Eyelid Surgery

Eyelid surgery can benefit a great number of people both young and old. The eyes are the most attractive and alluring part of ones face and the eyelids serve as their "frame". Like the frame of a picture, the eyelids can either detract from or accentuate the natural beauty of the eye.

Most commonly eyelid surgery is performed to remove excess skin and to either remove or reposition fatty pouches. The skin and fat tend to give a tired or sad appearance and it is even possible for eyelid skin to become so loose that it blocks vision. While mostly a procedure to reduce the signs of aging, some people have puffy eyelids or bags from the time they are teenagers warranting the surgery early in life.

Lower eyelid surgery is a bit more complex than upper eyelid. There are many different approaches to the lower eyelid depending on the needs of the patient. In years gone by, lower eyelids were typically done with an incision under the eyelashes, fat and skin were removed, and the skin closed. While this approach typically improved the “bags”, it also had the shortcoming of leaving some people with long, hollowed-out, albeit bag-less, lower eyelids. A more recent development was doing lower eyelids through an incision inside of the eyelid. This was strictly to remove fat (the bags) and did so with shorter recovery and lower risk. Again however, hollowness could ensue.

For the past several years I have made a shift in my approach regarding the lower eyelid. The concept is that a bag is only a bag if it has a hollow groove under it. This groove can be called a “tear-trough”. As our faces age, most people lose fat in the upper cheeks which exposes the fat surrounding the eye, causing it to protrude as a bag. Rather than remove the bag, my approach is to fill the hollow under the bag, creating a fuller and more youthful cheek that transitions smoothly into a full lower eyelid.

There are different techniques to accomplish this filling. Fat transfer is one approach where a small amount of fat is liposuctioned from elsewhere in the body and injected into the lower eyelid. This approach, when successful, works well, but the failure rate is high and there is a significant risk of lumps. A second approach is to inject off-the-shelf products like Radiesse into the hollow. This is a temporary, but effective solution. My preferred approach is to use a small implant to fill the hollow. The implant is inserted through an incision inside the eyelid through which it is placed on the bone. When healed, it essentially becomes one with the bone both in appearance and to touch. With the implant you get a consistent and permanent filling of the tear-trough that doesn’t fail “to take” or end up uneven as fat injections can.

While I have had great success with using the implant, every lower eyelid is different. Sometimes the older techniques are best for a particular person. The only way to know is to visit for a consult and have me examine your eyes. With an exam I will inform you of the likely outcomes, risks, recovery, and costs of each approach so that you can make an informed decision on which approach is best for you.

Typically, eyelid surgery is performed in my private operating room and takes a couple of hours to complete both upper and lower eyelids. Anesthesia is usually of a type called "twilight" however the procedure can be done with just local anesthetic if preferred. The upper eyelid operation always involves incisions in the skin, however these incisions are hidden away when your eyes are open allowing for easy camouflage just days after surgery. The lower eyelids can be done either with a skin incision or through the inside of the eyelid; your specific situation will determine which is best.

My patients usually have little pain after surgery and often only Tylenol is necessary, although stronger pain medications are provided. You will need to take a couple of days off from your normal routine. For the first week after surgery you will need to restrict yourself from heavy lifting, bending, and exercise. Most people can return to desk work in as little as two days after surgery. Bruising varies from patient to patient. For the upper eyelids it is usually very minimal. The sutures are removed after 4 or 5 days and make-up can be worn 24 hours after the sutures are removed in most cases. The lower eyelids will vary greatly based on what needed to be done.

Before and after upper eyelid surgery and laser skin resurfacing

Before and after lower eyelid surgery: note the removal of bags, loose skin, and wrinkles.

Before and after upper and lower eyelid surgery as well as Botox.