Purpose: Improve the appearance of the upper eyelid, typically by reducing hanging or exceedingly full tissues
Incision: Located increase of upper eyelid extending slightly to the side
Anesthesia: Patient choice. Local anesthesia only, local plus oral sedation, local plus IV sedation
Recovery: Typically painless. Typically almost no bruises. Typically mild swelling.
Upper eyelid surgery is one of the most common procedures in facial plastic surgery. It is a very rewarding procedure since the benefits can be very significant while simultaneously burdening the patient with relatively little cost and inconvenience. Please see below for a discussion on how brow lift and upper eyelid relate.
As we age, the skin in the upper eyelids loses its elasticity and becomes stretched resulting in a flap of skin. This flap of skin may start to “crawl out your eyelashes” to the point that it obscures vision and causes fatigue as you strain to hold the eye open. The heaviness of tissues often gives people the impression that you are tired, old, angry, stern, un-inviting, or similar. It also obscures the brightness of the eyes giving a dull look to the eye. On occasion, young people will have exceedingly full upper eyelids that may also benefit from the surgery. The surgery nearly always includes removal of some of the skin of the upper eyelid and may also include trimming/reshaping of the underlying fat and muscle.
The procedure itself takes about 30 minutes. Many patients choose to have it done under local anesthesia only because of the simplicity of doing it this way, but most choose sedation for the sake of putting their mind at ease. If local anesthesia is chosen, expect it to hurt for about 5 seconds on each eyelid as the anesthetic is infiltrated into the tissue.
Recovery from this surgery is typically well tolerated. To minimize bruising and swelling I use great care and patience. I use a radio frequency tissue cutting device that seals the microscopic vessels as I operate which is a key factor in keeping bruising to a minimum. There is typically no pain during the recovery. Makeup may be worn a day after the sutures are removed. The day after surgery you may resume sedentary activities such as driving and moving about. Some patients will even return to work a day or two after the surgery if they have desk jobs. Exercise is resumed a week after surgery and gradually ramped up to 100% by 2 or 3 weeks.
Complications of upper eyelid surgery include dry eye, injury to the eye, asymmetry, excessive bleeding, poor scar, and infection. Dry eye is the most common complication but typically resolves in weeks or months. Patients with dry eye conditions need to consider this before surgery and may choose to be more conservative or simply forgo the procedure.
There is an important relationship between eyebrow position and upper eyelid shape. Raising the eyebrows draws out tissue from the upper eyelids and improves the flap and droop. However, it is typically not necessary to do a brow lift to get a very satisfactory upper eyelid result. Before doing a brow lift, you must appreciate that the eyebrow will also change, not just the eyelid. This is very important. If you like the shape and height of your eyebrow do not do a browlift. Many surgeons will insist on doing a brow lift as part of upper eyelid surgery, but I strongly disagree with this. I am not opposed to brow lifting when we are confident that it is the change the patient wants. It is also quite reasonable to do an upper eyelid surgery first, then re-evaluate and decide if you think you might like a brow lift. Simultaneous browlift and upper eyelid also raises the risk of dry eye. Finally, be aware that the dreaded “surprised” look is not a complication of upper eyelid surgery; it is a result of an over-zealous brow lift.
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.
Additional Before & After Photos: