As we age, the delicate skin around the eyes begins to sag and wrinkle. Excess skin and fat around the eyes can cause puffiness and give you a tired, aged appearance. In more extreme cases, the sagging upper eyelid skin obstructs vision. Our board-certified plastic surgeon, Joseph Mele, MD, FACS, is extensively trained and experienced with advanced eyelid surgery procedures that can address these common concerns.
What is Eyelid Surgery?
Eyelid surgery, also known as blepharoplasty or an “eyelid lift,” is a procedure designed to address aesthetic or functional concerns relating to the upper and/or lower eyelids. By removing excess skin and fat, and tightening the skin around the eyes, an eyelid lift can enhance the appearance of your eyes, improve your peripheral vision, and restore your self-confidence.
Eyelid Surgery Video Presentation
Am I a Good Candidate for Eyelid Surgery?
You may be a good candidate for eyelid surgery (blepharoplasty), if you have:
- Excess skin obscuring the natural fold of the upper eyelids
- Loose skin hanging from the upper eyelids, maybe even impairing your vision
- Excess skin causing bags and wrinkles on the lower eyelids
- Puffy appearance on the upper eyelids, making your eyes look worn down and tired
- Bags and circles under the eyes, often with a depression that accents the bony border beneath the lower eyelids
- Droopiness of the lower eyelids, revealing the white (sclera) below the colored iris
The best way to decide if blepharoplasty is right for you is to schedule a private consultation with Dr. Mele so that an evaluation of your concerns can be addressed. A generous amount of information about eyelid surgery is detailed below; however, a consultation is interactive and specific to your situation. During your consultation, the options pertaining to your needs are discussed in detail and your questions are answered in an individualized manner. This allows crafting the best possible approach for your procedure.
Eyelid Surgery Before-and-After Photos
What Are the Various Types of Eyelid Surgery?
Dr. Mele is experienced with multiple blepharoplasty techniques including:
- Subciliary Blepharoplasty – allowing for the removal of excess lower eyelid fat
- Transconjunctival Blepharoplasty – incisions are hidden inside the lower eyelid
- Asian Eyelid Surgery – tailored to the unique anatomy of the Asian eyelid
Dr. Mele is also trained in various reconstructive eyelid tightening procedures that can address functional concerns with the eyelids, including:
- Ptosis Repair – to lift a sagging upper eyelid
- Ectropion Repair – to repair a droopy lower eyelid
- Entropion Repair – to reposition the eyelid when the eyelashes rub on the eye
The following sections describe the various eyelid surgery types and techniques in greater detail. If you have questions, or if you would like to schedule a consultation with Dr. Mele, please contact our office.
Upper Blepharoplasty – Upper Eyelid Lift Surgery
Blepharoplasty of the upper eyelids is often called “upper blepharoplasty.” While a variety of problems can be improved with upper eyelid surgery, the most frequent correction is the removal of excess skin. Upper blepharoplasty removes the redundant skin that accumulates on the upper eyelid and allows for a more awake and youthful appearance. Too much upper eyelid skin makes us look tired and inattentive. If you wear eye makeup, you know this extra skin can rub and distort even the most carefully applied cosmetics.
Upper Blepharoplasty (Palpebral Fold Incision)
A thin, curved incision is made in the upper eyelid fold to remove extra skin. The removal is performed so that the closure will hide in the arch of the normal fold, and not be visible with the eye open. The upper eyelid has the thinnest skin on your body, so this incision normally heals quickly and is usually difficult to detect.
Upper blepharoplasty can also be combined with ptosis surgery. Ptosis surgery is designed to correct an eyelid that droops down to, and sometimes over, the pupil, blocking vision. While too much upper eyelid skin can sometimes weigh the eyelid down and block peripheral vision, ptosis may be caused by stretching, weakness, or detachment of the main muscle that opens the upper eyelid. It is important to be checked for ptosis as part of your blepharoplasty consultation.
Lower Blepharoplasty – Lower Eyelid Lift Surgery
Blepharoplasty of the lower eyelids is often called “lower blepharoplasty.” The most frequently used approach for correction of a baggy lower eyelid is the subciliary incision. Unlike upper blepharoplasty, lower blepharoplasty is concerned less with excess skin and more with excess fat of the lower eyelids. Bags beneath the eyes are seldom solely a problem of excess skin. Often, the fat in the lower eyelid pushes forward beneath the skin and gives rise to excess lower eyelid fullness. Removal or repositioning of this fat can smooth out the lid and improve your appearance.
