Eyelids (Blepharoplasty)

 

Our eyes reflect so much about us. When we age, the droopy upper lids and bags under our eyes make us look tired. By getting rid of excess fatty deposits that hood the upper eyelids, repositioning excess muscle, and removing excess skin, the eye seems to open up again, creating a more energetic and youthful appearance. Sometimes the lower lid might be readjusted to better frame the iris. Repositioning periorbital fat is sometimes helpful as well as re-insetting the lower lid lateral attachment. After training with a dedicated oculoplastic surgeon, I find blepharoplasty surgery to be among the most attractive types of surgery, as it is minimally invasive to patients and provides a satisfying result.

 

Eyelid aesthetic surgery is also known as eye lift or blepharoplasty

When to Consider Eyelid Surgery

·       If you have excess, hanging skin covering the natural fold of the upper eyelids

·       If you have loose skin hanging down from the upper eyelids over the eyelashes

·       If your upper and lower eyelids appear puffy, making your eyes look tired and aged

·       If you have deep grooves under your eyes


 

Pros

·       You will eliminate the puffiness and bags under your lower lids and the hooded skin on your upper lids, making you appear younger and healthier.

·       You may no longer have vision problems related to overhanging eyelids.

·       Any scars from the eye lift will be hidden in your natural eyelid creases, making them almost indiscernible.

Cons

·       It will take time to see results after surgery.

·       You'll likely be bruised and swollen and your eyes may be itchy and dry following the procedure.

·       If your eyebrows droop and you have creases in your forehead, you may also need a brow lift.

These are the top three pros and cons to weigh when considering eyelid surgery. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.

 

Are you a good candidate for eyelid surgery?

The following are some common reasons why you may want to consider eyelid surgery:

·       You have excess skin obscuring the natural fold of the upper eyelids

·       You have loose upper eyelid skin that impairs your vision

·       You have a puffy appearance to the upper eyelids, making your eyes look tired and sad

·       You have excess skin and fine, ‘crepe paper’ type lower eyelid wrinkles

·       You have bags and dark circles under the eyes

·       Your upper eye surface is too small or not smooth enough to apply makeup

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.


Detailed Procedural Info

How is a eyelid surgery procedure performed?

Eyelid surgery (blepharoplasty) can be performed on your upper eyelids, lower eyelids, or both. Based on a preoperative evaluation of factors such as your underlying facial muscle structure, bone structure, and the symmetry of your eyebrows, Dr. Rosing will decide how much skin, muscle, and/or fat to remove.

·       Dr. Rosing will make precise markings to indicate where excess tissues will be removed in your upper eyelids and in your lower eyelids.

·       In your upper eyelid, Dr. Rosing will make an incision hidden within the natural fold of the upper eyelid.

·       In the lower eyelid, the incision will be hidden just below the lower lashes. Alternatively, when excess fat is being removed, the incision can be placed inside the lower eyelid (transconjunctival incision). A laser may sometimes be used in conjunction with this method to tighten lower eyelid skin.

·       Dr. Rosing will remove tissue through these incisions using surgical instruments, including scalpels, surgical scissors, radiofrequency cutting devices, and, sometimes, cutting lasers.

·       Sometimes fat may be redistributed in the lower lids to eliminate puffiness or bulges. Dr. Rosing may make other adjustments to correct special problems such as muscle laxity.

·       He or she will then apply sutures or tissue adhesives (glue) to smooth and reconfigure areas around the eyebrows and eyelids. Sutures are invisible to the eye and are commonly self-dissolving. In most cases, there is virtually no detectable scar.

·       Less tissue is removed in patients with dry eyes to avoid exposing more of the eye to the air, which can cause symptoms to worsen.

·       Dr. Rosing also may use a laser to enhance the procedure by resurfacing skin and smoothing wrinkles in the eyelid and eyebrow area.

What are my options?

Dr. James Rosing is board-certified in plastic surgery and focuses on eyelid aesthetic and reconstructive procedures. During your consultation, he will educate you as to what your options are and in his assessment, which is the right procedure for you based on your physical characteristics and aesthetic concerns.

Upper eyelids 
Dr. Rosing will place the incision line at the natural eyelid crease through which he or she will remove excess skin, muscle, and fat. Lasers may be used to remove this excess tissue to reduce swelling and bruising.

  Upper blepharoplasty procedure. The result to look for here is realized when measuring the distance from the eyelashes of the upper eyelid to the crease. After the procedure, this distance will be greater as the excess skin that falls over the lid fold is removed. These cases are routinely done in the office using numbing injection +/- oral medication for relaxation. The case takes about one hour and there is 1-2 days downtime. I see patients back in the office after one week to remove the suture that is placed along the lid crease. Upper blepharoplasty is one of the most underutilized procedures by both men and women. The procedure is straight forward technically, subtle yet significant aesthetically, with little downtime.

Upper blepharoplasty procedure. The result to look for here is realized when measuring the distance from the eyelashes of the upper eyelid to the crease. After the procedure, this distance will be greater as the excess skin that falls over the lid fold is removed. These cases are routinely done in the office using numbing injection +/- oral medication for relaxation. The case takes about one hour and there is 1-2 days downtime. I see patients back in the office after one week to remove the suture that is placed along the lid crease. Upper blepharoplasty is one of the most underutilized procedures by both men and women. The procedure is straight forward technically, subtle yet significant aesthetically, with little downtime.

Lower eyelids
There are a number of options for performing lower eyelid surgery:

·       The traditional approach places the incision just below the eyelashes, trimming and/or repositioning excess skin and fat, and tightening the lower eyelid muscle.

·       In the transconjunctival approach, effective in improving lower eyelid bags and puffiness, Dr. Rosing places the incision inside the eyelid. Dr. Rosing can remove excess fat through a transconjunctival incision, but not excess skin.

·       The ‘skin pinch’ blepharoplasty removes only a bit of skin. This is effective if you have strong lower eyelid support and only a little extra skin. In some patients laser resurfacing can both tighten excess skin and remove wrinkles.

   Lower eyelid blepharoplasty, transcutaneous approach with fat transfer. I perform a canthopexy for all transcutaneous lower blepharoplasty cases.

Lower eyelid blepharoplasty, transcutaneous approach with fat transfer. I perform a canthopexy for all transcutaneous lower blepharoplasty cases.

·       The use of hyaluronic acid (HA) fillers is a nonsurgical alternative for the lower eyelids. Restylane, Juvéderm, and other soft tissue fillers can be injected into the tear trough (crescent-shaped under-eye area) to rejuvenate the appearance of the under-eye area. Results are varied and last approximately six months.

What will my eyelid surgery incisions and scars be like?

Upper eyelid surgery: Dr. Rosing will mark the natural lines and creases of your lids and keep your scars as hidden as possible along these natural folds. Fine sutures will be used to close the incisions, thereby minimizing scar visibility.

Lower eyelid surgery: In traditional blepharoplasty, Dr. Rosing will make the incision in an inconspicuous site along the lash line and smile creases of the lower lid. In a transconjunctival approach, Dr. Rosing corrects eyelid puffiness caused by excess fat by making an incision inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin