What is a Blepharoplasty?
A blepharoplasty or eyelid lift is a surgery that removes excess skin from the upper or lower eyelids for functional or cosmetic purposes. Blepharoplasties are one of the most common plastic surgeries and are very effective. A blepharoplasty can be performed by general plastic surgeons, facial plastic surgeons, and oculoplastic surgeons.
When to Consider Blepharoplasty or 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 and Cons of Eyelid Lift Surgery
- 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.
- 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.
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 and have realistic expectations, you are most likely a good candidate for this procedure.
How is a Blepharoplasty 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. Gruber will decide how much skin, muscle, and/or fat to remove.
Dr. Gruber 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. Gruber 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. Gruber 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. Gruber may make other adjustments to correct special problems such as muscle laxity.
Dr. Gruber 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.
What are my options?
Dr. Gruber will choose the right procedure for you based on your physical characteristics and aesthetic concerns.
Dr. Gruber will place the incision line at the natural eyelid crease through which he or she will remove excess skin, muscle, and fat. Stitches are placed and taped to the temples and forehead to avoid knots.
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. Gruber places the incision inside the eyelid. Dr. Gruber 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.
- 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.
- Natural Fat Transfer to the cheekbone area can also be effective in hiding under eye bags and grooves.
What will my eyelid surgery incisions and scars be like?
Upper eyelid surgery: Dr. Gruber 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. Gruber will make the incision in an inconspicuous site along the lash line and smile creases of the lower lid. In a transconjunctival approach, Dr. Gruber corrects eyelid puffiness caused by excess fat by making an incision inside the lower eyelid. This technique requires no external incision.
Your initial consultation appointment
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Dr. Gruber will evaluate you as a candidate for eyelid surgery and clarify what blepharoplasty can do for you.
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Previous surgeries
- Past and present medical conditions
- Allergies and current medications
It is important to be completely honest during the consultation. Also, bring photos of yourself at an earlier age; they may serve as a good point of reference for discussing your goals. It’s a good idea to be fully prepared to answer these questions:
- What is your history with any noninvasive cosmetic procedures?
- What outcome do you expect from the surgery? What is your chief motivation in undergoing eyelid surgery?
Dr. Gruber may also:
- Ask you to look in a mirror and point out exactly what you would like to see improved
- Take photos for your medical record, measure your face, and use computer imaging to show you the improvements you can expect
- Evaluate your health status, including pre-existing health conditions or risk factors
- Evaluate the elasticity of your skin
- Discuss your options and recommend a course of treatment
Based on your goals and physical characteristics, Dr. Gruber will share recommendations and information with you, including:
- An approach to your surgery, including the type of procedure or combination of procedures
- The outcomes that you can anticipate
- Your financial investment in the procedure
- Associated risks and complications
- Options for anesthesia and surgery location
- What is needed to prepare for the surgery
- What you can expect to experience after surgery
- The doctor will also share before-and-after photos of cases similar to yours and answer any questions
How do I prepare for a eyelid surgery procedure?
Dr. Gruber will provide you with preoperative instructions, answer any questions that you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.
You can expect to be asked detailed questions related to dry eyes, glaucoma, eye-related allergies, and other eye problems. Tell the doctor if you have circulatory problems, thyroid problems, diabetes, or other serious medical conditions. You will be asked about your current medications, including over-the-counter medications. Make sure to discuss herbal supplements you take, as some of them may cause bleeding problems.
Dr. Gruber will conduct a physical examination, which may include testing your tear production. Special tools may be used to measure parts of your eyelids.
Expect to have your eyes photographed from different angles. These photos help with planning the surgery and assessing its immediate and long-term effects.
Dr. Gruber will discuss your expectations with you. An honest discussion will help determine a satisfactory outcome. Be prepared to talk about your motivation for seeking blepharoplasty and what you hope the results will be. Dr. Gruber can tell you whether your expectations are in line with typical results.
In advance of your procedure, Dr. Gruber will ask you to:
- Stop smoking at least six weeks before undergoing to promote better healing.
- Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve), and vitamins/homeopathic regimens that can increase bleeding.
Eyelid surgery is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least for the first night following surgery.
What can I expect on the day of eyelid surgery?
Your eyelid surgery may be performed at the outpatient surgery center or in our office-based surgical suite. Most eyelid procedures take at least one to two hours to complete.
Medications are administered for your comfort during the surgical procedure.
Local anesthesia with or without sedation is commonly used during eyelid surgery, though general anesthesia can be used instead.
For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
After your surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored.
After blepharoplasty, a lubricating ointment will be applied to your eyes to protect them and prevent dryness. The ointment may cause temporary blurred vision.
You may leave later that day to recuperate at home. You will need someone to drive you home, and it is a good idea to have someone stay with you the first night.
