Dr Edward H Davidson, MD, FACS
Director, Palm Beach Plastic Surgery Institute
Blepharoplasty or “eyelid lift” surgery is the most popular facial cosmetic surgery procedure, so we asked Dr Edward Davidson, Director of Palm Beach Plastic Surgery Institute, the key questions.
What is blepharoplasty, and how is it done?
Blepharoplasty is eyelid rejuvenation surgery of the upper and/or lower eyelids to remove excess skin and fat. For the upper lid, a “pinch” of skin is removed through an incision that leaves a scar that is concealed in the natural upper lid crease. The lower lid skin can sometimes be tightened with laser alone, or excess skin is removed through an incision hidden just under the eyelashes. Fat removal of the lower lid is typically performed through an incision hidden inside the eyelid. It’s an extremely impactful and powerful procedure to restore a youthful appearance to the face.
Who is a good candidate for this surgery?
Blepharoplasty can benefit both men and women experiencing excess skin folds of the eyelids, as well as a heavy feeling or tired appearance from “bags” and dark circles under their eyes. Excess skin can make it difficult to wear makeup, and patients may also note a loss of the youthful smooth transition of the lower eyelid to the cheek.
To be a candidate, patients must be in good health, with any medical issues well-controlled. Blepharoplasty may be contraindicated in patients with preexisting dry eyes or uncontrolled thyroid issues. Patients with ‘droopy’ upper lids may also need blepharoptosis repair (i.e. muscle tightening/repositioning surgery) rather than blepharoplasty. It also must work for a patient’s social and work commitments and finances.
Do patients need to be asleep for this surgery?
Upper lid blepharoplasty is typically performed under local anesthetic in the office in less than an hour. Laser tightening of the lower lids is also an in-office procedure that needs only topical anesthetic. Lower lid blepharoplasty is otherwise performed in the operating room with patients sedated.
Does upper lid blepharoplasty change the eyebrow?
Upper lid blepharoplasty doesn’t affect brow position directly. However, it is important to evaluate brow position when considering blepharoplasty surgery. Sometimes, we see “brow strain,” or someone working to lift his or her brows to compensate for excess upper lid skin. These are the patients who will often look worse with heavy upper eyelids after forehead Botox. That forced brow elevation will resolve after blepharoplasty.
Others may have a droopy brow or brow ptosis that can mimic or worsen excess upper lid skin, requiring a brow lift instead of or combined with blepharoplasty.
Does blepharoplasty change eye shape or affect vision?
While it is possible to alter eye shape, blepharoplasty ordinarily is aimed at enhancing natural eye shape rather than changing it. However, eyes may appear more open. Sometimes, there can be some temporary impaired vision from swelling or, in lower blepharoplasty, from ointment placed inside the lids or due to a temporary supportive suture between the lids that is removed after one week, which is why we advise to avoid driving for one week after lower lid blepharoplasty.
Blepharoplasty can also sometimes temporarily lead to dry eyes or make preexisting dry-eye worse. Upper lid blepharoplasty can actually improve vision, especially when excess skin is hooded over the eyelashes.
What’s the recovery like?
Of course, it depends on exactly what is done. For upper lids only, patients have minimal bruising and swelling and minimal down time. By two weeks, aside from a little redness of the scars, patients are back to normal activities.
For lower lids, I typically tell patients to expect bruising and swelling to last up to one month, and half of that is gone by about two weeks. For patients who work, I recommend taking one week off work. I ask out-of-town patients to stay local for one week. Most patients feel ready to go out socially after two weeks.
I do advise that it’s three months before being “event ready” so plan the timing of surgery with that in mind before a family wedding or an important vacation, for example, and remember, all scars can take up to one year to fully mature.
