Eyelid skin is the thinnest skin on your face and is likely to be the first facial feature to reveal signs of aging. Wrinkled folds of skin on the upper eyelids, bags under the eyes and sagging eyebrows can make a person look older, tired or sad. Plastic surgery can reshape the eyelid area and improve appearance.

What is a blepharoplasty?

A blepharoplasty is a surgery that removes excess skin and fat on upper and/or lower eyelids. It is commonly done for cosmetic reasons. It may also be done to improve vision if the skin folds interfere with normal vision.
Blepharoplasty is a common form of cosmetic surgery. Thousands of these procedures are performed successfully each year.

Who performs a blepharoplasty?

Most blepharoplasties are performed by oculoplastic surgeons (physicians who specialize in plastic and reconstructive surgery of the eye), by plastic surgeons or by ear-nose-throat surgeons. Dermatologists (skin doctors), general ophthalmologists, and oral-maxilofacial surgeons are also performing more of this surgery currently.

What types of cosmetic eyelid surgeries are done?

The most common type of oculoplastic surgery is removal of excess skin and fat on the upper eyelids.

Often, the surgeon simultaneously reconstructs the eyelid creases to create a more pleasing appearance. This method may also be used to make oriental eyes look more western.

Excess skin and fat can also be removed from the lower eyelids (bags under the eyes). Additionally, drooping eyebrows may be lifted. This is done by one of several different methods. The most common techniques involve lifting the brow through the same incision made for the blepharoplasty or by endoscopically elevating the brow. The brow can also be lifted by removing excess skin above the brow or on the scalp. Droopy eyelids also may be corrected by tightening eye muscles. If required, all these changes may be made during a single surgery.

What results can the patient expect?

During the first visit to the surgeon, the patient and doctor discuss the surgery and the expected results of the surgery. The patient looks in a mirror and points out what he or she would like to improve in appearance. The surgeon then evaluates the patient’s facial features to determine if surgery can help the problems the patient wants corrected. The amount and type of surgery done depends on the patient’s goals, medical history, general health, age and skin texture.

The surgeon and patient discuss the patient’s motives for and expectations of the surgery as well. It is important to have realistic expectations. Cosmetic eyelid surgery can improve appearance, not make it perfect. Moreover, eyelid surgery cannot correct some blemishes, such as skin discoloration, fullness of cheeks and deep eyelid creases. The surgery improves this condition, but does not remove wrinkles on the outer edges of the eyelids.

What blepharoplasty does is to create a smoother area around the eyes, giving a more youthful look. A brow lift results in a more alert appearance.  Most of the cosmetic changes occur in the first few weeks after surgery. However, the entire effect of the surgery may not be apparent for a year. Depending on the patient’s physical traits and the type of procedure applied on the patient, one may decide to repeat the surgery in five to 20 years.

How and where is blepharoplasty performed?

Most patients are operated on in an out patient surgical facility or may have surgery as an outpatient at a hospital. The choice depends on the patient’s preference and health. Generally, sedating as well as anesthetic agents are used during the procedure to keep the patient comfortable.

How safe is cosmetic eyelid surgery?

Modern cosmetic surgical procedures are very safe. Complications such as infection or blood clots are rare. However, aspirin, aspirin products, non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil), naprosyn and others can cause excessive bleeding during and after the surgery. The patient should therefore not take aspirin or NSAIDS for two weeks before the surgery. In addition, “blood thinners” such as warfarin (coumadin) must be managed by the appropriate attending physicians before the time of surgery.

It is normal to have some bruising and swelling for a week or so after surgery. Cold compresses applied to the eyes can help reduce these problems. If there are obvious bruises even after a week of healing, they can be covered with makeup.

The stitches will be removed several days after surgery, leaving very fine scars. These scars will be barely visible within two months. Sometimes, however, a noticeable scar remains after a brow lift as excess skin is removed directly above the brow. A scar can be avoided by lifting the brow through the upper eyelid incision.

Noticeable scars or more severe problems result from poor healing after eyelid surgery. Such problems may require a second, touch-up operation. The likelihood of complications is reduced by adhering to the doctor’s instructions on follow-up care.

One lower lid blepharoplasty method avoids even the smallest scars. This technique involves making a cut on the inside, rather than the outside, of the lower eyelid. A dissolving suture is used, so there is no need for suture removal and consequently there are no visible scars. There also is less bruising and swelling. The “internal” approach is best for persons younger than 50 or others who need only fat removed (rather than fat and skin).

Can laser be used for blepharoplasty?

A new way to perform eyelid surgery is with a contact laser that has a probe like a scalpel. This scalpel uses heat energy to cut through skin, muscle and fat.

The advantages are a faster operating time and less bleeding and pain. When done by an expert, this procedure appears to be as safe as traditional blepharoplasty. However, very little is known about the risks of laser.

How much does a blepharoplasty cost?

Surgical fees vary widely depending on the length and complexity of the operation. They range from $1,000 to $4,000 or more, according to the American Society of Plastic and Reconstructive Surgeons. Most insurance plans do not cover the cost of blepharoplasty unless the surgery is needed to improve vision.

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