In my 10+ years at NewBeauty, I’ve seen very of dramatic before and after photos and cases of blepharoplasty (aka blepharoplasty) have always stood out as some of the most incredible transformations. A person’s eyes say a lot about them – they are the windows to the soul, after all – and when their appearance doesn’t reflect how a person feels inside, it can lower self-confidence and change the way others perceive them.
One of the most common complaints surgeons hear from patients is “I look tired,” whether it’s due to sagging upper eyelids, prominent fat on the lower eyelids, or a combination of both. But in the right hands (a board-certified plastic surgeon with plenty of experience), cosmetic blepharoplasty can not only make you look awake, but turn back the clock. See what you need to know about blepharoplasty, according to top surgeons.
What is blepharoplasty?
“The word blepharoplasty comes from the Greek words blepharon, meaning eyelid, and plastos, meaning formed,” explains San Diego eye plastic surgeon Allison McCoy, MD. “Blepharoplasty is a type of plastic surgery that rejuvenates the upper eyelids, lower eyelids, or both, in order to improve appearance and vision. Upper eyelid blepharoplasty involves removing excess eyelid skin by sculpting or repositioning eyelid fat, as needed. A lower eyelid blepharoplasty involves changing the fat, muscle and/or skin under the eye to restore a smooth, youthful contour.
Woodbury, New York, ophthalmic plastic surgeon David Schlessinger, MD says blepharoplasty is the medical term for eyelid surgery. “The procedure is often performed with the goal of restoring a youthful appearance to the eyes by changing the shape or function of the eyelid. A large part of my practice involves removing eyelid bags of the upper or lower eyelids.’
Blepharoplasty can be cosmetic or functional, but blepharoplasty is primarily cosmetic. “Blepharoplasty—upper or lower—is primarily for cosmetic changes and improvements involving excess skin that develops as the eyelids and skin around the eye area are stretched,” explains Beverly Hills, CA, ophthalmic plastic surgeon Raymond Douglas, MD. In some cases, loose upper eyelids may impair the patient’s field of vision and therefore blepharoplasty will be considered a functional procedure.
What are the most common reasons people seek blepharoplasty?
The eyes often show the first visible signs of premature aging because the skin is thinner around the eyes. Patients either want to lift drooping eyelids or remove bags under the eyes, says Dr. Schlessinger, noting that almost anyone who needs it is a candidate (except those on blood thinners who can’t stop taking them). “Genetics, aging, muscle atrophy, skin laxity, and loss of fat and collagen from the brow bone all contribute to excess skin on the upper eyelid sag down to the lash line,” explains Dr. Douglas.
“Over time, the muscles that support the upper eyelids and the breakdown of collagen and elastin in the dermis, as well as rubbing, wearing makeup and exposure to UV rays, contribute to free radical damage and loss of skin structure. Dr. Douglas continues. “As a result, both excess skin and the movement of adipose tissue can become prominent, gathering under the eyelids and appearing with heaviness or sagging of the browbones, drooping eyelids and puffiness or bags under the eyes.” Upper or lower eyelid surgery will correct these problems.
Who is a good candidate for blepharoplasty?
Good candidates for upper blepharoplasty are people who have loose upper eyelid skin that covers their eyelashes, affects their vision, causes unwanted wrinkles, or in some cases makes it difficult to apply eye makeup or mascara, says Dr. Douglas. “For lower eyelid blepharoplasty, the best candidates are patients who have prolapse or herniation of the fat bags of the lower eyelid, also known as lower eyelid bags,” he explains. If needed, patients can also choose to have upper and lower eyelid surgery at the same time.
“Unfortunately, nationally, blepharoplasty is the most revised surgery behind rhinoplasty,” adds Dr. Douglas. “When done correctly, however, it’s still a great option for patients who want a more refreshed look to their eyelids. Both the patient’s candidacy and the surgeon’s skill matter.”
What does blepharoplasty surgery involve and what is recovery like?