Lower Blepharoplasty (Subciliary Incision)
Subciliary literally means below the hairs, and a subciliary incision is placed just below the eyelashes of the lower eyelid. This provides a discreet location and the ability to both remove the excess and tighten the lower eyelid skin. Even more importantly, it allows Dr. Mele to remove any excess lower eyelid fat. Repositioning the lower eyelid fat may work better if you have a hollow adjacent to your lower eyelid bags. The fat can be removed from where it is excessive, and transplanted to where it is lacking, further smoothing your results.
Lower blepharoplasty can also be combined with ectropion repair. Ectropion is a problem with the position of the lower eyelid, where the eyelid droops and gaps away from the eye. This can occur as a normal part of aging or from injury to the lower eyelid. If the eyelid is lax, cosmetic surgery can be performed; however, additional attention is paid to the lower eyelid to physically support and tighten the lid. Checking for lower eyelid laxity is a routine part of your blepharoplasty evaluation.
Lower Blepharoplasty (Transconjunctival Incision)
When the lower eyelid skin is already smooth and tight, and the major problem is a bulging fat pad causing bags under the eye, a transconjunctival approach to lower blepharoplasty is preferred. The moist pink lining of the eyelids is called the conjunctiva. A transconjunctival incision is made along the inside of the lower eyelid. This provides completely hidden access to the fat pads of the lower eyelid, without any external scar.
Transconjunctival Blepharoplasty Before-and-After Pictures
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- Before surgery, the skin is tight but excess fat beneath the eye causes a visible bulge. Shadowing from this bulge can enhance dark circles under the eyes.
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- After lower eyelid surgery with the internal approach (transconjunctival blepharoplasty), the fat bulge beneath the eye is removed and there is no external scar.
The transconjunctival approach is ideal for young patients with bags under their eyes who have good skin tone and smooth lower eyelid skin. Since most blepharoplasty patients do not have smooth lower eyelid skin, the transconjunctival approach is not performed as frequently. Patients with only fine wrinkles, however, can sometimes choose the transconjunctival approach for fat removal and follow this up with an ancillary procedure such as a chemical peel or laser skin resurfacing to reduce their fine wrinkles.
Asian Blepharoplasty (Asian Eyelid Surgery)
Asian eyelid surgery is blepharoplasty modified to the anatomy of the Asian eyelid. Since the structure inside the eyelid is different when compared to the Caucasian eyelid, different techniques may be necessary to achieve the best results. Additional attachments inside the Caucasian eyelid cause a single dominant fold in the upper eyelid skin, and block the eyelid fat from dropping down inside the eyelid. The upper eyelid fold in the Asian eyelid is less defined, and it is often a series of multiple incomplete folds, none of which extend fully across the lid. The fat in the Asian upper eyelid sits lower in the lid and adds to the upper eyelid fullness.
Asian Blepharoplasty Before-and-After Pictures
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- Before Upper Blepharoplasty: The upper eyelid skin is resting on the eyelashes.
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- After Upper Blepharoplasty: The fold above the eye remains smooth and discrete.
Different approaches are selected depending on the desired result. When a more distinct fold is desired, the goal is to create a single fold that extends completely across the upper eyelid which gently curves above the eyelashes. The upper eyelid fat can be positioned higher in the lid, or selectively removed to decrease the upper eyelid fullness. It is important to discuss these options as part of your blepharoplasty consultation.
For additional information about Asian Blepharoplasty, be certain to visit our page dedicated to Asian Eyelid Surgery.
Eyelid Surgery for Functional Concerns
As mentioned above, sometimes the changes in the eyelids are more than cosmetic. Functional problems can occur with age or as the result of injury. A thorough evaluation before your blepharoplasty can discern these types of problems so they can be repaired concurrently.
Ptosis Repair
For the upper eyelid, the lid can droop over the eye and obstruct vision. This is termed blepharoptosis, and different types of Ptosis Repair are available depending on the severity of the ptosis.
Ectropion Repair
For the lower eyelids, drooping results in downward migration of the eyelid, away from the eye. When the lid rolls outward, it is termed ectropion. Which Ectropion Repair will work best depends on the amount of ectropion.
