Blepharoplasty

Upper/Lower Eyelid Lift

Photo by shvili/iStock / Getty Images

 As we age, excess tissue typically occurs around the eyes as your eyelid skin stretches and the muscle underneath weakens. As a result, the fat surrounding the eye may also begin to bulge causing sagging upper lids and bags under the eyes. This can give the impression of being tired or overworked even when you are well-rested. Blepharoplasty is a procedure that allows for the removal of excess skin, fat or both from around the eyes. This procedure can be performed on both the upper and lower eyelids to achieve a more refreshed appearance. Sometimes, in addition to making you look older, excess tissue around the eyes can cause a visual disturbance especially in the periphery, and removal of this tissue can significantly improve or eliminate your vision problems.

WHO IS A GOOD CanDIDATE FOR BLEPHAROPLASTY?

LOWER EYELIDS:

As with upper eyelid surgery, the best candidates for lower eyelid surgery are men and women who are 35 or older, physically healthy and realistic in their surgical expectations. Puffy, bulging lower eyelids or lower lids with excess skin can both be addressed. Any medical conditions of the eye should be brought to Dr. Champagne’s attention for evaluation during your consultation.

Upper eyelids:

The best candidates for eyelid surgery are men and women who are physically healthy and realistic in their surgical expectations. Most patients who undergo upper eyelid surgery (upper blepharoplasty) at our Beverly Hills facility are 35 or older, but if droopy eyelids run in your family, you may benefit from this procedure sooner. Also, you may be a good candidate if excess eyelid skin is obstructing your vision. Any medical conditions of the eye should be brought to Dr. Champagne’s attention for evaluation during your consultation.

Photo by shvili/iStock / Getty Images

WHAT TO EXPECT DURING YOUR INITIAL CONSULTATION:

Dr. Champagne will review your medical history and perform a physical exam. Be prepared to answer questions about current and past medical conditions. Talk about any medications you are currently taking or have taken recently, as well as any surgeries you have had. It is extremely important to tell us if you are allergic to any medications. To determine your treatment options and candidacy for blepharoplasty, Dr. Champagne will examine and measure areas of your face with your eyes open and closed. In addition, you will take photographs for your medical record. During your consultation, Dr. Champagne will discuss with you your reasons for wanting blepharoplasty and what your expectations are in terms of appearance after the procedure. Blepharoplasty can be performed both safely and comfortably in either an in-office or operating room setting. Dr. Champagne will discuss both options with you during your consultation.

PREPARING FOR BLEPHAROPLASTY:

Depending on your age and general health, certain preoperative tests may be necessary. We will discuss these with you and be sure that they are performed prior to undergoing surgery. If you are a smoker, Dr. Champagne will recommend that you stop smoking both before surgery and during your recovery period as smoking decreases blood flow in the skin and can slow the healing process. In addition, smoking increases the risk of tissue damage. By stopping smoking, you will improve your ability to heal and optimize your postoperative results. If you need help quitting smoking, we will be happy to assist you. Certain medications will need to be avoided both before and after surgery such as aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding. We will provide you with a list of all medications to be avoided. For the day of surgery, you should also make plans for someone to bring you to and from our office or surgical center and stay with you at least the first night afterwards. If a caregiver is not available, or if you prefer to recover in privacy, our office staff will be happy to schedule postoperative care for you with our world-class postoperative care facility.

WHAT IS THE RECOVERY?

Upper eyelids:

Recovery for upper blepharoplasty usually lasts approximately one week. An ointment is applied to the upper eyelids during the first few days following the operation. Fine sutures placed during surgery are removed after 4 to 5 days. Swelling and bruising can be expected during the first week or so, but this usually subsides quickly, especially when ice packs are used.

Lower eyelids:

As with upper blepharoplasty, recovery for lower blepharoplasty usually lasts two weeks. For removal of bulging tissue, an incision is made behind the eyelid (transconjunctival), no sutures are placed, and therefore, none need be removed. In the instance where excess skin needs to be removed, there is an external incision, and fine sutures placed during surgery are removed after 4 to 5 days. Swelling and bruising, which is reduced with the use of ice packs, can be expected during the first one to two weeks.

BLEPHAROPLASTY Q & A

Q: Are there alternatives to surgical removal of excess upper eyelid skin?
A: Yes, there are several alternatives to removing upper eyelid skin to improve drooping, however, these options work best if there is only a small amount of excess skin present. The alternatives are:

1) Botox Brow Lift: In my office, I use Botox at the sides of the eyes to relax the circular muscle around the eye that causes the eye to squint. This muscle is also responsible for “crow’s feet” wrinkles. By relaxing this muscle, the eye is able to “open up” at the sides giving a slight lift to the upper eyelid and brow. The result is not permanent, but typically lasts 3-4 months at which point a maintenance treatment is required to continue the effect.

