Blepharoplasty (Eyelid Surgery)
The eyes are one of the most important facial features, and often the first one noticed by those around us. Many patients report feeling like they constantly look tired, even when they otherwise feel completely rested. This is often due to excess skin or fatty tissue underneath the eyelid, which can cause a droopy appearance in the upper eyelid, and puffiness of the lower eyelid.
To achieve the best results in rejuvenation of the eyes, eyelid surgery is often performed in conjunction with other procedures such as a facelift, brow lift, or skin resurfacing via laser or chemical peel. Dr. Cain or Dr. Richardson will perform a complete analysis of the eyes and other facial features during your consultation in order to determine which procedure or combination of procedures will give you the results you desire.
What is a blepharoplasty? Is a blepharoplasty the same as an eyelid lift?
Blepharoplasty is the medical term for eyelid surgery and can refer to either upper or lower eyelid surgery. An eyelid lift is just another name for eyelid surgery. This would be known as an upper blepharoplasty or lower blepharoplasty respectively. There are many different techniques for eyelid surgery, and some of these will be discussed below. In general, each surgery is customized for each individual patient depending on their anatomy, goals, and needs.
How and where is eyelid surgery performed?
Eyelid surgery is an outpatient surgery that we most commonly perform in our fully equipped and accredited outpatient surgical center at Texas Facial Aesthetics. Patients are able to experience quick in an out surgery times in the comfort and privacy of our surgical suite. In most cases, patients are given IV sedation by our board-certified anesthesiologists in order to allow them to sleep through the procedure. In some cases, we may perform upper eyelid surgery (or select lower eyelid procedures) under purely local anesthesia. Most patients choose IV sedation for comfort. Alternatively, some patients will choose to have eyelid surgery at the local hospitals under general endotracheal anesthesia for various reasons.
What happens during a blepharoplasty? How is upper eyelid surgery different from lower eyelid surgery?
Upper eyelid surgery is typically performed by excising the excess skin and fatty tissue through an incision that follows the natural crease of the eyelid. This helps to hide and minimize the incision site. The upper eyelid incision generally heals extremely quickly and can be difficult to find within just a few weeks. Beneath the skin of the upper eyelid lies a layer of muscle, some of which might be trimmed in order to improve the cosmetic outcome. We may also trim this muscle to eliminate bulk for patients with visual field deficits. Beneath the muscle layer, the upper eyelid contains the lacrimal gland on the outer portion of the eyelid, and fatty pockets in the central and inner portions of the upper eyelid. In some cases, we may remove some of the upper eyelid fatty tissue in order to rejuvenate the eyes or remove excess bulk.
In the lower eyelid, the incision may be made just underneath the lash line, totally inside the eyelid, or at the outer corner of the eye. Each patient’s procedure is customized to achieve the desired goals. The fat underneath the lower eyelid may be removed or repositioned to eliminate puffiness and create a smooth transition between the lower eyelid and the cheek. Extreme care is taken to ensure that if fat is removed, only the appropriate amount of fat is removed, in order to avoid a hollow appearance postoperatively. In some cases, we may also recommend lower lid tightening, such as a lateral tarsal strip procedure, cheek augmentation with fat grafting or implants, or other procedures to complement lower eyelid surgery.
Is eyelid surgery painful?
Generally, no, there is not much pain associated with eyelid surgery. We do give patients pain medication to take if needed, but most patients have very little if any discomfort postoperatively.
What can I expect after a blepharoplasty? What is the downtime and recovery after eyelid surgery?
The eyes will feel swollen and tight after eyelid surgery. In some cases, there may be some mild bruising, but not always. If patients have dry eye, they may experience temporary worsening of dry eye symptoms after blepharoplasty. Be sure to mention any dry eye symptoms during your consultation so that we may help to plan accordingly. Discomfort is usually minimal as discussed above.
All sutures are removed at one week after surgery, so most patients will choose to take about a week out from work or school to recover. We ask that patients refrain from strenuous activity for two weeks after surgery in order to avoid bleeding or any other wound issues during the healing process.
Do I need eyelid surgery or a brow lift?
This really depends on the patient. We commonly perform brow lifts at the same time as upper and/or lower eyelid surgery. Many patients actually need BOTH a brow lift to support the brows (not lift them into a high position or surprised look) AND upper eyelid surgery. In some cases, if upper eyelid surgery alone is performed, the eyebrows may relax a bit and appear even heavier if they are not supported with a brow lift. Some patients will achieve excellent results with upper eyelid surgery alone. Dr. Richardson or Dr. Cain will help you sort through the options and customize a treatment plan.