Eyelid Malposition
Malposition means wrong position. Eyelid malposition can result in visual obstruction, dry eyes, tearing, and if left untreated, it can lead to blindness. Different corrections are needed depending on the severity of the malposition. It is important to see a qualified eyelid surgeon, like Dr. Mele, so that the best options for your eyelids are selected.
To schedule a consultation with Dr. Mele, call (925) 943-6353 or fill out our contact form at the bottom of this page.
Preparation for Blepharoplasty
Dr. Mele will review how to prepare for your eyelid rejuvenation at your preoperative appointment. Your individual instruction may vary, but in general, very little disruption of your daily routine is usually necessary. You should be in good health. Any pre-existing medical problems should be identified and controlled prior to surgery. If you catch a cold prior to surgery, please call the office and let us know.
Avoiding medications or supplements that increase the risk of bleeding during the weeks leading up to surgery is very important. Bleeding not only makes the procedure more difficult, it also increases post-operative bruising and discomfort. Bleeding also increases the risk of complications, so minimizing the chance of bleeding is always worthwhile.
Regardless of the type of anesthesia selected, general or local with sedation, you should not eat or drink anything for eight hours prior to surgery, unless you are specifically instructed otherwise. Many prescription medications should be taken the morning of surgery with a small amount of water, but each medication needs to be reviewed.
On the day of surgery you will want to arrive rested and about an hour before the scheduled operative time. Avoid makeup, especially eye makeup, the day of the procedure. Dr. Mele will review the day’s plan and outline the goals. A preoperative checklist is completed so that everything is ready for your blepharoplasty procedure.
What Does the Blepharoplasty Procedure Involve?
During blepharoplasty surgery, Dr. Mele makes a discreet incision along the crease of the lid. The exact location is selected to maximize your results while minimizing the scar. Next, the extra skin, fat, and occasionally a small amount of excess muscle are removed. The incision is then meticulously closed, resulting in smoother eyelid skin, which is both tightened and lifted.
All cosmetic procedures are performed in an accredited surgical facility. Blepharoplasty can be performed under local anesthesia with light sedation, or under general anesthesia. The method best for you will be determined as part of your personal blepharoplasty consultation.
Blepharoplasty can be combined with other facial plastic surgery procedures to achieve balanced facial rejuvenation. This treatment is often combined with brow lift, facelift, cheek augmentation (cheek implants), and other cosmetic plastic surgery procedures. Dr. Mele will be happy to explore all of your options with you if you are interested in additional treatments.
Blepharoplasty Introduction Video
What Can I Expect During Blepharoplasty Recovery?
After your eyelid surgery you should have fairly mild discomfort. Tylenol® is often sufficient for pain control, though stronger medication is sometimes needed for a few days. Elevation of the head and cool compresses to the eyes are recommended for the days after surgery. Sunglasses are recommended after eyelid surgery when you are outside. Dark glasses are not just a good disguise—they help to block the wind if your eyes feel dry, and they reduce glare if you are sensitive to light. This helps speed your healing and will make you feel better faster. Most upright activities are permitted; however, vigorous activities that increase your heart rate and raise your blood pressure are to be avoided. Bending down, straining, and lifting heavy objects are also prohibited after blepharoplasty until Dr. Mele clears you for those actions.
Follow-up visits are scheduled at critical points after surgery to make sure you are healing well. Activities will be liberalized as your healing progresses. Regular activities are usually possible a week or two after your procedure. Scar management will also be reviewed to speed your healing and minimize any scarring.
How Noticeable Are Eyelid Surgery Scars?
Eyelid skin is the thinnest skin on your body. As a result, surgical scars after eyelid surgery also tend to be thin and inconspicuous. The goal is to hide the scar in the folds around the eyelids, so that even thin scars are hard to see.
For the upper eyelids, the scars are placed in the eyelid creases. When the eyes are open, the majority of the scar is hidden in the fold. In fact, for Asian Eyelid Surgery, the scar helps enforce the fold in double eyelid surgery. If you have lateral hooding, the upper blepharoplasty incision is carried to the side of the eye. This scar extension can be hidden in a smile line, and allows for the removal of the excess skin that blocks lateral gaze.
