As one of the first things that most people look at, your eyes have a big impact on your face. Small changes around the eyes can affect your whole appearance, making you look tired, angry, or just plain unapproachable. Unfortunately, aging often shows up first on the eyes. Decreases in elasticity can lead to sagging around the corners that gives a sad look, bags underneath that make you look tired, and sagging of the upper lids that can make you look angry or even obscure your vision. Some people even experience these issues early on, giving them life-long issues with sleepy-looking eyes.
Blepharoplasty, or eyelid surgery, can correct these appearance issues by removing excess skin and fat from the eyelids. This decreases sagging and under-eye bags, which can make your entire face look alert, awake, and years younger. Eyelid surgery can also correct some texture issues like crepey skin or grooves under the eyes.
Your first step toward correcting your eye problems is a consultation with Dr. Masri. During this initial meeting, you’ll explain what is bothering you and go over your concerns about and goals for the surgery. Dr. Masri will evaluate the problem, discuss realistic surgical outcomes for your situation, and carefully explain your options.
Blepharoplasty is available for both the upper and lower lids, depending on your specific combination of problems. Sagging of the upper lid is always corrected the same way with the incision placed at the crease of the eyelid to allow removal of skin and fat while camouflaging the scar.
For under-eye issues, Dr. Masri will walk you through the incision options available. The traditional blepharoplasty uses an incision along the lash line to allow full removal of excess skin as well as fat. If your only issue is excess fat causing the appearance of bags, there is also a transconjunctival incision, which is placed just inside your eyelid to allow removal of fat but not skin. This incision leaves no visible scar.
Dr. Masri will also discuss other procedures that you may wish to have at the same time as your eyelid surgery. Many patients have the procedure in conjunction with a face lift, a brow lift, or fat transfers or fillers to plump the area and further reduce signs of aging.
Once you’ve settled on the details of your procedure, you’ll also go over your medical history as well as any precautions that you may wish to take to reduce the normal risks of surgery.
Your blepharoplasty will begin with sedation. In most cases, eyelid surgery is performed with a local anesthetic and intravenous sedation, but general anesthesia is available for patients who prefer it.
Once you are sedated, Dr. Masri will begin by making the appropriate incisions on the crease of your upper lid, inside the lower lid, or on the lashline of the lower lid. These will be carefully placed in such a way as to blend with the natural contours of your eyelids to hide any scarring. He will then remove excess skin and fat to reduce sagging, remove crepey skin, reduce bags, and correct other issues.
Once everything has been carefully recontoured, the incisions will be closed, dressings will be placed, and you will be sent off to the recovery room.
For the first few days after your surgery, there will be swelling and bruising around your eyes. Many patients experience blurred or double vision due to the swelling, as well as tearing issues like dry eyes or excessive tearing. These problems typically resolve within a week or two. Ice packs and eye drops will both be useful to reduce these side effects. In most cases, pain is quite minimal and should be easily controllable with over-the-counter medications as long as you avoid drugs like aspirin that can increase bleeding.
After surgery, you should take care to keep your head elevated. This means sleeping in a reclined position rather than lying down for the first few days. Strenuous activities should be avoided, since they can raise blood pressure and increase bleeding and swelling. In most cases, patients can return to work within two weeks. Your incisions may be visible for a while, but the scars will fade for up to a year.
Possible Risks and Complications
Like all surgeries, eyelid surgery brings a slight chance of bleeding, infection, negative reactions to anesthesia, and hematoma. There are also chances of changes in sensation like numbness or tingling or visible scarring. Both of these problems normally resolve on their own within a year. Visible scarring can be minimized with proper care such as avoided unprotected sun exposure.
Blepharoplasty also has two more specific risks: Dry eyes and malformations. Dryness of the eyes is very common in the first week or two after surgery due to friction from the swelling, but in a few cases it persists for longer, leading to potential damage to the corneas. Any lingering dryness should be brought up during your follow-up visits so that it can be corrected. In extreme cases, surgical correction may be necessary.
Malformations of the lower eyelid are another rare but possible complication. This normally consists of the lower lid tightening too much after surgery, which can cause incomplete lid closure. While this sometimes resolves on its own as swelling decreases, lasting malformation will require surgical correction.
Eyelid Surgery FAQs
Will my insurance cover eyelid surgery?
Insurance companies can cover blepharoplasty if it is to correct a legitimate interference with vision. In most cases, they will require a picture of the problem as well as a documented exam, which can be conducted at your consultation.
I have sagging around my upper eyelids. Should I get blepharoplasty or a brow lift?
It depends on exactly which part is sagging. Excessive skin on the eyelid itself may require eyelid surgery to correct, but if the problem is the skin under the brows, a brow lift will be more appropriate. It can sometimes be hard to tell exactly which part is the problem, so a professional consultation may be useful to determine the correct solution.
Can blepharoplasty change the shape of my eye?
In most cases the goal of eye surgery is to rejuvenate the eye without changing the shape. If the patient desires a shape change, however, certain techniques can create almond-shaped eyes, add a crease to the eyelid, or otherwise change the shape of the eye. It’s important to remember that this will be a permanent change and carefully consider how a change in eye shape will change your entire face before making a decision.
Can eyelid surgery correct asymmetrical eyes?
Most people have some degree of asymmetry in their eyes, and the possibility of surgical correction depends on the reason for it. Blepharoplasty may be an appropriate solution if the asymmetry is caused by different amounts of sagging on each side, but if the problem is with the underlying bone structure, eyelid surgery will not correct it. Fillers may be used in certain cases to bring a more symmetrical appearance.
Can under-eye bags be treated without surgery?
In some cases, fillers can be used to camouflage bagging by plumping the surrounding areas. To reliably remove or relocate the fat causing the bags, though, eyelid surgery is usually necessary. If bags are the only problem, the less invasive transconjunctival incision can be a good choice.