Upper bleph? (photo)

I noticed the skin on my upper eyelids has started sagging down. It makes me look older than I actually am. I've tried under eyebrows filler which helped a little bit. Would an upper blephroplasty be a better solution? Also, would a lower bleph help the wrinkles under my eyes? Those only show up when smiling but never go away even after Botox. My whole eye area makes me look old and feel insecure. HELP!

Doctor Answers 10

Upper blepharoplasty is appropriate for candidates with excess upper eyelid skin

While it is impossible to say if you are a good candidate based on your photo alone, in general, if a significant amount of excess skin is present on the upper eyelids, an upper blepharoplasty would be a good option to consider. Upper blepharoplasties can open up the eye area tremendously and create a brighter, more youthful look. As for wrinkles underneath the eyes, a lower blepharoplasty will not do much for those. Laser resurfacing or a chemical peel are the best treatments for under eye fine wrinkles. You should visit a board-certified plastic surgeon for a comprehensive evaluation to come up with a custom treatment plan to address your specific concerns. I hope this helps.

Eyelid aging

Periorbital aging is multifactorial.  It appears that you are losing fat in the periorbital area from the A frame appearance of the upper eyelid.  Removing upper eyelid skin may change the way you look to others and removing fat will actually age patients in many cases. Take photos of yourself from your early twenties to a consultation with a board certified plastic surgeon  and that is what you should be trying to achieve. The trend in eyelid surgery is additive and minimal if any resection of tissue.

Will A Forelid Blepharoplasty Make Me Look Younger?

When I took my Boards in plastic surgery, there was a picture of a female with aging eyelids and a significant turkey gobbler deformity of her neck, and the question was:  If she could only have one surgery, what would be the best use of her money?  The answer, of course, was do the eyelids first.  When we talk to each other, we look at each other's eyes.  More than any other feature on the face, the eyes are looked at the most, and if they appear old or tired or anything else, we immediately make assumptions about that person.

From the picture you sent, I would consider you a borderline case.  Your upper eyelids are showing definite signs of aging, and they may be touching your eyelashes which send a message to the brain having you pull up your eyebrows, leading to forehead wrinkles.  Therefore, an early upper eyelid blepharoplasty would push back the time when your forehead wrinkles begin to show, possibly for years. 

As far as your lower eyelids are concerned, if you were my patient, I would recommend a lower eyelid blepharoplasty with a muscle sling.  The muscles of the face are very interesting in that they are not similar to muscles in the body.  The muscles in the body comes from mesoderm whereas the muscles in the face are truly skin muscles, and therefore they come from the ectoderm.  Since there is a connection between all the skin on the face and all the muscles of the face, if the lower eyelid blepharoplasty is done correctly, you can pull your cheek eminence back up where it belongs and decrease the depth of your nasal labial fold, all at the same time as doing a lower eyelid bleph. 

The good news is San Francisco has many outstanding Board Certified plastic surgeons and other core surgeons with years of experience in blepharoplasty surgery.  I highly recommend you interview at least three who have good reviews on RealSelf showing an expertise in eyelid surgery.


Conservative upper eyelid blepharoplasty

 The photograph demonstrates a small amount of excess skin on the upper lids which can be addressed with a conservative upper eyelid blepharoplasty. The brow asymmetry and will stay the same. When performing lower lid blepharoplasty, the amount of skin to be removed on the lower lids is made at rest, not when smiling. In our practice we performed the excess skin incision with a pinch technique and closed the incision with tissue glue.   For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

You have many choices in how to tighten your eyelid skin

and blepharoplasty is certainly one of them.  But the final recommendation really depends on what your expectations are as laser and ThermiSmooth can also tighten the lid skin without incisions.   So schedule a visit with a plastic surgeon who has access to laser and ThermiSmooth to find out what may work best for you.  Those who don't have access will recommend a blepharoplasty since that is the only option they can provide.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Upper bleph?

Although, the determination of whether or not your are a good candidate for a blepharoplasty can't be made bases solely on one photo.  From your photo and description, I believe you may be a good candidate for both an upper and lower eyelid blepharoplasty.  The procedure usually takes about an hour and a half to perform.  You would want to be out of the "public eye" for 5 to 7 days following the procedure.  Seek out a board certified plastic surgeon with extensive blepharoplasty experience.  Best wishes, Dr. Lepore. 

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.9 out of 5 stars 50 reviews

You really need a detailed personal consultation.

You have eyebrow asymmetry.  This generally is caused by relative upper eyelid ptosis with eyebrow compensation.  A personal consultation is needed to very carefully assess the position of the inner eyelid margins (the actually eyelid).  Ptosis or latent ptosis will drive the position of the eyebrow.  The left eyebrow is held in a higher position than the right brow which suggests there is ptosis in the left side.  The right side is crowded by tissue and in this particular photograph the right eye appears smaller than the left side.  Generally in eyelids with prior blepharoplasty, there can be an injury to the insertion of the tendon that raises the eyelids.  During revision surgery, this tendon should be reattached to reinforce the upper eyelid crease.  Be certain that the surgeon you see understands these issues and actually examines and measures the eyelids prior to proposing eyelid surgery for you.  The lower eyelids I would address with a phenol chemical peel.  TCA peels are not strong enough to make a difference here.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Hooded upper eyelids and wrinkly lower eyelids

Thank you for sharing your concerns and photo. You would benefit from upper blepharoplasty and lower eyelid skin resurfacing. Prior to the resurfacing, Botox should be injected into your lower eyelids to prevent the wrinkles from reforming following the laser treatment. See an experienced eyelid surgeon in person for proper evaluation and guidance.
Good luck,

Upper lid skin and lower lid wrinkles

The photo doesn't allow a good evaluation.  It does look like you have excess skin and that could be addressed with an upper lid blepharoplasty. It would take a consultation and evaluation to make a firm recommendation. As far as the lower lids if there are rhytids (wrinkles) at rest they could be treated with laser resurfacing or some form of chemical peel (TCA or phenol).  Wrinkles that come only with smiling are dynamic and will not be removed with resurfacing. You should have Botox prior to any resurfacing to maximize your long term results.

Wayne F. Larrabee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Possible blepharoplasty

It is a bit difficult to fully evaluate your eyelids with only the photo you provided.  It would be helpful to see a photo when you are not smiling as well.  Your eyelashes are also partially obstructing the view of your upper eyelids, so an exam would really be ideal to get the best idea of which procedures might be of benefit to you.  In general, if there is excess or droopy skin on the upper eyelids, an upper blepharoplasty would help to improve this issue.  Lower eyelid wrinkles can sometimes be improved with laser resurfacing or chemical peels and sometimes surgery.  

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