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You may not realize it, but when you look at someone, you look mostly at their eyes. For this reason, a nice eyelift has a transforming effect on the whole appearance of my patients. It’s surprising how much more attractive a person appears after a blepharoplasty has given them large, bright eyes with a delicately sculpted crease in the upper eyelid. This operation definitely gives “the most” for “the least”.

Let’s discuss the upper eyelids first.   As we age the eyebrows tend to fall slightly, and extra skin seems to appear (from where?!) on our upper eyelid.  This starts to happen as early as our thirties, and if left unchecked can sometimes lead to the skin of our lid touching our eyelashes.  Eventually this can cause difficulty in the upper field of gaze, but most of us will want to fix it long before we start running in to low hanging objects because we can’t see them, or before we start thinking that traffic lights now only have yellow and green!

During the operation excess skin and tissue is marked, injected with anesthesia, and excised.  Stitches are then placed in such a way as to create an elegant (in females) upper lid crease.  Extra fat that can bulge, especially at the inner aspect of the upper lid, is also removed.  

Now let’s talk about the lower lids.  As we age the fat inside the eye socket tends to fall forward creating small outpouchings on our lower lids.  The skin can also become wrinkled and excessive for a number of reasons ranging from heredity to sun exposure, to too much laughing (!).  We treat this first by removing the excess fat.  Often, especially in younger patients, this causes the skin to tighten up on its own.  For other patients, we may need to help the skin tighten up a little by performing a peel or laser resurfacing.  Certain patients, however, simply have too much skin on their lower lid.  In these cases we trim the excess skin.  If we need to trim skin, the incision is placed just below the eyelashes and is virtually invisible.  If no skin is trimmed, we usually make the incision inside the eyelid.

Another technique in lower lid surgery involves repositioning (instead of removing) the fat along the bony rim just below your eye.  This takes fat from a bulge and places it into a crevice, evening out the contour of the lower lid.  This may also be done in conjunction with a resuspension of your cheek fat pad back to its more youthful position.  This procedure is sometimes called a “midface lift”, and while it is a little more involved than an eyelift, it may be performed through the same incisions.  The result is once again a very natural, rested, more youthful appearance.


FAQ’s (Frequently Asked Questions) about Blepharoplasty.


I have dark circles under my eyes, will a blepharoplasty help?

If the dark circles are caused by shadows from bulges in the lower lid skin then a lower blepharoplasty will help them, but dark circles may be caused by severaldifferent things.  In some people, pigment (melanin) just seems to accumulate in the lower eyelid.  We don’t know why.  If your circles are caused by pigment, we can often lighten them with a peel.  We also have some creams which block pigment production.  In other people, the small blood vessels under the skin of the lower lid fill with blood.  We think this may be exacerbated by nasal congestion, such as in people with allergies.  Other than treating the allergies, no specific therapy will help this type of dark circle.  Some people place a cool washcloth on their eyes which may cause the blood vessels to constrict (become smaller) thus lessening the bluish hue, but the effect soon wears off.  


My upper lids are starting to fall a little, but my lower lids look fine, should I wait to have the surgery?

No!  Upper lid surgery alone will give you a beautiful result which will you will enjoy for the rest of your life.  


I am young, and my upper lids are fine, but I have bulges in my lower lids, just like others in my family, should I have surgery?

Some families have a tendency to have lower lid bulges starting very early in life.  These are easily corrected with a lower blepharoplasty performed through a hidden incision inside the eyelid.


If I have surgery in my 30’s or 40’s will I have to have it again later?

The results of blepharoplasty are extremely long lasting.  If you need repeat surgery (and you likely will not) it will usually be in 20 – 30 years.  A repeat procedure is not particularly difficult.


What are some possible complications of blepharoplasty?

If you have dry eyes you may need some lubricant drops or ointment for the first few weeks after surgery as the eyelids are readjusting.  If your lower lids are extremely lax (usually found in older men) the lower lid may droop slightly (pulled down by mild scar tissue) but this can be easily fixed with a simple suspension procedure.


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