Blepharoplasties usually remove excess skin, especially from the lower eyelids, and reduce or remodel excess fat from around the eyelids.

For the upper eyelids, removing skin and focal pockets of fat is the most common procedure. For revisional upper eyelid procedures, we often perform scar revisions and restoration of fat with LiveFill to the upper eyelid.

For the lower eyelids, conventional lower eyelid surgery (subciliary incision) involves removal of fat and sometimes skin. Sometimes the procedure is performed from inside the eyelid (laser blepharoplasty or transconjunctival blepharoplasty). The subciliary procedure is falling out of favor among doctors who perform a great deal of revision eyelid surgery because of the characteristic problems it can cause, namely pulling down of the eyelid, alteration in eyelid shape, hollowing out of the eyes. Revisions to the lower eyelid usually involve cheek advancement (cheeklift) techniques, canthal reconstruction, eyelid reconstruction and eye volume restoration with LiveFill.

Definitely educate yourself to these issues and make sure your doctor is skilled with revision procedures, a good indication that the primary problems will be avoided!

The eyes are the first to be affected by aging. The eyelid tissue is thin and delicate the skin can wrinkle, bag, and protrude. Depending on the genetics involved, it can begin at a disconcertingly young age, but usually somewhere in the early thirties people begin to notice changes (earlier with sun exposure).

Cosmetic eyelid surgery is evolving right along with the rest of facial plastic surgery. At its simplest blepharoplasty involves the removal of excess fat and redundant eyelid skin, either through an external incision just under the lash line or just inside the lower lid in the conjunctiva. (Remember the kid in grade school who used to turn his eyelids inside out and scare everybody? That's the transconjunctival incision area.) However, there's much more than that to modern occuloplastic surgery.

With endoscopic brow repositioning and cutaneous laser resurfacing most of the signs of aging in the upper eyelid can be corrected without a traditional upper blepharoplasty. "Rejuvenating the eyes with an endoscopic browlift is a wonderful breakthrough for many reasons," believes Dr. Simoni. The eyelid skin is very specialized. It's thin and delicate and irreplaceable. Removing this lid skin in an upper lid blepharoplasty can impair the blink function since what's now moving over the eye is thicker brow skin. Dry eyes can also be exacerbated, affecting reading, photography, and a whole host of pleasurable activities.

"Lower lid blepharoplasty has made exciting advances as well," says Dr. Simoni. "We're able to reposition fat and simultaneously tighten the skin, all without visible incisions." Those protruding pouches of flesh under the eye are most noticeable in the morning, when fluids are retained. But mother nature didn't give anyone too much eye fat. Traditional techniques of fat removal eventually lead to a hollow, sunken look. So instead of taking it out, the surgeon can use the fatty tissue to hide the bony obital rim. Through an incision hidden inside the lid the fat is repositioned and sutured into place. The result is a smooth, scar-free lower lid.

Sometimes an external incision is necessary, but excess skin can often be addressed with a mild TCA solution (20-25%) of the periorbital region. All but the deepest creases will be erased.