Is a blepharoplasty part of a facelift?
Eyelid surgery is not technically part of a facelift. A facelift is considered a different procedure and involves lifting the cheeks, jawline, and neck. That being said, we very commonly perform eyelid surgery at the same time as a facelift so that patients can have one anesthesia session and one recovery period.
I am worried about looking hollow or gaunt after eyelid surgery. Should I be concerned?
We only remove fat in patients that need fat removal, and are very conservative with fat removal. In some cases, we may perform fat grafting in conjunction with lower eyelid surgery to rejuvenate a hollowed lower eyelid or midface area. We may also perform fat repositioning (transposition) rather than fat removal for select individuals.
What are the contraindications to a blepharoplasty?
Blepharoplasty contraindications and limitations are similar to most other elective facial surgery procedures. Patients should be generally healthy without severe heart, lung, or kidney problems. Individuals with bleeding disorders or on blood thinners might not be candidates for elective eyelid surgery, especially for cosmetic purposes. People with abnormal immune systems or wound healing problems also might not be eligible for eyelid surgery. Be sure to discuss any medical conditions with us in order to make sure you are a good candidate for both surgery and anesthesia.
Is a blepharoplasty safe?
Yes, blepharoplasty is a safe procedure with very low complication rates. Risks include bruising, bleeding, swelling, lid malposition, infection, blurry vision, chemosis (swelling of the lining of the eye), scarring, need for future surgery, and anesthesia problems, but luckily these are mostly quite rare. Patients can expect some degree of bruising and swelling as a normal part of the recovery process.
Is eyelid surgery safe for all skin types, ethnicities, and races?
Yes, unlike many laser treatments around the eyes or other non-surgical procedures that might not be safe on various darker skin tones, eyelid surgery is not dependent on skin type, color, or ethnicity. We safely perform eyelid surgery on patients of all races and skin types. Even in patients with a history of keloid scars or hypertrophic scars, the eyelids generally heal quite well without any evidence of overactive scar tissue.
When should you get a blepharoplasty?
Blepharoplasty has a variety of indications. While most eyelid surgeries that we perform are for cosmetic purposes, some are for vision obstruction from overhanging skin on the upper eyelids. If you feel like your eyelids are blocking your vision, this may be covered by your health insurance and deemed medically-necessary. This would require certain tests in order to be approved.
While most eyelid surgeries are performed on patients with aging facial features, we perform eyelid surgery even on very young patients in some cases. Patients in their late teens or early twenties might even be candidates for eyelid surgery. This is due to the genetic component of excess lower eyelid fatty tissue that may occur even in young people. The appearance of the eyelids is based on factors including genetics, age, sun damage, and other environmental factors.
Is eyelid surgery only for women?
Absolutely not – we commonly perform blepharoplasty procedures in men and women of all ages.
Who is qualified to perform a blepharoplasty?
Facial plastic surgeons, oculoplastic surgeons, or general plastic surgeons perform eyelid surgery. Doctors in these three specialties perform the vast majority of eyelid surgeries and are usually well-qualified to do so. As facial plastic surgery specialists, we only perform procedures on the face, neck, and scalp. Our entire focus is on overall facial aesthetics, and the eyes are at the heart of the facial appearance.
How long does eyelid surgery last? Is a blepharoplasty permanent?
Eyelid surgery is essentially permanent. The aging process continues, and some patients may feel as if there is some progression of aging like return of skin laxity or return of fatty tissue over the years, but patients rarely need a second blepharoplasty procedure for cosmetic purposes. When this does occur, it is usually 10-20 years after the first procedure.
Will I look different after eyelid surgery?
In some ways, yes. We will remove the excess skin or puffiness that is causing the cosmetic or functional problem, but we will retain your natural eyelid shape and appearance. We are looking to help patients look like the best version of themselves, not to look like someone else.
How much does a blepharoplasty cost?
Surgical procedures and terminology can vary widely from one patient, provider, and location to another. Keep in mind that there are many different factors that affect the cost of a procedure. Surgeon fees, facility fees, and anesthesia fees all play a role. For most blepharoplasty procedures, patients can expect to pay somewhere between $4,000 – $6,000. Additional fees are involved if other procedures are performed simultaneously, such as a brow lift, facelift, etc. After a consultation with Dr. Richardson or Dr. Cain, we will provide you with a detailed and exact surgical quote for the procedures that are discussed.
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