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What is a Blepharoplasty - What Does It Do?

can a eyelid doctor explain blehparoplasty and how it works

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Upper Eyelid Rejuvenation with Blepharoplasty

+8
Excessive or 'redundant' upper eyelid skin is a very typical aging change that leads people to seek eyelid surgery. In many patients, this surgery can be performed under light sedation with local anesthesia as an outpatient office procedure. In a few cases, protruding fat behind the eyelids is also removed. As with most facial aging changes, no two people present with exactly the same eyelid concerns. Surgical treatment is therefore individualized to the needs of each individual patient.
My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.
With each passing year I find myself performing less 'invasive' lower lid surgery (i.e a formal lower blepharoplasty) and more lower lid rejuvenation by means of structural fat grafting.  The reality of aggressive lower lid surgery - which involves some combination of skin excision, fat pad reduction and/or fat pad transposition, orbicularis (muscle) redraping and excision, and canthal support (to hold up the lateral aspect of the lower lid while everything heals) - can easily create an 'operated' appearance.  Every experienced blepharoplasty surgeon understands quite well that the lower lid can be very unforgiving, and that an 'operated' appearance can be produced despite the best efforts of even the most skilled hands.
Some patients absolutely require an aggressive approach to the lower lids: those with bulging fat pads, marked skin and muscle redundancy, and obvious lower lid laxity.  Many patients with mild to moderate aging changes, on the other hand, can obtain youthful and natural-appearing results by means of structural fat grafting - to fill in the tear trough, and to blend the contour at the lower lid / cheek junction.  This can be especially useful for patients with a hollow or gaunt appearance at the junction of the lower lid and cheek, and for those with poorly projecting cheekbones that provide minimal support for the lower lid.  If this area is inherently hollow, then the last thing a surgeon should do is remove fat from behind the lower lid, as doing so will only serve to aggravate the hollow appearance and will actually accelerate the apparent aging of the eye area.
Patients with full cheekbones and excellent lower lid support usually do very well with a traditional lower blepharoplasty, although if I feel that I can produce an equivalent result by means of fat grafting and a modest amount of skin excision I will certainly choose the less invasive (and quicker recovery) fat grafting option.  Patients with poorly projecting, flat cheekbones in which lower lid support is lacking, on the other hand, are at significant risk for post-blepharoplasty complications and that obvious 'operated' lower eyelid appearance.  These patients are often best served by structural fat grafting to camouflage the hollowness and create some lower lid support.
Adding fat definitely improves lower lid support, and it often reduces the amount of lower lid skin excision that is required to produce an improved lower lid appearance and a blended lower lid / cheek junction.  I frequently see patients who have previously undergone a blepharoplasty procedure in which an excessive amount of upper and/or lower lid fat has been removed, and they invariably report that since that surgery they feel that they look tired, older, and even ill.  For patients with post-blepharoplasty hollowness, the only way to restore a healthy and more youthful appearance is to restore the missing soft tissue volume, and this can reliably be accomplished by means of structural fat grafting.
Structural fat grafting is a procedure in which small amounts (less than 0.1 cc at a time) of fat are carefully introduced in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each micrograft, new blood vessels are able to grow into the grafted fat, allowing it to persist indefinitely. If this process of blood vessel ingrowth (neovascularization) does not occur, then the transferred fat cannot truly be considered a 'graft' and is instead just another temporary 'soft tissue filler' that is broken down and reabsorbed over several weeks.  Fat grafting requires specialized training and specialized surgical instruments, as well as patience and meticulous attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing aesthetic enhancements can be achieved.
Because the lower lid tissues tend to be quite thin, a conservative approach is an absolute necessity for fat grafting of this area.  If one overfills the lower lid  /cheek junction, and most of the fat persists, then the patient ends up with unnatural fullness that needs to be corrected.  I tell patients that our plan will be to add fat until an ideal contour is achieved and then we have to let it heal and see how much persists.  Because the amount of fat that survives is variable, some patients require a second and rarely even a third fat grafting procedure to reach the desired endpoint of improvement.  As fat grafting can be performed as an office procedure under mild oral sedation, and fat grafting recoveries are brief compared to traditional lower blepharoplasty surgery, supplemental fat grafting procedures are easily accomplished.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 37 reviews

Blepharoplasty helps improve the shape of aging eyelids...

+6

Blepharoplasty helps improve the shape of aging eyelids by trimming of excess skin and by sculpting of the deeper layers (fat and muscle).

It is important to realize that blepharoplasty does not help with the following:

  • Droopy eyebrows
  • Wrinkles caused by smiling or squinting
  • Thin and sun-damaged skin
  • Dark circles under the eyes
  • Volume loss in the tear trough area

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 130 reviews

Blepharoplasty refers to any surgery which is used to...

