Board Certification: American Board of Plastic Surgery
Manhattan Eye, Ear & Throat Hospital, Fellowship in Aesthetic Surgery
Board Certification: American Board of Plastic Surgery
Manhattan Eye, Ear & Throat Hospital, Fellowship in Aesthetic Surgery
Blepharoplasty is the general term for aesthetic eyelid surgery. The upper eyelids (upper blepharoplasty) and lower eyelids (lower blepharoplasty) can be safely addressed separately or together.
As we age, the skin of the upper eyelid can become loose which obscures the lid crease, makes it difficult to apply makeup, and, more importantly, detracts from the youth and beauty of the eyes. In rare instances, this skin can affect certain parts of a patient’s upper visual field. Upper blepharoplasty aims to remove excess skin in a tasteful, subtle way. If performed well, the incision hides in the native crease and the eyes look refreshed without appearing “operated on.” Certain patients also benefit from tightening of the underlying muscle that elevates the eye. This procedure is referred to as a “ptosis repair.” Ptosis repair is not a standard maneuver for most surgeons who perform upper blepharoplasty. If one eye or both eyes droop, a discussion with your surgeon regarding the need for ptosis repair should be had prior to undergoing an upper blepharoplasty.
Lower blepharoplasty aims to address the three fat pads of the lower orbit that can become more apparent as we age. A combination of loss of subcutaneous fat, decent and retraction of midface structures, and hypertrophy or growth of the orbital fat can lead to the appearance of “bags” of the lower eyelid. These bags can cast shadows on the face and often leave a patient looking tired even after a great night of sleep. Lower blepharoplasty aims to reduce or reposition these fat pads and then address excess skin, muscle, and lid position as needed. Autologous fat transfer (fat grafting) to the midface can be a nice adjunct to a lower eyelid blepharoplasty in the correct patient. There are many ways to perform this operation and they all have their benefits and risks. A thoughtful discussion should be had with your surgeon prior to undergoing lower blepharoplasty.
Upper blepharoplasty, also known as an upper eyelid lift is a popular option for individuals with excess eyelid skin or droopy eyelids. Upper blepharoplasty allows a plastic surgery to refresh the upper eyelids through skin removal, conservative volume reduction, and sometimes, reshaping the aging eyelid.
Yes. In general, the upper eyelid manifests signs of aging earlier than the lower eyelid. As we age, the skin of the upper eyelid becomes more redundant. In some cases, the connection between the main eyelid elevator muscle (levator palpebrae superioris) and the eyelid separates leading to a droopy eyelid (ptosis).
Eyelid ptosis, or droopy eyelid, is a condition where the eyelid margin is covering a portion of the pupil. This varies from mild, moderate, and severe based on the amount of the pupil covered. There can be many reasons for this including congenital, neurologic, or acquired. The most common type of ptosis is acquired, or aponeurotic ptosis, where the levator muscle of the eyelid or the attachment between the levator muscle and the eyelid are stretched. This type of ptosis can be treated at the time of upper blepharoplasty.
The scars of an upper blepharoplasty tend to hide very well. This is especially true if they are designed to be in the natural crease of your eyelid. After the eyelid heals, it is often difficult to see upper eyelid lift scars.
Upper blepharoplasty reduces excess skin of the upper eyelid. This can give the eyes a more refreshed and youthful look. It also allows female patients to more easily apply makeup to the upper eyelid. In severe cases where the excess skin impairs a part of the visual field, reducing the skin excess can have functional benefits as well.
Upper blepharoplasty is typically performed on patients in their 30s, 40s, 50s, and beyond. That being said, some individuals who have excess skin above one or both eyelids that present earlier can safely have excess upper eyelid skin removed.
While every patient is different, an upper blepharoplasty lasts about 10 years. This is similar to the amount of time that the results from a facelift are generally thought to last. Once excess skin is removed, the clock is reset. As the eyelid opens and closes many times each day, that skin begins to stretch which leads to the development of excess upper eyelid skin and signs of aging. This is not a fault of the surgery but instead a natural aging process.
