Which Blepharoplasty Type is Better?

I was looking into getting a blepharoplasty and there are two kinds: the one that involves an incision, and the one that is just string. The string procedure is known to "undo" itself over time and it less reliable than the incision. However, if the patient is not happy with the results of the incision procedure you cannot undo it. Which procedure would you recommend? How long is the recovery time for each procedure? I want my results to be natural looking and I want to be out in public within 2 weeks of the surgery.

Doctor Answers 15

Forget the string, have a transconjunctival blepharoplasty

Strings pull out and can distort your skin if not placed correctly-these techniques have caused terrible results and are usually offered by doctors who do not know how to or have not been trained in eyelid surgery, in my opinion.

Blepharoplasty surgery can provide a beautiful result when done by an experienced board certified plastic surgeon. There is no non-surgical substitute when a blepharoplasty is truly indicated.

The more modern transconjunctival blepharoplasty with arcus release and fat repositioning or grafting is the best procedure that has been developed and the scar is invisible on the inside of the lower eyelid.

Consult a board certified plastic surgeon who is an expert at eyelid rejuvenation.

See before and after pictures of transconjunctival blepharoplasty: Set 1 and Set 2

String surgery vs. real surgery

Blepharoplasty is rejuvenation of the eye area. Upper or lower eyelids can be rejuvenated. That's where the standardization in periorbital surgery ends.

In recent years, focus has shifted toward fat preservation, microadjustment in eye shape, and considering the face as a whole, rather than just the "do the eyes approach" with a standard removal of skin and fat.

There is no one single technique that is right for every patient. A skilled plastic surgeon will rely on many different techniques (fat preservation, fat removal, fascial-fat graft addition, canthopexy, canthal adjustment, cheeklifts, midface lifts, brow elevation techniques, multivector facelifts) to get the result that will achieve the needed result and address the patient's needs. Ignoring any one of these techniques will not give the patient what they deserve--- an optimal result.

We routinely remove strings from patients when we redo their surgeries. I would not recommend them. In tissues that have not been undermined and held in place (a mainstay of elevation techniques), strings simply cut through the tissues as the results slip quickly away.

String placement is frequently haphazard when we remove them (in completely different anatomic layers on each side). Few patients are happy long term with their string lifts.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Go with the tried and true procedure

To be honest, your description of a string-only procedure sounds like something not used very often. If you go to an experienced plastic surgeon there should be little concern about being able to "reverse" the procedure.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Which Blepharoplasty Is Better?

If one has redundant skin and fat it is better to do a skin pinch removal with preservation of obicularis muscle and removal of fat, if any, or repositioning of transconjunctival.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 63 reviews

Traditional blepharoplasty is the gold standard

The “string” blepharoplasty has not been time-tested and is not universally accepted amongst facial plastic surgeons. Traditional blepharoplasty has been performed for many, many years and continues to be the gold standard. The swelling and bruising which occurs after a blepharoplasty should be subsided at two weeks so that patients can return to their normal social and daily functions including exercise.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

String Procedure not recommended for eyelid rejuvenation

I too am not sure about what procedure you are talking about regarding the placement of a string but I can tell you it will not produce natural long lasting results. Eyelid rejuvenation is best accomplished with surgery (blepharoplasty), volume replacement (fat or fillers), or skin rejuvenation. Which of these modalities would be best for you would be determined by your board certified plastic, occuloplastic, or facial plastic surgeon.

Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

Incisional surgery more reliable

String procedures are primarily suspension procedures that pull tissue upward but do not correct the underlying problem. Most patients excess skin on the upper lids with a small amount of fat herniation and on the lower lids more fat herniation with less excess skin

The lower lids are usually more of a problem to treat. That's why there are so many different approaches and techniques described. Fat can be repositioned, removed, or reset and the excess skin is usually pulled slightly laterally with or without the underlying muscle and fat pad. In addition, the lateral suspension ligament of the eye may be shortened or repositioned in order to maintain an almond shape to the eye (lateral canthopexy).

Consult your plastic surgeon about what's the best procedure for you


Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 20 reviews

If you have a real issue get REAL surgery

I've never been a fan of "fly by night" surgery that can be done by anyone who claims to have a medical backround. If you have a real, diagnosible issue, then get real gold standard surgery. With these other procedures you'll spend money now then again in a year to get the real surgery. If it sound too good to be true...

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

Strung up in Dallas?


In cosmetic surgery in general, the less invasive you are, the less dramatic and shorter lasting your results are. The benefit is that the recovery time and expense are usually less. String lift recovery is maybe 5 days and eyelid surgery 7-10 days. Although string lift procedures for elevating the eyebrow do have some lifting effect on the upper eyelid, they do not directly address the eyelid. They are also considered less invasive than open eyelid surgery and thus the results don't last as long. Good luck!

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

Stick with the gold standard

You should stick with the gold standard. There are many tricks and gimmicks, however the best procedure is the traditional blepharoplasty. If you post pictures, we may be able to give you more specific advice. Two weeks should be plenty of time for your recovery. You may have trace swelling and/or resolving minimal bruising. Most patients are ready to go out in public without sunglasses within a week of surgery.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 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.