Eyelid Surgery to Tighten Excess Skin? (photo)

I am wondering what would be the best treatment, surgically or otherwise for my upper eyelids? I am scared surgery will leave me with a lot of lid just above my lash line and will make my eyes appear more bulging with little volume in the area below my brow? Would pixel laser treatments be able to tighten this excess skin? The side view is taken in the morning and looks a little more puffier than it normally does

Doctor Answers 7

Lasers are limited, but upper eyelid blepharoplasty & laser combo can address the excess skin and fat in your upper eyelids

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As a cosmetic oculofacial plastic surgeon, I make sure that patients understand the limits and outcomes of surgeries such as lasers. An evaluation and physical examination are also important to decide the appropriate surgery for the patient. When patients visit my office, I use a Q-Tip to roll the skin underneath to know if a strategic reduction of excessive skin would make a difference.

I usually do not recommend lasers for puffiness in the inner corner of the eye. In using lasers, thermal energy is applied to contract the skin in order to have smoother and tighter skin. Unfortunately, if used aggressively, the outcome of lasers tend to be difficult to predict. In addition, puffiness in the inner corner of the eye is caused by eyelid fat prolapse which lasers cannot fix. You will really need surgery to reduce that fat.

In my practice, I would do a combination procedure of a conservative removal of skin and fractional CO2 laser. A conservative removal of skin would give you enough skin to close your eyes and this will also give your eyes a good, round shape. This combination approach would address the extra skin and the fat pockets resulting in a smoother contour and tighter skin which lasers alone cannot do.  I hope that was helpful, and thank you for question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Eyelid surgery?

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I think you would obtain a beautiful result with upper lid blepharoplasty. Anything less would be a compromise.

Janet Woodyard, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 18 reviews

Upper blepharoplasty

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The primary goal of an upper blepharoplasty is  to remove excess skin, and herniated fat in the medial compartment of the eyelid. The incision is located directly in the eyelid crease and the incision was closed with dissolvable sutures. The surgery takes  approximately 30 minutes  under general anesthesia. Expect 2 weeks of bruising and swelling around the eyes for postoperative healing. The  link below is to our  blepharoplasty photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

I think your concerns are valid.

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Anything that is done for your upper eyelids needs to start with an assessment of your upper eyelid ptosis.  You appear to manifest levator dehisence ptosis.  This generally allows some of the upper eyelid fat to be pulled into the orbit with the retracting levator aponeurosis.  Correcting the ptosis will prevent your upper eyelid platform from appearing too long which is precisely what will occur if only upper blepharoplasty is performed.  Correcting the ptosis will often allow the forehead and eyebrow to relax which will help the upper eyelid/subbrow volume.  Judicious anchor blepharoplasty at the time of ptosis surgery will support the sagging eyelashes, snug the crepey skin of the upper eyelid platform.  Skin excision needs to be performed very conservatively.  Be careful out there because having a "blepharoplasty" without correctly the ptosis will be a huge problem for you that you don't need.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Excellent candidate for upper lid blepharoplasty.

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Picture seems to demonstrate the patient that is an excellent candidate for upper lid blepharoplasty. You might want to consider video imaging to get some idea of what you would look like after this operation.

Options to help with upper eyelids

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An examination in person would provide the most information, but there are several methods to help with the upper eyelids.  If the eyebrows are a bit low, a forehead lift can be done to raise the brows and this helps with the upper eyelids as well.  If the brow position is okay, then just an upper blepharoplasty can address the excess skin of the upper eyelid.  Laser treatment to the upper eyelids could help, but not as much as the surgical options.   

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Upper Blepharoplasty or Laser

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You have a moderate amount of excess skin in the upper eyelids and a small fat pat at the inner aspect of the upper eyelid.  Conservative upper eyelid blepharoplasty should address these areas and improve the contour quite nicely without producing an "over done" appearance.  Fat grafting just below the orbital rim could also be used to fill the orbit but you still may have a small amount of skin excess.  Lasers work better with fine skin wrinkles and do not appreciably help excess skin.  An in-person consultation with a plastic surgeon certified by the American Board of Plastic Surgery and a member of the American Society for Aesthetic Plastic Surgery should give you the information that you need to make your decision.

Philip E. Fleming, MD
Nashville Plastic Surgeon

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.