be accomplished through several tiny incisions inside the lower eyelid, no visible scarring from the blepharoplasty procedure results.

Upper Eyelid Surgery

Upper eyelid lift surgery allows the surgeon to remove excess skin and fatty tissue that create the appearance of droopy, inflated eyelids. While the fat deposits, loose skin, and drooping of the eyelids typically occur because of age, this wonderful procedure can reverse the effects of time to restore a youthful, refreshed appearance.

During upper eyelid surgery, incision lines are made in the natural creases of the upper lids so any resulting scarring is hidden. The surgeon trims away any excess skin that is obstructing vision or contributing to a droopy or tired appearance. In some cases, the muscles are repositioned as well. The remaining skin is lifted and reattached for a more youthful look. The incisions are then closed with fine sutures. The goal of upper eyelid surgery is to leave the patient looking refreshed, and most experienced surgeons are able to avoid the unnatural "wide awake" look that comes from overcorrection.

Visit the DocShop gallery to view more eyelid surgery before and after photos.

Photo credit: Vincent R. DiGregorio, MD

Eyelid Surgery Risks and Benefits

In most instances, eyelid surgery (blepharoplasty) is a minimally invasive procedure that is performed to correct certain aesthetic or functional abnormalities of the eyelids. The benefits of this type of procedure are great. However, with eyelid surgery, as with all surgeries, the inherent side effects and risks must be weighed while considering if the procedure is right for you. Most side effects associated with eyelid surgery are temporary, but permanent impairment must always be a realistic concern.

Aesthetic Benefits

Eyelid surgery has many benefits, the most obvious being an improvement in the overall appearance of the eyes. Eyelid surgery can be performed to remove excess skin that obscures the natural fold in the upper eyelids. It can also correct puffiness in the upper eyelids that cause the eyes to appear tired. For the lower eyelids, blepharoplasty can remove excess skin and correct fine wrinkles and lines. The bags that sometimes appear beneath the eyes can be removed, and the droopiness that sometimes occurs revealing the white portion of the eye beneath the iris can be corrected.

Another benefit of aesthetic eyelid surgery is the way the results make you feel about yourself and the way you look. Eyelid surgery is often performed to correct some perceived imperfection that impacts the way an individual feels about his or her appearance. A successful eyelid surgery can make your eyes look younger and more alert while providing you with enhanced self-esteem and confidence in your appearance.

Functional Benefits

Eyelid surgery has various functional benefits that result in the improvement of one’s vision. While the removal of excess skin can have aesthetic benefits, it can also restore peripheral vision that has been obscured by droopy, sagging eyelids.

Many purely cosmetic procedures are not covered by insurance providers because they are elective in nature. Since blepharoplasty can be performed to restore vision, many, if not most, insurance providers will typically cover the surgery as a non-elective procedure. A visual field test may be necessary to determine to what degree the excess skin inhibits peripheral vision and to establish the true range of vision, but your surgeon can assist you with this process.

Side Effects

Eyelid surgery results in some common side effects that patients can expect to experience following the procedure. Typically, these side effects are short in duration and treatable in terms of alleviating any associated discomfort. In the following sections, you can read about the degree of post-operative pain to be expected, as well as the likelihood and treatment of any swelling or scarring that might occur as a result of the blepharoplasty procedure.

Pain

Though eyelid surgery is a minimally invasive procedure, there is some pain associated with the post-operative recovery phase. The severity of the pain will likely depend on the skill of the surgeon and the health of the patient. Following eyelid surgery, your eyelids will most likely feel sore and tight while the anesthesia is wearing off. Medication prescribed by your physician may be used to lessen the intensity of the pain and alleviate discomfort. Some patients have described the post-operative pain associated with blepharoplasty as mostly uncomfortable, but not extreme, similar to that of a sunburn or windburn.

Swelling

Following eyelid surgery, swelling is likely to occur around the incision areas. Cold compresses or iced eye pads can be used to minimize swelling. Be careful when applying compresses or pads so as not to rupture the incisions. Swelling can also be reduced by keeping the head elevated as much as possible. Any swelling that does occur may result in blurry vision for several days after the procedure.

Avoiding excessive blinking as well as strenuous activities that increase blood flow to the eyes can help to reduce or even prevent extreme swelling. Simple ice compresses placed over the eyes can assist as well.

Scarring

The skill of the facial plastic surgeon will likely play a factor in determining the amount of scarring that occurs following the blepharoplasty procedure. More skilled surgeons are able to keep scarring to a minimum. While some degree of scarring should be expected following eyelid surgery, most scars will fade over time and become inconspicuous to the casual observer.

Some patients believe that applying aloe vera or vitamin E after the sutures are removed can reduce scarring. Application of these creams must be done carefully to avoid damage to the wounds.

