A Plastic Surgeon Explains the Benefits and Risks

For those uninitiated with the knife and scalpel, there’s simply no better time for a sting than winter. It’s the perfect time to retreat, heal, and emerge from the ice age refreshed and ready to take on the world. And with each passing year, there are new treatments and injectables that help those interested in enhancing their beauty and maintaining their youth. One such treatment that has been steadily gaining traction in recent years is upper eyelid blepharoplasty. We agreed with Dr. Dara Liottadual board certified facial plastic and reconstructive surgeon to learn details about what the procedure is, why and more you may be interested in.

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What is upper eyelid blepharoplasty?

Blepharoplasty is eyelid surgery, so an upper eyelid blepharoplasty is just that: a procedure that improves the appearance of the upper eyelid. It is generally performed when a patient has excess skin or a “swelling” of the upper eyelid covering the eye, which may leave less room for upper eyelid makeup, for example. Dr. Liotta explains, “A common complaint I hear when a patient is ready for upper eyelid blepharoplasty is that when they put on eyeliner or mascara, it falls on the skin of the upper eyelid. Either they have to pull up the eyebrow. That extra skin or puffiness can make the eyes look tired or smaller.” Essentially, an upper eyelid blepharoplasty can help open up your eye and make you look more youthful and awake. “The goal of upper eyelid surgery is not to change the shape of the eye, but simply to rejuvenate the area and make the eyes look brighter“, says Dr. Liota.

Who is a good candidate for this procedure?

Anyone who feels they have hooded eyelids or excess skin or fullness on the upper eyelid.

What are the benefits of this process?

According to Dr. Liotta, the goal of upper eyelid blepharoplasty is to make the eye appear more open and alert and to rejuvenate the eye area. Unlike non-surgical procedures, the results of upper eyelid blepharoplasty are permanent.

Are there risks or contraindications for an upper eyelid blepharoplasty?

There is a risk of scarring. With this procedure, there is a small scar left in the eyelid crease, Dr. Liotta explains, but generally this incision heals very well. “Occasionally it stays a little red or slightly paler than the surrounding skin — so if someone’s looking for it, they might be able to see it.” As a reminder, as would be the case with any scar on the body, it takes a full year for this cut to heal and the scar to be permanent.

Additionally, getting too much skin or fat around the upper eyelid can make the eye look hollow and aged. This risk is also called “A-frame distortion”. If too much skin is taken—which Dr. Liotta that it only happens in the most extreme cases – one can hardly close one’s eyes. Therefore, it is important to look for a surgeon with extensive experience in blepharoplasty.

What does recovery usually look like?

For 5 to 7 days after the operation, depending on the specifics of the procedure, there will be stitches in place in the crease of the upper eyelid. Once the stitches are removed, the incisions will likely be red for one to three months. It is okay to use makeup on the incision lines one week after the stitches are removed. “It may take 3 to 6 months to see the full results of upper eyelid blepharoplasty. The incisions and final scar are considered final after one year.”

What are the post-operative instructions for upper eyelid surgery?

1. There will be blue stitches in the eyelid crease that will be removed 5 days after surgery. A burning sensation is normal for the first 24-48 hours. If you have sharp pain, tell the doctor immediately.
2. Sleep with the head of your bed elevated (two pillows) to reduce pressure on the face and reduce swelling.
3. Crushed ice in ziplock bags or frozen peas may be applied for the first 48 hours after surgery.
4. You will use antibiotic ointment on the eyelid incision twice a day until the stitches are removed.
5. You can wash your face and remove the stitches and any bandages you have wet after two full days (48 hours). Just let the soap and water rinse over the incisions and dry.
6. You can resume light exercise 10 days after surgery, moderate exercise in two weeks and full exercise in three weeks.
7. Avoid NSAIDs (Ibuprofen, Motrin and Aspirin) for two weeks after surgery.

Are there procedures/treatments one could do instead of a superior bleph for a similar impact?

“Botox can be used on the muscles around the eye to try to lift the brow and increase the upper eyelid space. This does not directly remove excess skin or tissue in the upper eyelid (as surgery does), but by lifting the brow, can help the appearance of the upper eyelid,” explains Dr. Liotta. This is called a ‘Botox brow lift.’ In this treatment, Botox is used to relax the muscles that pull the brow down, allowing the brow to relax upwards.

“The muscles that give you ’11 lines’, the vertical lines between your brows that you see when you make an ‘evil face’, are called furrows. The furrows are depressors of the medial (inner) part of the brow. you make an evil face and look in the mirror , you can see how the brow descends on the inside.” Relaxation of these muscles allows the inner and middle part of the brow to float up. “The depressor lateralis (muscle that pulls down the arch of the brow and outer corner of the eyebrow) is the circular muscle that rotates around the eye and gives us pupil legs when we smile. It is called the orbicularis oculi muscle. Relaxing certain parts of this muscle allows the arch and side of the brow to float up and can help give you more room in the upper lids,” she explains.

Results vary depending on the patient’s anatomy and the results are certainly not as dramatic as surgery and obviously not permanent.