Blepharoplasty is a very common aesthetic surgical procedure for men as well as women. As we age, excess skin can form around our eyes, causing us to look older, tired, wrinkled or puffy. This is natural because, as we grow older, our skin loses elasticity and previously tight tissues can begin to droop. With eyelid surgery (blepharoplasty), we work toward restoring a youthful and refreshed appearance to your eyes without noticeable scarring.
When we look at the tissues around the eyes, we need to consider the upper and lower areas separately. The upper eyelid is connected to, and very influenced by, the brow. The tissues below the eyes are connected to the cheek. So when we address the eyelids, we have to consider and often work with the condition of these surrounding areas to achieve the correct effect.
The upper lid is surgically corrected through an incision along a natural crease in the eyelid. We address the lower eyelid through an incision concealed just under the lash line. Through either incision, we can adjust or remove fat deposits, tighten muscle structures around the eye, and remove any excess skin. The need to address either the upper lid, the lower lid, or both varies widely from patient to patient.
Blepharoplasty is performed in the office operating suite under local anesthetic (injections of numbing medication) and intravenous sedation, or general anesthesia if the procedure is more extensive. The procedure typically takes from one to two hours and patients can return home the same day. The stitches are usually left in place from three to five days. There may be bruising and swelling which slowly dissipates over one to two weeks.
This is one of the more popular facial procedures since nice improvements can often be obtained with minimal time for recovery compared to other procedures. It is important to consider other aspects of the facial tissues when considering eyelid surgery, including the position of the brow and the position of the mid-face tissues. These areas do affect the appearance in the eyelids. Scarring is usually quite minimal due to the fact that eyelids heal with very fine and light scars.
UPPER EYELIDS + BROW
The effects of aging in the upper eyelid are so common that eyelid surgery is regularly performed for medical as well as cosmetic reasons. Sometimes the upper eyelid has become so heavy and low that it interferes with the patient’s ability to see. This is considered a medical problem, and we work to improve the structure of the eyelid to improve vision.
It’s important to understand that it’s not just the skin of the eyelid that has drooped. As tissues become lax with age, the entire brow can move down, creating the drooping effect in the eyelids. If we raise the brow (brow lift) there will be less tissue in the upper eyelid and the problem is greatly improved. Even so, some patients have more tissue that will need to be removed from the eyelid itself.
Many people are concerned that a brow lift will make them look “startled.” This can be a genuine issue if the center of the forehead (the medial brow) is raised too high. This kind of effect needs to be avoided. The brow lifts we prefer address the sides of the brow (the lateral brow). We do not directly lift the center of the forehead. Instead, with a lateral procedure, tissues are lifted outward towards the temples. In this manner, we can significantly improve the area, avoiding a startled appearance. We perform the entire procedure through a small incision just above the hairline. If additional tissue needs to be removed from the eyelid, the incision is made just above the lash line.
LOWER EYELIDS + MIDFACE
Sometimes we address the lower eyelids alone, frequently it is appropriate to also consider the condition of the cheek. As we age, the cheeks become more lax. Rather than having smooth tissue under the eyelid, the lower eyelid has become longer and somewhat sunken. We acquire furrows below the eyelids, and the cheek tissue itself can be a bit lax and irregular. The nasolabial folds, a furrow going from the nose down to the corner of the mouth, can also become very deep. In this case we can consider doing a cheek or a “mid-face lift.” By lifting the cheek, we soften the crease of the nasolabial folds and bring tissue up under the eye; this shortens and better supports the eyelids.
Not every patient will require a mid-face lift to improve the lower eyelid. In their case, it is appropriate to perform a less extensive procedure with changes isolated to the lower eyelid.
If a person has extra fat in their lower eyelids (puffiness), we remove it. However, we want to be very conservative removing fat from around the eye, to avoid a “gaunt” look. We conduct the procedure from inside the lower lid; this allows us to avoid cutting through all three layers of the lower eyelid. If we need to remove a little bit of skin, we do that right below the lash line; that way we don’t have to cut through the muscle of the lower eyelid. These incisions usually heal extremely well. The tissue around the eyelid is very privileged when it comes to healing, so there is rarely an objectionable scar.
This is how a mid-face lift is performed: through small incisions, we go under all layers, along the bone, under all the tissue. We use an absorbable device to attach to the tissue. It looks like plastic, but it’s very safe and is completely absorbed by the body. We then elevate the tissues, muscles and all, to their new position and suture. Fairly quickly, the insert completely dissolves, and the tissues naturally fuse themselves to the bone in their new positions. That usually lasts quite a long time.
COSTS + RECOVERY
We perform surgery here in Santa Fe at our private operating room under general anesthesia. Patients typically recover in two to three weeks. Patients cannot drive themselves home and should be out of work for a few days. They are given oral pain medication to ease any discomfort.
The cost varies depending on what procedure or combination of procedures are desired. Costs vary widely from patient to patient; it largely depends on how much work is done — a small incision in the eyelid costs a lot less than if there is a brow or mid-face lift and some additional work on the eyelid. Blepharoplasty procedures including doctor’s fee, operating room and anesthesia typically range from $3,800–7,500.
Like so many aspects of plastic surgery, a careful balance has to be maintained. A successful blepharoplasty, brow lift, or mid-face lift procedure must create significant change to be worthwhile, but it should still look natural. This is where years of hands-on, surgical experience can really make the difference.
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