For the lower eyelids, the incision is made in one of two locations. The most common placement is just below the lower lid’s eyelashes. This allows the scar to hide along the edge of the lid and it is usually difficult to see. This placement allows for the unpacking of the lower eyelid bags and removal of excess lower eyelid skin. Additional tightening is accomplished by extending the incision down and away from the lid laterally. This incision extension is hidden in a smile line like the upper eyelid’s extension, and allows for further tightening of the lower eyelid.
The second place that the lower eyelid incision is made is inside the lower eyelid. This incision does not allow for the removal of excess lower eyelid skin; however, for young patients with overly full lower eyelids and tight skin, it allows the incision to be completely hidden. This incision does not provide optimal improvement for most of Dr. Mele’s San Francisco Bay Area blepharoplasty patients, but if you are a candidate, it can be an excellent option for you.
How Long Do the Results from Eyelid Surgery Last?
Blepharoplasty removes the excess skin and fat from the eyelids. The fat does not grow back, so having to go back and remove more fat is not common. The skin can loosen with age, and this is the most common reason to redo blepharoplasty. Even so, most eyelid surgery patients only need one operation.
Risk factors for a second operation include: initial surgery at a young age; poor skin elasticity; sun damage; smoking; and brow ptosis (sagging) with age. Sun damage and smoking can be mediated with good habits. Elasticity can be improved with proper skin care and sun avoidance. If a second operation is needed, it is usually for recurrent skin laxity, and it tends to be a smaller procedure limited to the skin.
Longevity of blepharoplasty can also be enhanced with non-surgical procedures, such as dermal fillers and BOTOX® Cosmetic. Be certain to ask about maximizing and maintaining your results.
How Much Does Eyelid Surgery Cost?
The cost of eyelid surgery varies with what needs to be done and the type of anesthesia utilized. Standard eyelid surgery includes the removal of excess skin and fat, but sometimes there are other problems that require correction.
If the upper eyelids sag and threaten to block vision, additional surgery may be performed to tighten the muscles that open the eyelids. If the lower eyelids have poor tone, a lid shortening procedure may be needed to prevent the eyelid from moving away from the eye.
If the eyelids are aging together, often the upper and lower blepharoplasty can safely be performed together. This can provide a cost savings. An exception is patients with dry eyes prior to surgery. In these cases, the upper and lower eyelid procedures should be separated to decrease the risk of chronic dry eyes.
Local anesthesia costs less than general anesthesia. So having the procedure under local can save you money, but only if you can tolerate it. Local anesthesia means you are awake. Sedation can be added to help you relax. This is given intravenously just before the numbing-up process. For your safety, IV sedation requires careful monitoring.
It is important to note that sedation does not mean asleep. If you want to be asleep, general anesthesia is the better option for you. Patients who are extremely nervous do better with the help of an anesthesiologist. In general, half my patients prefer sedation and half prefer general anesthesia.
There are many variables, so giving a precise range without seeing you is difficult. The office can supply you with a current price range if you call (925) 943-6353. An estimate is supplied with all consultations, and this gives us a chance to go over all of the applicable options for your eyelids. Financing is an option, and more information about financing is available on our plastic surgery financing page.
Complementary Procedures
Blepharoplasty can be performed by itself, or with other aesthetic facial procedures. When the eyelids are “in the lead” in aging, correcting them restores facial harmony. In some cases, only the upper or lower eyelids need maintenance. In other cases, it makes sense to do both upper and lower blepharoplasty together.
In some cases, when the eyelids, lower face, and neck are aging together, complementary procedures may be discussed with the goal of maintaining facial balance. It is not unusual to perform blepharoplasty during a facelift, neck lift, or other facial plastic surgery. Facial harmony is more important than any one procedure. Dr. Mele carefully assists patients who are interested in combining surgeries for optimal results.
Non-surgical procedures can also be complementary. FIllers are used for periorbital hollows or to smooth the tear troughs. BOTOX® Cosmetic is used to smooth animation lines around the eyes such as frown lines and smile lines (crow’s feet). BOTOX® injections can also be used in some cases to elevate the brow and open the eyes.
Contact Our Practice
If you are looking to improve the appearance of your eyes, consider a blepharoplasty consultation at our San Francisco Bay Area and Walnut Creek, CA, office. This simple, outpatient procedure can produce dramatic results.
For your convenience, blepharoplasty before-and-after photos are available to view online. If you would like more information, or if you are ready to schedule a consultation with our plastic surgeon, please call (925) 943-6353 or fill out our contact form.