2) Fractional radiofrequency skin tightening: In my office, I perform fractional radiofrequency skin tightening with the use of Fractora. Fractora treatments are considered minimally invasive in-office procedures that can be tailored to one of three intensities- light, medium and deep. Depending on intensity, skin recovery periods range from 3-10 days. Multiple treatments are typically necessary to achieve optimal results.

3) CO2 laser skin resurfacing: Skin resurfacing with the use of CO2 laser technology creates a controlled injury of the superficial skin layers which provides both a tightening effect as well as stimulation of new collagen and elastic fibers which helps to rejuvenate aging skin. Skin recovery time for this procedure is usually 5-7 days, and a pinkish skin tone can be present for several weeks following. Until it resolves, the pinkish tone can be camouflaged with mineral makeup.

4) Facial sculpting with injectable filler: Filler injectables like Restylane and Juvederm can be placed under or just above the level of the brow to provide elevation of the upper eyelid skin and reduce the droopy appearance. Filler treatments in this area typically last 6-9 months at which point a maintenance treatment required for continued effect.

Q: Can surgical eyelid tightening or rejuvenation be performed in the office?
A: Yes, eyelid surgery, whether performed on the upper eyelids, lower eyelids or both, can be performed as an in-office procedure. As a matter of fact, I perform this procedure quite often in my office, and it is an extremely comfortable experience for my patients. Typically, the procedure takes under one hour for both eyes.

Q: Are there alternatives to surgical removal of excess lower eyelid skin and bulging?
A: Yes, just as with upper eyelid surgery, there are several alternatives to removing lower eyelid skin and fat to improve lower eyelid “bags”, however, these options work best if there is only a small amount of excess skin and bulging tissue present. The alternatives are:

1) Chemical peels: A chemical peel can be performed in-office and is tailored to the amount of loose skin as well as depth of wrinkles using various strengths of topically-applied compounds such as TCA (trichloroacetic acid) or Phenol. A chemical peel can provide both smoothing and some tightening effects to the lower eyelids but are not a good option for darker skin types.

2) Fractional radiofrequency skin tightening: In my office, I perform fractional radiofrequency skin tightening with the use of Fractora. Fractora treatments are considered minimally invasive in-office procedures that can be tailored to one of three intensities- light, medium and deep. Depending on intensity, skin recovery periods range from 3-10 days. Multiple treatments are typically necessary to achieve optimal results.

3) Filler injectables: For patients who have lost volume under their eyes resulting in deep depressions commonly termed “tear troughs”, an injectable filler like Belotero can be placed within this area to rejuvenate a hollow appearance. This is an in-office procedure. Bruising can occur but is rare, and mild swelling may last 2-3 days. In my practice, I have seen results in this area last up to two years.

4) Fat transfer: Similar to using filler injectables, your own body fat, typically taken from the abdomen, can be placed in the tear trough area and around the eyes to rejuvenate areas that have lost volume over time. This procedure is performed in an operating room setting, and 7-10 days of downtime should be expected to allow for bruising and swelling to resolve.

5) CO2 laser skin resurfacing: As with upper eyelids, skin resurfacing with the use of CO2 laser technology creates a controlled injury of the superficial skin layers which provides both a tightening effect as well as stimulation of new collagen and elastic fibers which helps to rejuvenate aging skin. Skin recovery time for this procedure is usually 5-7 days, and a pinkish skin tone can be present for several weeks following. Until it resolves, the pinkish tone can be camouflaged with mineral makeup. For the proper patient, this procedure can be very effective, especially when combined with injectable filler in the tear trough region.

Q: When can I exercise after eyelid surgery?
A: Because exercise causes heart rate and blood pressure elevation that can ultimately lead to post-surgical bleeding, strenuous activity should be avoided for two weeks after surgery to allow time for complete tissue healing and recovery.

Q: Are there any contraindications to eyelid surgery?
A: Yes, there are relative and absolute contraindications to blepharoplasty including excessive lower lid skin laxity, significant ptosis (drooping or heaviness) of the eyebrows- a browlift may also be required, prominent or bulging eyes in relation to the bony rim surrounding the eye itself, systemic conditions such as excessive bleeding or healing difficulty, and symptoms of xerophthalmia or “dry eyes”. These will be addressed during your consultation.

OTHER BENEFICIAL PROCEDURES:

Those patients who undergo blepharoplasty may also benefit from a lower facelift, browlift and midface lift or fat transfer procedure. Other complementary procedures include Botox injections and laser skin resurfacing.

SCHEDULE A PERSONALIZED, CONFIDENTIAL CONSULTATION:

Please contact Dr. Jason Champagne to schedule a personalized, confidential consultation with our facial plastic surgeon, Dr. Jason Champagne. During your consultation, Dr. Champagne will address your goals and answer any questions you may have regarding blepharoplasty or any other procedure we offer.