+5

Blepharoplasty refers to any surgery which is used to correct a cosmetic deformity of the area around the eye. It may be used to remove excess skin of the upper eyelid which can result in vision improvement or simply remove the bags around the lower eye. Blepharoplasty can be performed on either the upper or lower eyelids or both at the same time and either the left or the right side or both at the same time.

Indications for upper eyelid blepharoplasty are several. Excess upper eyelid skin can produce a cosmetic deformity or can sometimes interfere with vision. To determine if excess upper eyelid skin interferes with vision, a test is done which measures a person’s ability to see objects in their peripheral vision in a natural position and with the excess skin taped out of the way.

Excess upper eyelid skin can also be causing a cosmetic problem and for women this often leaves them without a platform to put makeup on. Upper eyelid blepharoplasty involves removing the excess skin of the upper eyelid, possibly with some muscle, and closing the incision in a natural skin crease. Once healed, the incision is imperceptible.

During the procedure, fat may be removed from the middle part of the eyelid to produce a less full look. Care must be taken as sometimes a low brow may be causing excess upper eyelid skin and the correct procedure to fix excess upper eyelid skin is actually putting the brow back into its correct position.

Lower eyelid blepharoplasty is usually a cosmetic procedure. It involves removing the fat from the around the lower portion of the eye which generally causes bulges around the eyes as we age. The procedure can be done from inside of the eyelid or possibly through a small incision in the skin just below the eyelash line. In either case, once the incision heals, it too is imperceptible.

There are risks associated with blepharoplasty procedures and it is always important to seek a trained and experienced surgeon for any surgery. An experienced surgeon can sit and talk with you about the risks and benefits of the procedure.

It is important to share with your surgeon all of your medical problems and any medications that you may be taking. This includes herbal supplements and over the counter medications as some of these can interfere with blood clotting and increase the risks associated with the procedure. The surgeon may ask that you cease using some medications for a time period before and after surgery to ensure the best possible outcome.

Blepharoplasty surgery is generally performed as an outpatient procedure. Recovery times vary though most people can return to normal, non-strenuous activities within a week. Again, an experienced surgeon can better inform you as to the expected outcomes and return to normal activity schedule.

If you are contemplating blepharoplasty surgery, be sure to research the procedure and find a qualified and experienced surgeon. Additional research will help you to be a well informed and thoughtful patient.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 12 reviews

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Blepharoplasty rejuvenates the eyelids by removing eye bags and eye hoods

+4

Blepharoplasty is eyelid plastic surgery. Why patients seek blepharoplasty:

  • Puffy eyes
  • Eye bags
  • Dark circles under eyes
  • Excess skin on upper eyelids
  • Hooded eyes

To change Asian eyes
Upper blepharoplasty is doen to remove excess skin from the upper eyelids. Lower blepharoplasty is done to remove eye bags, puffy eyes and dark circles under the eyes.

More modern techniques are the laser blepharoplasty whic use the laser instead of a scalpel to reduce bleeding and bruising.

A newer technique for the lower eyelids is the transconjunctival lower blepharoplasty-this technique uses a tiny incision on the inside of the lower eyelid instead of the visible external incision. The external incision can weaken lower eyelid support, while the internal transconjunctival incision preserves lower eyelid support and avoids a change in eyelid shape which can occur with the external incision.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Blepharoplasty (Eyelid Lift) Explained

+3

The technical name for an Eyelid Lift  is "Blepharoplasty"

Candidates have excessive sagging or wrinkled skin on the upper or lower eyelids and or puffy lids from bulging fat pads.  In the upper eyelid, this sagging skin may interfere with vision and reduces the defined appearance of a natural upper eyelid crease so applying make-up may not be possible for women.  Candidates also have puffy pouches of fat in the upper or lower lids creating a tied and aged appearance.  Many of these changes are familial, so taking a look at your parents photos will often tell you what you may look like if surgical improvement is not selected.

A blepharoplasty is designed to re-drape and remove this sagging excess eyelid skin, and to remove the “bags”, by trimming away or redistribute excess fat to augment the lower eyelid cheek junction (fat preservation blepharoplasty).  Normally, everyone has some fat around the eyeball, but if the quantity of fat increases, or the local tissues stretch and weaken, the fat begins to bulge producing the “bags”.  Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging.  These changes have a striking effect on one’s appearance.  An attractive face with these early signs of aging can affect a patient’s self image, attitude and sense of well-being.

In some cases the upper or lower lids can be treated alone or, if indicated, all four lids may be treated at the same time.  At times, a forehead lift or Brow lift, cheek lift (mid face lift) and/or a face-lift is done along with the eyelid surgery. For example a cheek lift can be used along with repositioning the lower lid fat to decrease the dark depressed circles around the eye and give more fullness to the cheeks while decreasing the creases between the lower cheek and lip (nasolabial folds).  Excess drooping of the eyebrows and corners of the upper eyelids may require a forehead or brow lift to correct the area. There are a variety of techniques including short scar, forehead reduction (for receding hairlines) and hidden scar (such as endoscopic brow lift) lifts behind the hairline that can be performed. The surgeons at Pacific Center for Plastic Surgery will tell you which technique is best suited for you.

