Eyelid Surgery

I have done 1000's of eyelid operations over the last 40 years. My first choice now is a "light" general anesthesia. This does add some additional expense, but patients experience NO pain and are always happy they paid the extra money. In my pre-op consultation, I discuss the options with the patient, and together we make a decision. If patients exhibit "anxiety", or have a history of claustrophobia, hypertension, cardiovascular disease, neck or other body pains/issues such as lying still on their back, then a "light general" is always best. Happy patients that experience no pain or medical issues during their surgery send their friends !

I am scheduled for a lower bleph next month. When I spoke with the surgeon, I said I wanted twilight sedation, to which he said yes, however when the nurse called me today, she explained that he may or may not use intravenous sedation and often uses just oral sedation. This seems risky to me. Is that adequate? I spoke with one woman here who had only the oral sedation and she said it was very unpleasant. Now I'm worried - about pain and freaking out while under the knife.

Lower blepharoplasty with only oral sedation - bad idea?

Without a photo it is difficult to comment. My advise, make an appointment for a eyelid consultation, bringing with you photos that were taken prior to the first operation. In general, a 2nd blepharoplasty can be done by a well experienced eyelid surgeon, and many times issues which a patient has with the results from the first operation can be corrected during the 2nd operation. Pre-op photos from before the first surgery are essential.

I have had an upper and lower blepharoplasty 9 years ago. Wasn’t satisfied with the results since it left my eyes rounder than they were and hollowed. Used to have a little hooded eyes congenitally and more almond shaped. Anyways, over the years they sagged a lot and I’m looking forward to have a second upper blepharoplasty. Can it be corrected to their original almond shape again and little hooded and get rid of the deep wrinkles?

Second blepharoplasty after 9 years. Could it be correct? First one left rounder and hollowed eyes. Would get rid of wrinkles?

Your brows are fairly symmetric. The upper eyelids are a little "different". It looks like removing a small amount of skin from your right upper eyelid should make you happy. Your eyes are somewhat "prominent", however, be happy with this as someone in the family tree has a similar look and should embrace it as "that's me".

My left eyebrow is higher then my right one and it has a large lid. As for my right eye. It’s hooded and the right eyebrow is lower than the left. It also seems that my eye shapes are different. Is there any way that I can fix this? :)

How can I fix my eye asymmetry? (Photo)

I really need to see a photo. There are surgical procedures which are designed to correct and normalize the junction of the eyelids and cheek. Fillers and implants are not as safe for correction in such cases, but do play a roll.

Would infraorbital implants improve the eye/cheek junction? Do the infraorbital implants make the face more fuller or heavier? Thank you so much for your answers.

Would infraorbital implants improve the eye/cheek junction?

Your issues can be corrected by surgically getting your eyebrows to the same height. At present, your right eyebrow is high compared to the left one. In such cases, your face and eyelids will not look the same. Good news, this can be corrected by forehead/brow surgery. There may also need to be after the aforementioned surgery, a upper eyelid "touchup".

My eyes are extremely asymmetrical and I am not just imagining this or suffering from a body dysmorphic disorder. It ruins my life people subconsciously take them as a sign of bad genetics within seconds of looking at me. People asked me if I have had an accident in the past that caused it it is insufferable at this point. As for surgical options there still does not seem to be a reasonable one available. Would craniofacial surgery likely leave me more disfigured or could symmetry be achieved?

Extremely noticeable and disfiguring eye asymmetry. Can nothing be done? (Photo)

In this case, easy fix. Your brow position is symmetric, a good thing. More skin needs to be carefully removed from your right upper eyelid and you will be symmetric and happy with the result.

My eyelids have had this asymmetry for awhile, and it bothers me a lot. It’s impossible to take a picture without it being incredibly noticeable...and in this new age of video calls for work, therapy, doctors, school, literally everything, it’s been affecting me a lot more than usual. The hoods on my eyes are so different as well, so you see eyeliner on only one eye! Is it my brow bones, or is there less volume in one cheek vs the other? Are my eyebrows part of it?

Can eyelid surgery fix asymmetrical eyelids that don’t have an underlying cause? (Photo)

Without a photo it is difficult to ascertain your issue. People are often not symmetrical and cannot always be "made" symmetrical with surgery. In my pre-operative consult I always point out any asymmetry if it exists. I show them a photo of same or have them look in a mirror or bring in an old photo. Often patients are not aware of asymmetry until I point out the finding. If it can be corrected during an operation, I will make an attempt to correct this during the upcoming procedure. It is not always possible. Sometimes B-tox can be used to help create symmetry.

Upper eyelid surgery, eye asymmetry, I look angry. What can I do?

When the two eyes do not appear to be looking in the same direction, this is called strabismus. You will need to make an appointment with an Ophthalmologist to determine if your eyes are "lining up" or if one turns in, out, or appears higher or lower than the other eye.

In the mirror and pictures on a phone with the camera same side of screen I look normal. With the other side camera I look like I have lazy eye. Do I? Please respond

Do I have lazy eye?

Upper eyelid surgery on someone with an epicentral fold should include creating an upper eyelid fold, as seen in "Western eyelids", but I never try and eliminate the epicanthal fold as seen in Asian eyelids. Creation of an upper eyelid crease is possible and to be expected, but total removal of the epicanthal fold is usually not possible or advisable.

I had blepharoplasty &amp; epicathoplasty 4 yrs ago when I was 34.The epicanthoplasty was barely visible, but I decided to ignore it.Since then, my eyelids have drooped down and I look exactly as I did 4 yrs ago. 1) Is it normal for eyelids to droop that much in 4 yrs?Are you able to tell from stitching whether they mistakenly performed a non-incisional surgery (as opposed to incisional)? 2) The surgeon is no longer at the clinic tho the clinic still exists.Do clinics ever offer a redo 4 yrs later?

Was my epicanthoplasty non-incisional? Anything to be done about eyelids that have reversed back to how they looked? (Photo)

Your lower eyelids "dip" in the center, and need to be tightened in this area, as part of the fix. In addition, fillers won't solve your complaints and bags, but will only make them more pronounced. So you need a lower lid blepharoplasty, with the incision on the skin side, tightening of the lids centrally, removal of the fat at the lid/boney orbit junction. If the closure beneath the skin is done properly, there will be a very nice contour between you lower lids and bone.

9 months ago I had 1ml of Restylane injected via catheter in my tear troughs. After most of the acute swelling resolved, I felt like my eyes looked puffy. I had 3 sessions of hyaluronidase injections which did not resolve the issue. I now have under eye bags. This was not my first time getting under eye filler... I had it once years ago with no issues, but with a different doctor. Will a blepharoplasty correct this? Photos are 1 month before filler and now (9 months later).

Eye bags that won't go away Restylane filler in tear troughs. Will a blepharoplasty correct this? (Photo)

Steven G. Pratt, MD, FACS

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Oculoplastic surgeons, also known as oculofacial surgeons, are ophthalmologists who have completed advanced training in eyelid, orbit, tear duct system, and facial cosmetic and reconstructive surgery.

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Steven G. Pratt, MD, FACS

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