During an upper blepharoplasty, the surgeon cuts the eyelid crease to remove excess skin and then sutures the area. “Sutures are most often dissolvable, but if they are not, they are removed in about a week to 10 days,” says Dr. Douglas. There are different degrees of upper blepharoplasty depending on the extent of skin laxity: “Moderate is a crescent of skin. Medium includes a larger amount of excess skin and fat. and Severe may involve correcting the ptosis, which means cutting and shortening the eyelid muscle,” explains Dr. Douglas.
“Lower eyelid blepharoplasty techniques typically reposition the fat, creating an improved cheek contour,” says Dr. Douglas. “In cases where there is excess skin and laxity, a small skin pinching procedure may be performed just below the lash line to remove the excess skin.”
Dr. Schlessinger says the surgery is usually done under local anesthesia or sedation. “It’s usually painless,” he adds. “Recovery is also quick and painless. We do not recommend heavy physical activity for two weeks after surgery to avoid complications.” Most patients can return to work and social activities after one or two weeks (some may need three), depending on the extent of the surgery and subsequent healing.
The eyes may be bruised and the eyelids may be swollen for a few days to a few weeks. “The area can be sore, tight and itchy during this time as well,” says Dr. Douglas. “The eyes may be sensitive to light or continue to water as well. Medication can be given for any pain and it is important not to irritate the area.
What are the risks associated with blepharoplasty and how can they be minimized?
According to Dr. Schlessinger, blepharoplasty is extremely safe. “Although bleeding and infections can occur, these are very rare,” he says. “We recommend avoiding blood thinners such as Aleve or aspirin during the procedure. Avoiding alcohol, smoking and sun exposure also reduces the risk of complications. Generally after blepharoplasty you should rest and go. We give an extensive list of instructions to our patients to ensure a speedy recovery.”
To minimize the risk of complications, be sure to do your research when choosing a provider. “You should only choose an experienced, board-certified surgeon who does a lot of blepharoplasty,” says Dr. Schlessinger. “Ophthalmic surgeons are an excellent choice as they specialize in blepharoplasty.” Facial plastic surgeons and plastic surgeons are also trained in this procedure, but may focus on other parts of the face or body, so asking to see before and after pictures of recent cases can be helpful.
If too much fat is removed, Dr. Douglas says the eyes can look hollow. “If too much skin is removed from the upper eyelid, it can result in the patient looking startled or overly taught,” he adds. “This can also cause misalignment of the lid or a lifted lid. Other complications include asymmetry in the eyes, changing the shape of the eye and the ability to close both eyelids properly.”
What are some alternative treatments to blepharoplasty for those who are not ready for surgery?
For patients with drooping eyelids (also known as ptosis), Dr. Schlessinger says it can be temporarily treated with Upneeq, a first-of-its-kind, FDA-approved, prescription eye drop that lifts the upper lids to open the eyes. “It’s a simple and safe daily drop and a great way to test the waters or put off surgery for one to five years, or even more,” adds Dr. Douglas.
Other options Dr. Douglas is considering for some patients is a brow thread lift, which can help temporarily restore a drooping eyelid. PlasmaPen treatments for mild eyelid laxity. radio frequency (RF) microneedling. and Tixel. “With the PlasmaPen, scarring is possible if the aftercare instructions are not followed as they help scab formation, healing and removal,” he explains. “RF microneedling with Vivace Ultra is a great way to tighten tissues and help collagen in an area that is extremely difficult to “tone up”, and Tixel provides similar benefits, with the addition of helping with dry eyes, so there will be less rubbing and irritation.”
Dr. McCoy also uses “neurotoxin injections to lift the lateral brow, which can provide a temporary, modest improvement in eyelid droop for the outer part of the eyes. This is repeated every 10 to 12 weeks to maintain the results,” he says. “In patients who have drooping eyebrows due to genetics, aging or weight loss, brow lift surgery can simultaneously improve the appearance of the eyes and eyelids. Browlfting and blepharoplasty are complementary procedures that can be done separately or together, depending on the individual’s unique anatomy.”
Dr. Schlessinger notes, however, that “if you have really heavy eyelids and/or prominent fat bags, then there is no substitute for surgery.”
