Services-BlepharoplastyBlepharoplasty, or cosmetic eyelid surgery, is one of the most common facial plastic procedures and ranks the highest for men and women in patient satisfaction surveys. The upper and lower eyelid incisions for men and women are fairly standard around the world, but they must be individualized for each patient. Remember that all patients have some asymmetry of the orbits, which can include the brows, the lids and the pupil height. These incisions include the behind-the-lower lid approach (transconjunctival) in those patients with fat only, and those patients with facial injuries requiring orbital rim exposure. Since both lids contain skin, muscle and fat, a successful tailored outcome is dependent on the preoperative evaluation of the patient, the experience of the surgeon and the execution of the operation.

The upper lid incision, placed in the supratarsal crease, heals well and through this exposure, the proper amount of skin, muscle and fat is removed. Some patients only require skin and medial fat (near the nose) removal. Patients with heavy lids require muscle removal and fat sculpting to obtain a good result. With a youthful eyelid, the lid crease can be seen on the patient’s lateral view. Creating this feature requires precise incision placement and tissue removal. At times, brows can be lifted through the upper lid approach.

The lower lid is different from the upper lid because its anatomy flows into the cheek, and predictable aging features develop in most of us. Younger men and women may only require a conservative skin, muscle and fat removal. As we age the fat protrudes, creating bags and shadows, and the skin of the lid and cheek or midface descend. However, a ligament binds the eyelid fat to the orbital rim, creating a double convexity or bulge of the lid and cheek and a groove which separates the two areas. This must be addressed at surgery by suture suspension of the lid, and at times, the cheek tissue to the orbital rim. Since the groove is more noticeable toward the nose, the fat in this area can be preserved and repositioned over the orbital rim. At the time of the Blepharoplasty, most of our patients benefit from applying a chemical peel to the lower lids to erase the fine lines not treated by surgery.

Eyelid skin is the thinnest skin of the body. For this reason alone, it can swell and discolor yet heal beautifully. Dressings are not needed postoperatively, but ointments and ice water compresses are routine. Men and women can be seen in public within 10 days without glasses. Women can use shadow and mascara at that time. Since the healing is rapid and the incisional scars become inconspicuous, men frequently have eyelid surgery as the one and only facial plastic procedure that they ever have. Women frequently begin facial rejuvenation with eyelid surgery in their 30’s and 40’s and go on to other age-related procedures such as Facelifts, Browlifts and Facial Skin Resurfacing.

Poets tell us that the eyes are “the windows to our soul”. Blepharoplasty can eliminate sagging, hooded eyelids, unwanted fat protrusions or bags and wrinkles and help you look as energetic and cheerful as you feel.