Blepharoplasty or Eyelid Surgery

The eyelids are one of the first facial features to show signs of aging. Sagging upper eyelids may require an eyelid lift. Puffy lower eyelids can belie a more youthful and energetic personality. Occasionally, hereditary factors contribute to puffiness of the lower eyelids even in younger patients. Blepharoplasty is an eyes & brows surgery which can restore vitality to the eyes. During upper blepharoplasty, Dr. Khosh utilizes perfectly hidden incisions to remove saggy upper eyelid skin. In lower blepharoplasty, Dr. Khosh often places the incision inside the lid, in order to avoid any scars. Excess fat from the eyelids is removed or repositioned to restore a youthful appearance. Redundant lower eyelid skin can be treated with a pinch excision or with laser skin resurfacing. Swelling or bruising resolves in about ten days, and most patients return to a full schedule within two weeks. Dr. Khosh offers other procedures such as brow lift, facelift, Botox treatments, laser skin resurfacing, filler injections and fat grafting to compliment the results from blepharoplasty.

As the overall intent of the surgery is to give you a more youthful and refreshed look. It would be beneficial for Dr. Khosh to view some old photographs, which could provide a template or model to work towards. Contact our office today to schedule a consultation with Dr. Khosh.

Case Study

This 70-year-old lady sought consultation for eyelid lift in New York. She wanted to address the droopy upper eyelids and the very puffy lower eyelids or bags under her eyes, causing her to look tired.

  • Patient: 70-year-old with saggy upper eyelids and puffy lower eyes
  • Problem: Droopy upper eyelid skin, puffy lower eyelids
  • Procedure: Upper blepharoplasty (eyelid lift) and lower eye lift performed via an incision inside the lower lid (also known as trans-conjunctival lower blepharoplasty)

Frequently Asked Questions Regarding Blepharoplasty

Who is a good candidate for upper blepharoplasty?
Patients with relatively good health with redundancy and hooding of the upper eyelid skin, with or without prolapsed fat in the eyelid.

Who is a poor candidate for upper blepharoplasty?
Patients with dry eye conditions, or patients with uncontrolled high blood pressure, or poorly controlled diabetes. Additionally, patients who must take blood thinners are poor candidates for upper blepharoplasty.

What kind of anesthesia is used for upper blepharoplasty?
Upper blepharoplasty can be performed under local anesthesia, deep sedation, or general anesthesia. In general, if blepharoplasty is performed as a stand-alone procedure, and the patient is not overly anxious, local anesthesia is recommended.

How is upper blepharoplasty performed?
Excess eyelid skin is marked on the skin. Incisions are designed so that the scar would not be visible once the area has healed. Excess skin and or fat is removed, and the skin edges are closed precisely.

When would a brow lift procedure be recommended for an upper blepharoplasty patient?
If clinical examination shows decent of the eyebrow below the orbital rim, brow lifting will have a significant impact in restoring a youthful appearance to the upper eyelids.

How is the recovery from upper blepharoplasty?
There will be swelling and bruising of the eyelids for about seven to ten days. Pain is moderate and most patients feel quite comfortable with use of Tylenol alone. Applying ice and sleeping in a head elevated position will hasten resolution of the swelling. Patients can shower the day after surgery, and apply makeup once the sutures are removed in four to six days.

Does insurance cover the cost of upper blepharoplasty?
If redundancy of the upper eyelid skin is so severe as to interfere with peripheral vision, some insurance companies will cover the cost of upper blepharoplasty, since the surgery will have a functional impact.

Who is a good candidate for lower blepharoplasty?
Patients with puffiness or fullness of the lower eyelid skin who want a more youthful and rested appearance to their eyes.

Who is a poor candidate for lower blepharoplasty?
Patients who must take blood thinners, those with uncontrolled high blood pressure or poorly controlled diabetes are poor candidates for upper blepharoplasty.

What is poor eyelid tone and how does it affect lower blepharoplasty?
The tightness or recoil of the lower eyelid is known as eyelid tone. You may test this by grabbing your lower eyelid and pulling it away from the globe. When you release the eyelid, if it snaps back into position quickly, you have good eyelid tone. If the lower eyelid returns to its position slowly or incompletely, you may have poor eyelid tone. In patients with poor lower eyelid tone, additional procedures to tighten the lower eyelid (canthoplasty or canthal suspension) may be necessary during lower blepharoplasty.

What are the different techniques for performing lower blepharoplasty?
There are two techniques for performing lower blepharoplasty: trans-conjunctival (incision inside the eyelid), and trans-cutaneous (incision on the eyelid skin). Each procedure has its own indications. For younger patients without significant skin redundancy, or in patients with laxity of eyelid margin, trans-conjunctival approach is preferred. In patients with significant lower eyelid skin redundancy, or when the orbital fat is transposed instead of removed, the trans-cutaneous approach may be preferred.

What kind of anesthesia is used for lower blepharoplasty?
We generally recommend sedation while performing lower blepharoplasty. The trans-cutaneous form of lower blepharoplasty can be performed comfortably under local anesthesia.

How is the recovery from lower blepharoplasty?
There might be slight oozing of blood from the incision site for half a day. There will be bruising and swelling in the lower eyelid region that usually resolves by the tenth postoperative day. Applying ice and sleeping in an elevated position will minimize swelling. Most patients will return to their daily activities within two weeks.

What is recovery for cosmetic eyelid enhancement?
Typically, some bruising ensues following eyelid rejuvenation. This bruising is dissipated after 10 to 14 days. When skin sutures are present, they are removed 5 to 6 days following surgery. The patients may apply makeup following removal of the sutures. Eyelid surgery is usually not painful and patients do not require pain medication after the first day.

Related Procedures

Eyelid rejuvenation with upper and or lower blepharoplasty may be combined with other cosmetic treatments to enhance the facial appearance. Forehead lift and facelift rejuvenate the upper and lower face respectively. Non surgical treatments such as Botox injections and filler injections can soften the appearance of the forehead, crow's feet region, and the mid face. Fat transfer from the lower body to the face can affect a more permanent result than injectible fillers.Laser treatments with fractional lasers can erase fine wrinkles and improve the texture and color of the facial skin.