Potential Complications

As with all surgeries, eyelid surgery comes with risks and potential complications that vary in severity. The most severe of these complications include ectropian, hematoma, and retinal detachment.

  • Ectropian is a drooping effect that causes the lower lid to invert, requiring additional surgery to correct.
  • Hematoma is an even more serious complication involving blood accumulation beneath the skin. Hematoma is more likely to occur when eyelid surgery is performed in conjunction with another facial cosmetic surgery procedure such as a facelift or brow lift.
  • Retinal detachment, which can be caused by holes or tears in the retina, occurs when the retina is separated from the outer layers of the eye. Retinal detachment also requires additional surgery to correct.

Additional complications can also result from eyelid surgery, including:

  • Infection
  • Scarring
  • Excessive tearing
  • Adverse reaction to anesthesia
  • Dryness, burning of the eyes, both of which can usually be treated with artificial tear drops
  • The formation of whiteheads, or milia, that appear after suture removal; typically, the surgeon can treat these post-operatively
  • Difficulty keeping the eyes closed while sleeping; though temporary for most individuals, this particular complication has become permanent in others
  • On occasion, individuals have also reported experiencing blurred or double vision, but in most cases, these complications subside in a few days

The likelihood of serious complications arising from the procedure is typically influenced by both the surgeon's skill as well as the patient's individual response to the eyelid surgery. Certain severe risks or complications can be avoided by cooperating fully and completely following your surgeon's instructions. With patience, a willingness to cooperate, and a qualified surgeon, the complications of eyelid surgery and any associated risks can be dramatically reduced.

Visit the DocShop gallery to view more eyelid surgery before and after photos.

Photo credit: James P. Wire, MD

Results

Though eyelid surgery (blepharoplasty) results vary from patient to patient, most are pleased with the overall change in their appearance. For many, the procedure is about looking younger and more alert. For others, eyelid surgery is a welcome option for restoring vision that has become obscured. Below you can read about typical results you can expect following eyelid surgery, both in the short term and long term.

How Will I Look after Surgery?

We hope for complete success in any surgical procedure. However, we must always be realistic in anticipating the results. Though eyelid surgery may provide dramatic and pleasing results to the many that undergo the procedure, it does present the possibility for certain complications that could affect your overall satisfaction. In many instances, these can be corrected with simple treatments or minor additional surgery. But often, they correct themselves, in time, leaving the patient with a younger, more vibrant appearance.

Immediately following eyelid surgery, the incision sites will look red and irritated and there may be some minor bumpiness. The scarring from the blepharoplasty procedure should flatten in time and become inconspicuous. There will be some swelling and discoloration around your eyes during the eyelid surgery recovery process, but this will fade as you begin to look and feel better with each day. The severity of bruising and swelling differs from person to person; however, it typically goes away within a week or two.

Following this period of recovery, your eyelid surgery should yield some pleasing results. The wrinkles and heaviness of your eyelids will be eliminated or reduced by the blepharoplasty procedure. Eyes that had once looked aged and tired will appear brighter and more alert.

Will There Be Scarring from Blepharoplasty?

Though surgeons typically make incisions in the folds of the eyelids to hide any potential scarring, the appearance of some scarring from blepharoplasty is possible. As with most post-surgical complications of eyelid surgery, it can be treated by an additional revision surgery. Some patients believe that applying aloe vera or vitamin E can help in reducing the appearance of scar tissue. It is recommended that you avoid rubbing the area for approximately six weeks to avoid damaging the tender new tissue. Other patients choose to conceal any apparent scarring from blepharoplasty by applying makeup. Despite the scarring, many patients find eyelid surgery to be worth the price.

Long-Term Results

The results of eyelid surgery generally last for years. For some, the positive effects of their blepharoplasty procedure are permanent, allowing them to enjoy a lifetime of youthful-looking eyes.

It should be noted that while fat taken from the eyelids during blepharoplsty is removed permanently, as the aging process continues, the wrinkling and looseness that was seen in the skin prior to surgery may return. A brow lift performed in conjunction with blepharoplasty can reduce the likelihood of this occurring.

Most patients are pleased with their eyelid surgery results and the youthful enhancement that blepharoplasty can provide. After having the opportunity to see what eyelid surgery alone can do for their appearance, many individuals wish to complement these changes with other procedures, including the brow lift and facelift.

Visit the DocShop gallery to view more eyelid surgery before and after photos.

Photo credit: Vincent R. DiGregorio, MD

Find a Plastic Surgeon

If you think cosmetic eyelid surgery is right for you, let DocShop help you find a well-qualified blepharoplasty surgeon in your area.

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