When patients and friends ask me what I think is the one cosmetic procedure that will give you the biggest bang for the buck, hands down I think of blepharoplasty. The eyes are the communication and visual center of the face, often the first thing people will notice. The first signs of aging on the face are often manifested on the thin, wrinkly or loose skin around the eyes. Blepharoplasty, or eyelid lift, is in fact one of the most popular aesthetic cosmetic surgeries performed in the United States today. 

Blepharoplasty is a minimally invasive procedure that dramatically improves appearance and reduces droopy, baggy eyelids. Aging changes around the eyelid are due to several factors: excess skin, sun exposure, gravity, heredity and thinning and laxity of skin.  This leads to dermatochalasis, or excess skin, wrinkles, fat and tissue around the eyelids. This heavy or saggy look can make one appear tired, sad or angry.

Blepharoplasty surgery is not only performed for cosmetic purposes to enhance appearance, but it can also improve function.  Patients may complain of visual obstruction superiorly, fatigue with reading, or brow ache from lifting the forehead muscles to compensate for the heavy, drooping eyelids. In these instances, blepharoplasty or ptosis, or brow ptosis surgery is considered medically necessary and may be covered by insurance. Blepharoplasty is performed for reconstructive purposes to correct visual impairment caused by drooping of the skin or tissue of the upper eyelids.

Ptosis is a separate condition, involving the eyelid lifting muscle, also causing drooping upper eyelids.  The majority of patients develop ptosis due to aging changes, which can lead to visual obstruction. However, ptosis can also be congenital, and a drooping eyelid can interfere with visual development.  Ptosis is also associated with trauma, prior ocular surgery, and conditions such as thyroid disease, blepharospasm, nerve palsies or progressive neuromuscular conditions such as myasthenia gravis. Dermatochalasis can cause a “secondary” ptosis, with excess skin or tissue resting on the upper eyelid causing the eyelid to droop. Brow ptosis or drooping can also secondarily block superior vision as the brow descends, and worsen dermatochalasis.

It is important to recognize the variations between men and women in relation to anatomy and the proper evaluation and treatment of eyelids. Men naturally have low set less arched brows and fuller upper eyelids. As a result, men may tend to have problems with brows as they age causing heaviness of the eyelids. Corrective or cosmetic surgery to improve the appearance of sagging skin, brow or eyelid may involve removal of less tissue, or less brow lifting to avoid a feminizing result. Women, on the other hand, typically have a higher more arched brow, and may undergo a more dramatic lift of the brow or blepharoplasty. A discussion of these findings during the consultation, in addition to listening to the needs of the patient between the doctor and patient is essential. The goal is to achieve a younger, more refreshed version of yourself, and to improve visual impairment if necessary. Awareness of the uniqueness of the male and female eyelids, brow and face during the peri-operative process will enable better understanding of expectations and a more natural result.

The Asian eyelid is also unique in its anatomy and it is important that your surgeon has experience and knowledge of the nuances related to this. The Asian eyelid may have a low or no eyelid crease and thus one may notice aging changes such as fullness and visual obstruction in addition to heaviness of the eyelids. Younger patients may desire to raise the lower eyelid position to create a more Caucasian shaped eyelid. These factors should be recognized and discussed at your consultation. Your surgeon should discuss options for eyelid surgery that may or may not alter the eyelid crease position, or create a crease, so that the patient has an understanding and realistic expectation of the results. The goal is to create a natural aesthetic result while maintaining proper function of the eyelid.

Patients considering eyelid surgery to correct drooping eyelids will undergo evaluation by the surgeon, photographs and sometimes a visual field test to demonstrate the degree of visual field defect before surgery.  Your insurance may determine if surgery is medically necessary. When blepharoplasty of the upper or lower eyelids or brow lifting is performed to improve one’s appearance in the absence of any signs or symptoms of functional abnormalities, the procedure is considered cosmetic.

Before eyelid surgery, your health status and blood pressure will be evaluated. Blood thinners are usually stopped for a short period. Patients will work closely with our patient care surgery coordinators. Surgery is usually performed under local anesthesia with oral or with intravenous sedation at an outpatient surgical facility and lasts one to two hours. 

Many people desire upper and lower blepharoplasty to achieve a balanced look. For upper and lower eyelid blepharoplasty, the extra skin, fat and tissue are removed. If the muscle that lifts the upper eyelids is involved, ptosis surgery is performed to shorten or tighten a weakened muscle.  The skin incisions are then closed with suture at the natural eyelid crease in the upper eyelid and just under the lashes in the lower eyelids. There are several techniques of brow lifting, which can also be performed in conjunction with eyelid surgery including endoscopic or direct brow lift. Often incisions are hidden in a brow line, behind the hairline or in a furrow to minimize scarring. Additionally, laser eyelid surgery, laser resurfacing around the eyes and face, chemical peels, fat transfer or fillers can be performed in conjunction with surgery to smooth and tighten the surrounding skin. Office procedures including Botox or other neuro-modulators, fillers and excellent peri-operative skin care can also enhance the final aesthetic result.

Patients are instructed postoperatively to use antibiotic ointment on the incisions a few times a day, use ice packs for 2-3 days and to sleep on 2 pillows. Pain is usually controlled with oral pain medication and is minimal. Bruising and swelling of the eyelids peak the first 48 hours, and can typically last one to two weeks after surgery. Sutures are either dissolvable or removed in the office 5-7 days after surgery.  By two weeks, much of the healing is complete, with residual minor healing over the next 6 weeks. The final result can take several months.

The major risks of eyelid surgery are blurred vision, dry eye, bleeding, infection, scarring, wound infection, asymmetry of fat or skin removed, or loss of vision.  Removal of too much skin can cause serious problems relating to inability to completely close the eyelids and severe dry eye problems.  Severe bleeding around the eye is a rare complication, but it can affect vision and should be reported to the physician immediately.  In ptosis surgery, there are many factors that determine the overall outcome of the eyelid position, and consequently an adjustment of the eyelid may be necessary in some patients to achieve symmetry or proper position.

Dr. Amato is a board certified ophthalmic plastic surgeon and has performed thousands of surgeries around the eyes. Dr. Amato strives to restore form and function with an excellent aesthetic result. Listening to the patient, patient safety and comfort throughout the process, and achieving the desired results are Dr. Amato ‘s main goals. Call for a consultation today! (512-) 501-1010