Upper Eyelid Surgery. Any suggestions?

I have hereditary hooded eyes, worsening w/ age (47 yrs old). I am scheduled to do the upper eyelids in 2 weeks. My question is...in the morning and most of the day they are very hooded, but usually by about 7-8pm they look totally fine. How does the surgeon know how much to remove when I come the morning of surgery and they have LOTS of excess skin and then when night time comes the skin sinks back into the natural crease? Thanks you!

Doctor Answers 8


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Thank you for your question. The surgeon will determine how much of the excess fatty tissue and skin around the eyelid should be removed. Eyelid changes do not occur as rapidly after surgery as changes in other areas might which will work to the patient's benefit as they age. In addition, various types of chemical peels can be used to remove wrinkling in the eyelid area and provide an additional tightening effect to the skin. Always consult with a board certified facial plastic surgeon.

Best wishes,

Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Saggy upper eyelids surgery

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It all depends on your particular anatomy, the procedure type, and surgeon's experience and technique. There are 3 separate factors involved in making the upper eyelids saggy, including 1) excess skin; 2) droopy eyelid; 3) droopy eyebrow. The surgeon needs to understand what factors are involved and design the procedure to address each. See an oculoplastic specialist.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

My cosmetic eyelid surgery consultations run about 45 to an hour of time.

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That includes a very details discussion with you about your concerns, goals, and past medical history.  I do a very thorough examination of the eyelid and eyelids including sketching the eyes, measurements of the eyelids, dry eye assessment and a slit lamp examination to make sure there are no contraindications to eyelid surgery.  Based on this a very thorough discussion of options, recommendations, possible side effects, and likelihood of success is performed.  I also demonstrate how the eyelid will look with a blepharoplasty using an eyelid folder and we talk about precisely how much skin to remove and where the upper eyelid crease should be places.  Discussion is had about making a hard upper eyelid crease, the need for an anchor blepharoplasty, and if appropriate the role of forehead lifting.  Do you have upper eyelid or upper eyelid lash ptosis and how that is corrected.  I also address if there are good reasons why you should not have eyelid surgery and alternatively if something like a botox treatment would be a reasonable alternative.  If you have not had the benefit of such a thorough discussion with your surgeon, it is appropriate to be concerned about how much skin the surgeon will be removing.  If it was not discussed with you before hand, it should not be a surprise if the outcome of surgery is not what you expected.

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

Upper blepharoplasty or Browlift is the real issue!

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This is a common question. If you lift your brow and like the look=browlift. If the brow position doesn't bother you=upper Blepharoplasty. If you raise your brow and do not want it too high and still have excess skin=both. If your hairline is high the browlift should be the IrreTrichophytic Forehead Lift which will not raise your hairline orleave a noticeable scar. Hair will grow thru the hairline and not behind it.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

The amount of skin and fat removed depends on the experience of the surgeon.

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Patients commonly have the comment that their appearance varies at different times during the day, monthly, or sometimes for no apparent reason.  Most of the time the varying appearance of the upper lids is due to varying eyebrow position.  If that seems to be the case, I often either inject Botox to the forehead about a week before surgery, or at the time of surgery inject local anesthesia to the forehead to negate the effect of forehead muscle contraction causing variable eyebrow position. I also feel strongly that this procedure is most accurately performed under local anesthesia, which enables me to sit the patient up during surgery to take into account the effect of gravity and an upright posture - which greatly contributes to the best results.

Richard Weiss, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 5 reviews

Eyelid Surgery

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Hello and thank you for using RealSelf.com.  Great question.

A surgeon who performs an upper eyelid lift (blepharoplasty) measures exactly how much skin to remove.  I do this once the patient is sedated or under a general anesthesia.  There is a certain amount of skin to leave beginning just below your natural crease as well as between the lower edge of the eyebrow and the upper incision.  Also, it is a good idea to be sure the eyelids touch the lower eyelid margin after the excess skin is removed and the incision is closed.

Best point to remember is the fact that one can always take more if not enough is removed in surgery with a minor in-office procedure.  However, taking too much skin can lead to issues that may be difficult to correct.  Best for the surgeon to be a bit conservative.

Good Luck to you.

Robert J. Spies, MD
Paradise Valley Plastic Surgeon
5.0 out of 5 stars 94 reviews

Hooding of the eyes

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More often than not, there is some degree of brow ptosis when there is eyelid skin excess.

Therefore, the surgeon often recommends some type of brow elevation procedure along with removal of extra eyelid skin.  Remember, the tendency of eyes to have puffiness at various times of the day will continue even after eyelid surgery, although it will be better than prior to surgery.

The decision on how much skin to remove is based on anatomic factors, so that can be calculated prior to surgery.

Overly aggressive eyelid surgery produces hollow appearing eyes that do not close properly and look overdone, so that should be avoided.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Upper eyelid photos

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Thanks for your question. Its an interesting but not uncommon problem. It would seem that your eyes definately swell overnight and this swelling subsides during the day as you are stood up and gravity acts to reduce facial swelling. Some of the morning appearance  is from heaviness on the upper eyelid stopping them opening as much and giving the impression of more skin. 

I wouldn't suggest taking pictures of your eyes both in the morning and the evening and showing these to your surgeon.

Sohail Akhtar, MD
Manchester 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.