Blepharoplasty, Eyelid Surgery

Your eyes are one of your most prominent facial features. You might be interested to know that it is actually the skin surrounding the eyes (rather than the eyes themselves) that convey your emotions!


As we age, the eyelids lose their elasticity and this can cause them to look puffy or fat and sometimes can give the appearance of eye bags. These changes can start off as a minor annoyance and eventually become a real source of emotional distress (and even visual impairment).

A “Blepharoplasty” or eye lift surgery is a minor surgical procedure that helps to reestablish the architecture of the eyelids you had when you were young. This is achieved through a combination of removing excess skin, tightening and repositioning the remaining eyelid structure as well as working with the deeper structures like fat.  This procedure may involve the upper lids, the lower lids, or both.

New and Traditional Techniques

In a traditional blepharoplasty, an incision is made in the crease of the upper eyelid and is hidden in a crease.  Once healed, it is not noticeable as it very well camouflaged in the natural eyelid crease.  On the lower lid, the incision is made just under the lash line and when healed, is hidden by your eyelashes. Both incisions heal so well that it is difficult to detect, even by your surgeon.


The transconjunctival approach is a newer technique for eyelid surgery, involving an incision inside the lower lid.   Fat can be removed through this incision, but excess skin cannot be eliminated using this technique. This technique is well suited for those patients who do not need excess skin removed.


Laser resurfacingof the eyelids is a non-surgical alternative that may delay the need for a surgical blepharoplasty. It results in significant tightening of the skin around the eyes. Although it does not effect the fat around the eyes, it can still improve the appearance of fat of puffy eyelids.

Please ask your cosmetic surgeon if you have any questions about which procedure is right for you.

Surgery Day

An IV will be started so that a sedative can be given during the procedure (insuring that you stay comfortable and relaxed).   Local anesthesia is given around the eyes, so you will be numb.  You have the option to be awake or fully asleep for the procedure. If you elect to be awake during the procedure you will be awake but comfortable and relaxed.  General anesthesia is rarely needed during a blepharoplasty.

This procedure is performed on an outpatient basis at our surgical center in Issaquah, and we have had people come in from all of the local cities (from Bellingham to Tacoma and everywhere in between), and from all around the country and even Canada. It is important to arrange for care after the surgery. Someone will need to drive you home and be available to care for you for the first 24 hours.

Complications are unlikely when performed by a cosmetic surgeon with experience in blepharoplasty, but it is good to be aware of the risks These include: bleeding and swelling, delayed wound healing, infection, drooping of eye upper or lower eyelid, asymmetry, double vision and dry eyes.

Recovery: What to Expect

After your blepharoplasty, the area surrounding your eyes will have mild swelling, but the swelling will start to subside after the third day.   Some patients will experience blurry vision and this is typically normal.   Some of your stitches will dissolve on their own and any permanent external stitches will typically be removed in 5-7 days, and the swelling and bruising may continue for about 7-10 days.   You can resume normal activity within a week to 10 days, and you can start wearing makeup again after day 10.   Depending on how you usually heal, it may take 3- 6 months for the scars to lose their redness. If you experience this redness, it is typically mild and easily covered up with makeup.

As for the long term, wrinkling will recur later in life, however it is unlikely that the “bags” will come back because the fat has been permanently removed or repositioned.   Deeper wrinkles around the outer eye (extending onto the temple) are not always impacted by an eyelid lift, and if needed, these areas can be treated with laser resurfacing.

Other Topics and Procedures

 

If you decide that an eyelid lift isn’t exactly what you were looking for, there are some great alternatives.   For example, a neurotoxin like Botox or Dysport can be used to help soften the overactive muscles surrounding the eye, and this can improve your appearance dramatically (and non-surgically).  This can result in elevation of the brow and thus improving the upper eye lid architecture. Neurotoxins can also be used to help decrease wrinkles around the eyes and stop the skin from bunching around the lower eyelid. They can also soften a lot of the smile lines or crows feet lines.

Another option that can help improve the eye lid appearance is the use of fillers (like Juvaderm, Volbella, Vollure, Restylane, Refyne, Defyne, or Belotero). The fillers help to reestablish volume of the soft tissues around the eyes. This can help camouflage puffy eyes or eye bags. An alternative to filler is fat grafting. Fat grafting can be used to also camouflage the appearance of eye bags or dark circles under the eyes. To perform fat grafting, it employs the transferring of fat from another part of the body (typically the abdomen) to the cheeks and eyes. Fat grafting typically can last longer then fillers and may give a more natural appearance.

Another great option to help improve the appearance of the upper eyelid and brow is ultherapy. Ultherapy is a non-invasive device that can be used to help tighten the skin and deep structures of the brow.