Intended Result
The procedure creates a more youthful, alert, and rested appearance of the eyes in addition to widening the visual fields, if the excessive upper lid skin partially blocks vision.  The eyelid lift will not remove or erase all wrinkle lines but rather will soften the wrinkle lines.

One of the first signs of early aging is bagginess or puffiness around the eyes, often associated with wrinkling of the eyelid skin.  Blepharoplasty is designed to correct this condition and to restore the youthful, alert appearance of your eyes. This condition may be present in the upper eyelids, lower eyelids, or both. It also may be associated with looseness of the skin of the eyebrows or temple region.

Procedure Description
The incision in the upper lid usually lies in the lid crease. The incision in the lower lid lies just below the eyelashes and parallel to the lid edge.  Both incisions may extend for a short distance beyond the eyelids, toward the temple.  In certain cases, lower lid incisions may be made inside the lid (transconjunctival incision). This is useful when only excess fat is removed and eliminates external skin incisions.  Excellent healing is characteristic of eyelid skin, and once the wounds are mature they usually become quite inconspicuous. The outer part of the incision — the part extending toward the temple — is the slowest to mature, and is sometimes noticeably pink for some weeks after the operation. The stitches are removed in 3-7 days after surgery.

The operation is usually done in an outpatient surgical center,. A friend or relative should be available to take you home and stay with you for at least 24 hours after surgery. Some patients may be done in a hospital operating room, if other medical conditions are present.

A local anesthetic is used. The patient also receives sedation so that the operation will be a relaxed and comfortable experience. A general anesthetic may be indicated in some cases.
Additional procedures that would enhance the result are: Forehead Lift, Face Lift, Cheek lift (midface lift) Chemical Peel or Laser Skin Resurfacing.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 38 reviews

What is Blepharoplasty?

+3

Blepharoplasty is surgery to change the shape of the eyelids.

There are many different techniques that are individualized to the patient and some variations based on surgeon's preference.

The upper Blepharoplasty usually removes excess skin and fat to reduce a "heavy-lid" appearance and restore a brighter, less tired appearance.  The incision is made in the natural crease of the upper eyelid.

The lower Blepharoplasty may involve an incision just below the lash line, again in a natural crease, to remove excess skin and fat, or an incision inside the lid to remove fat.

There are techniques that can be used to change the shape of the eyelids and support a droopy lid.

These cosmetic procedures may be combined with techniques that improve function.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.0 out of 5 stars 7 reviews

Blepharoplasty is a constellation of surgical techniques

+3

Blepharoplasty is the medical term for aesthetic eyelid surgery.  Essentially it is the manipulation of the tissues of the eyelids to create a more aesthetic and youthful look.  This usually involves the skin, fat and muscle surrounding the orbit.  The desired affect is smooth skin without any bags or deep crevices.  The evaluation is unique for each patient.

Tal Raine MD

Talmage J. Raine, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 7 reviews

Blepharoplasty improves your looks

+3

Blepharoplasty or surgery of the eyes is one of my favorite surgeries. By removing excess skin and fat from the surrounding eye area, the whole face is rejuvenated. The operation takes about an hour and a half  to do (this depends on who's doing it). The recovery is within a week. You can wear make up at a week and go back to full activity in approximately 4 weeks. Most people return to work in 7 to 8 days.

Good luck

Carlos Wolf, MD
Miami Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Blepharoplasty rejuvenates eyelids

+3

Blepharoplasty is a surgical procedure to remove excess skin and muscle from both the upper and lower eyelids. Underlying fatty tissue that produces bagginess can be selectively removed or repositioned. Blepharoplasy can improve drooping skin and bagginess. It can improve vision in older patients who have hooding of their upper eyelids.. Blepharoplasty will not remove "crow's feet" or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows.

Gregory Turowski, MD, PhD
Chicago Plastic Surgeon
4.5 out of 5 stars 24 reviews

Goals of upper and lower lid surgery differ

+3

Upper lid blepharoplasty is the single most rejuvinating surgery for the face that there is. It removes extra skin and sometimes extra fat and produces a rested refreshed look. It does not lift the eyebrows however.

Lower lid surgery is more complex and carries more risk. It is primarily good for the removal or redistribution of buldgy fat bags. It is not for significant skin excision. Often the main problem is tear trough formation which can be effectively treated with Restylane without surgery.

Loose lower lids are particularly risky with surgery as are lids in patients whose cheek bones are underdeveloped. Sometimes in these cases a canthopexy is recommended to tighten the lower lid to minimize the risk of it pulling down during healing. But the canthopexy can make the lids look asian and decrease the width of the eye. Patients often complain, "I wanted to look better, not different."

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.