How is eyelid surgery performed?
Eyelid surgery (blepharoplasty) is typically an outpatient procedure. The surgeon will perform the surgery on your upper eyelids, lower eyelids, or both. Your surgeon will evaluate your underlying facial muscle structure, bone structure, and the symmetry of your eyebrows and determine how much skin, muscle, and fat to remove or reposition.
Your surgeon will mark your upper and lower eyelids to indicate where to remove excess tissue. Then he or she will make incisions to remove tissue using surgical instruments, including scalpels, surgical scissors, radiofrequency cutting devices, and, sometimes, cutting lasers. Your surgeon may make other adjustments to correct special problems (such as muscle laxity) and then apply sutures or tissue adhesives (glue) to smooth and reconfigure areas around the eyebrows and eyelids. If dissolving sutures are used, they are almost invisible to the eye. Sometimes, removable sutures are used on the skin surface for precise alignment, and are removed several days after surgery. In most cases, there is virtually no detectable scar.
If you have dry eyes, your surgeon will remove less tissue since exposing more of the eye to the air can cause your symptoms to worsen.
What are my eyelid surgery options?
There are a few options for eyelid surgery.
Upper Eyelid Surgery
If you have excess skin covering your natural eyelid fold, loose skin hanging down over your eyelashes, or puffy eyelids, you’ll need surgery on your upper eyelids.
Your surgeon will apply a local anesthesia to numb the area, then make an incision hidden within the natural fold of the upper eyelid so he or she can remove excess skin, muscle, and fat. Your surgeon may also use a laser or other peel to enhance the procedure by resurfacing skin and smoothing wrinkles in the eyelid and eyebrow area.
Lower Eyelid Surgery
If you have bags, puffiness, or deep groves below your eyes, you may benefit from surgery on your lower eyelids.
There are multiple lower eyelid surgery approaches, and your surgeon may recommend a combination of these procedures:
- The traditional approach smooths and tightens lower eyelids. The surgeon places the incision just below your eyelashes, trimming and repositioning excess skin and fat, and tightening the lower eyelid muscle.
- The transconjunctival approach reduces lower eyelid bags and puffiness. The surgeon places the incision inside your eyelid and removes excess fat, but not excess skin. The surgeon may use a laser in conjunction with this approach to tighten the lower eyelid 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. In some patients, laser resurfacing can both tighten excess skin and remove wrinkles.
- Hyaluronic acid (HA) fillers is a non-surgical alternative for the lower eyelids. Your surgeon can inject Restylane, Juvéderm, and other soft tissue fillers into your tear trough (crescent-shaped under-eye area) to rejuvenate the appearance of your under-eye area. Results are varied and last approximately six months.
Both (Upper and Lower Eyelid Surgery)
If you have issues with both your upper and lower eyelids, your surgeon may recommend a combined approach.
In some cases, your surgeon may recommend pairing your eyelid surgery with a brow lift or a facelift to achieve optimal results.