Yes. Upper blepharoplasty and lower blepharoplasty are often performed together. These operations are also often performed with brow lifts, facelifts, and other aesthetic plastic surgeries as long as the procedures can be performed in an expeditious manner.
Yes. Brow lift and upper eyelid blepharoplasty are commonly performed together during facial rejuvenation. These procedures can also be performed with a facelift as long as all three procedures can be performed in an expeditious manner.
Yes, upper blepharoplasty can be performed under local anesthesia. It is not a painful procedure and because the instruments are out of eyesight, it tends to be comfortable for both the surgeon and the patient.
If you are bothered by excess upper eyelid skin or ptosis then you may be a candidate for upper blepharoplasty. Individuals who are interested in upper blepharoplasty should be in good health and be fit for elective surgery. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing.
Lower blepharoplasty is a popular option for individuals with excess eyelid skin, large lower eyelid bags, and/or droopy lower eyelids. Lower blepharoplasty allows a plastic surgery to refresh the lower eyelids through volume reduction, skin removal, and sometimes, supporting or reshaping the aging eyelid.
Yes and no. In general, the lower eyelid appears to change with age. Sometimes the three fat pads of the lower eye become more prominent leading to a tired look. As we age, the fat of the midface droops and also loses volume. The combination of these two processes leads to the common appearance of aged and tired eyes.
Sometimes. In some individuals, the lower eyelid loosens and the entire lower lid appears lower. There are ways to tighten the lower lid including canthopexy and canthoplasty. These procedures can sometimes lead to an altered shape of the eye.
The scars for lower blepharoplasty vary depending on the approach. Sometimes, there is no scar or at least no visible scar. If only the fat pads need to be addressed, the incision can be made within the lower eyelid so that there is no external scar. If skin needs to be removed then a well-hidden incision can be made just under the lower lashes.
No, not always. Conservative removal of fat can give a very nice result. That being said, the fat can sometimes be transferred to above the tear trough to augment the midface and make the tear trough less visible. This can be a very powerful procedure in the correct patient.
Lower blepharoplasty can give the eyes a more refreshed and youthful look. Many times, patients complain that they look tired even after a great night of sleep. Lower blepharoplasty may help with this complaint.
Yes. Lower blepharoplasty is typically performed on patients in their 30s, 40s, 50s, and beyond. That being said, some younger individuals who have large lower eyelid bags decide to have a lower blepharoplasty in their 20s or earlier. It is unlikely in younger individuals that skin needs to be removed. Instead, the fat can be removed from a small hidden incision within the eyelid.
While every patient is different, a lower blepharoplasty is typically only performed once. The orbital fat that is removed is gone. Sometimes, a small amount of skin can be removed down the line.
Yes. Lower blepharoplasty and upper blepharoplasty are often performed together. These operations are also often performed with brow lifts, facelifts, and other aesthetic plastic surgeries as long as the procedures can be performed in an expeditious manner.
Yes. Lower blepharoplasty and upper eyelid blepharoplasty are commonly performed together during facial rejuvenation including facelifts. These procedures can be done together as long as all three procedures can be performed in an expeditious manner.
Maybe. This is surgeon-dependent. In my experience, even if the pain is controlled, patients do not like to be able to see instruments in front of their eyes. If the blepharoplasty is being performed through a transcutaneous approach (through the skin instead of through the inner eyelid), then doing a lower blepharoplasty under local anesthesia would be more tolerable. There are pros and cons to both approaches and the approach should not be determined based on anesthesia and cost.
If you are bothered by excess volume in your lower eyelid (bags) or excess lower eyelid skin, you may be a candidate for lower blepharoplasty. Individuals who are interested in lower blepharoplasty should be in good health and be fit for elective surgery. Patients with a history of eye problems or dry eyes require special consideration prior to lower blepharoplasty. Patients should avoid smoking and nicotine-containing products that can affect blood flow and, ultimately, healing.