Dr. Gruber will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- Normal symptoms you will experience
- Potential signs of complication
Recovery for Blepharoplasty Eyelid Surgery
For the easiest recovery period, have the following items readily accessible at home:
- Frozen corn or peas in ziplock bags (based on Dr. Gruber’s recommendation for cold application to the eyelids)
- Small gauze pads
- Eye drops or artificial tears (ask your doctor to recommend the proper type to meet your particular needs)
- Clean washcloths and towels
- Over-the-counter painkillers, which your doctor can recommend, but avoid Advil, Motrin, Naproxen, Aleve, and aspirin due to the increased risk of bleeding
Plan to stay home from work and limit your activities for one week after surgery to give your eyelids a chance to heal.
Immediately after eyelid surgery
You may experience excessive tearing, light sensitivity, and double vision just after the surgery.
Your incisions will be red and visible at first, and your eyelids may be puffy and feel numb for several days.
Swelling and bruising, similar to having “black eyes,” will likely last a week or more.
Dr. Gruber will probably instruct you to apply ice packs or cold compresses to your eyes to help reduce swelling.
Pain is usually minimal. You may be given a pain reliever such as acetaminophen (Tylenol or others) for mild discomfort, but remember to avoid aspirin, ibuprofen (Advil, Motrin, or others), naproxen (Aleve), and any other medications or herbal supplements that may increase bleeding.
If stitches were used, they’ll be removed after 5 to 7 days.
If you experience extreme or long-lasting pain or redness and swelling after the surgery, contact Dr. Gruber to find out if these symptoms are normal or a sign of a problem.
Recovery time frame after eyelid surgery
It is important that you follow all postoperative instructions provided by Dr. Gruber. This will include information about bandages, drains, taking an antibiotic if prescribed, and the level and type of activity that is safe. Dr. Gruber will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first two weeks
Although you will not have to rest in bed following surgery, you should plan to relax, stay home, and use cold compresses on your eyes on the day of surgery as well as the day after. The amount of time it takes for recovery varies. Here are some helpful guidelines:
- Follow Dr. Gruber’s instructions for care. For the first couple of days following surgery, expect to treat the incisions with ointment to keep them lubricated and place cold compresses on the eyes to reduce swelling. You will be advised to use eye drops to keep the eyes from drying. If you have dry eyes lasting more than two weeks, contact your doctor.
- Sleep with your head raised higher than your chest. You can use regular pillows, wedge pillows, or sleep on a recliner. Minimize swelling and bruising by keeping your head elevated as much as possible during the first few days of recovery.
- After upper and lower blepharoplasty surgery your eyelids will typically feel tight. You can treat soreness with acetaminophen. Significant bruising typically occurs, but will resolve within two weeks.
- Avoid straining, heavy lifting, swimming, and strenuous activities, such as aerobics and jogging, for ten to fourteen days. Specifically, you should avoid activities in which you must move your head abruptly or that increase the blood pressure in your head. This restriction includes, but is not limited to, bending over, which causes your head to be lower than your heart, and lifting objects heavy enough to cause you to strain. This restriction may apply for three to four weeks.
- You may notice that your eyes tire easily for the first several weeks of the recovery period. Take frequent naps. Avoid activities that may dry the eyes, including reading, watching television, wearing contacts, and using a computer.
- For the first two weeks after your surgery, wear dark sunglasses to protect the eyes from irritation caused by sun and wind.
- Dr. Gruber will remove the stitches between five and seven days after your eyelid surgery.
- You may feel well enough to resume normal activities a few days after surgery.
- Seek medical attention immediately if you experience shortness of breath, chest pains, an unusual heart rate, new pain, bleeding, or visual disturbance.
How Long Will the Results Last?
Your eyelid surgery results should be long-lasting. For the most part, removal of hooding and upper eyelid skin is a procedure that is performed only once. As aging continues, your brow can drop or descend, causing excess skin to reappear on the upper eyelid, but in this case the solution is a brow lift, not a second upper blepharoplasty. Lower blepharoplasty is usually performed to remove eye bags and puffiness around the eyes, and it too should only need to be performed once.
The cost of eyelid surgery varies from doctor to doctor, from one geographic area to another, and with surgical technique. The national average for upper or lower eyelid blepharoplasty is $3000. This is the physician/surgeon fees and does not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to eyelid surgery. The additional fees can add $2-3000 to the total cost. Total costs for both upper and lower lid surgery averages about $8000. Dr. Gruber’s prices are similar to the national averages, but these can vary based on the complexity of individual cases.
Limitations and Risks
Fortunately, significant complications from eyelid surgery are infrequent. Every year, thousands of people undergo successful eyelid surgery and are pleased with the results. Blepharoplasty, which remains the gold standard for eyelid rejuvenation, is usually performed without any major problems.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures.