Candidates for Surgery

Candidates have excessive sagging or wrinkled skin on the upper or lower eyelids and or puffy lids from bulging fat pads.  In the upper eyelid, this sagging skin may interfere with vision and reduces the defined appearance of a natural upper eyelid crease so applying make-up may not be possible for women.  Candidates also have puffy pouches of fat in the upper or lower lids creating a tied and aged appearance.  Many of these changes are familial, so taking a look at your parents photos will often tell you what you may look like if surgical improvement is not selected.

A blepharoplasty is designed to re-drape and remove this sagging excess eyelid skin, and to remove the "bags", by trimming away or redistribute excess fat to augment the lower eyelid cheek junction (fat preservation blepharoplasty).  Normally, everyone has some fat around the eyeball, but if the quantity of fat increases, or the local tissues stretch and weaken, the fat begins to bulge producing the "bags".  Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging.  These changes have a striking effect on one's appearance.  An attractive face with these early signs of aging can affect a patient's self image, attitude and sense of well-being.

In some cases the upper or lower lids can be treated alone or, if indicated, all four lids may be treated at the same time.  At times, a forehead lift or Brow lift, cheek lift (mid face lift) and/or a face-lift is done along with the eyelid surgery. For example a cheek lift can be used along with repositioning the lower lid fat to decrease the dark depressed circles around the eye and give more fullness to the cheeks while decreasing the creases between the lower cheek and lip (nasolabial folds).  Excess drooping of the eyebrows and corners of the upper eyelids may require a forehead or brow lift to correct the area. There are a variety of techniques including short scar, forehead reduction (for receding hairlines) and hidden scar (such as endoscopic brow lift) lifts behind the hairline that can be performed. The surgeons at Pacific Center for Plastic Surgery will tell you which technique is best suited for you.

Intended Result

The procedure creates a more youthful, alert, and rested appearance of the eyes in addition to widening the visual fields, if the excessive upper lid skin partially blocks vision.  The eyelid lift will not remove or erase all wrinkle lines but rather will soften the wrinkle lines.

One of the first signs of early aging is bagginess or puffiness around the eyes, often associated with wrinkling of the eyelid skin.  Blepharoplasty is designed to correct this condition and to restore the youthful, alert appearance of your eyes. This condition may be present in the upper eyelids, lower eyelids, or both. It also may be associated with looseness of the skin of the eyebrows or temple region.

Procedure Description

The incision in the upper lid usually lies in the lid crease. The incision in the lower lid lies just below the eyelashes and parallel to the lid edge.  Both incisions may extend for a short distance beyond the eyelids, toward the temple.  In certain cases, lower lid incisions may be made inside the lid (transconjunctival incision). This is useful when only excess fat is removed and eliminates external skin incisions.  Excellent healing is characteristic of eyelid skin, and once the wounds are mature they usually become quite inconspicuous. The outer part of the incision -- the part extending toward the temple -- is the slowest to mature, and is sometimes noticeably pink for some weeks after the operation. The stitches are removed in 3-7 days after surgery.

The operation is usually done in an outpatient surgical center,. A friend or relative should be available to take you home and stay with you for at least 24 hours after surgery. Some patients may be done in a hospital operating room, if other medical conditions are present.

A local anesthetic is used. The patient also receives sedation so that the operation will be a relaxed and comfortable experience. A general anesthetic may be indicated in some cases.
Additional procedures that would enhance the result are: Forehead Lift, Face Lift, Cheek lift (midface lift) Chemical Peel or Laser Skin Resurfacing.

Patients who have functional or visual problems caused by excessive upper eyelid skin may have coverage by their insurance policy. This usually requires documentation by an ophthalmologist regarding the medical necessity of surgery. Otherwise, these procedures are cosmetic and the patient is responsible for payment.

Post-Operative Healing

Sutures are usually removed within 3-5 days.

The initial mild discomfort is easily controlled with oral medication.

Eye makeup can be used shortly after sutures dissolve or are removed. In most cases the surgeons at Pacific Center for Plastic Surgery use self dissolving stitches which do not have to be removed.

Contact lenses can be worn when comfortable -- usually within 10-14 days.

Swelling, discoloration, and some bruising is to be expected.  It is not unusual to have some difficulty seeing during the first day or two after surgery because of the swelling and eye lubricants/ointment used during and after surgery.  Patients vary a great deal in their recovery rate, but usually can resume normal light activity or work 3-4 days after surgery, using dark glasses and make-up to camouflage the swelling and discoloration.  The patient will usually be presentable without dark glasses in 10 days.  A small amount of residual swelling persists for many weeks, but gradually disappears.

Sagging skin or wrinkles may recur as the years go by, but it is not common for "bags" to recur. The operation can be repeated as necessary. "Crows feet" (skin wrinkling at the corner of the eye, near the temple) is not greatly affected by this procedure; they may be helped with an ancillary procedure such as a laser, dermabrasion or chemical peel treatment.

Risks of Surgery

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare. We encourage you to ask Dr. Nichter and Dr. Horowitz about these risks and to determine if you are a good candidate for these procedures.

Before and After Photos

Before

After

These are actual case photos of one satisfied patient. To browse our extensive Before & After Photo Gallery, click here.