Blepharoplasty (Eyelid Surgery)

Blepharoplasty is eyelid plastic surgery performed to improve and rejuvenate the eyelids.  Blepharoplasty may be performed for the upper or lower eyelids.  Most patients seeking upper eyelid rejuvenation have excess skin hanging down toward the eyelashes.  During upper blepharoplasty, Dr. Bray, Jr. will remove this excess skin and in some cases remove excess fatty tissue and muscle.

Patients seeking lower eyelid surgery will usually have “bags” in the lower eyelids.  During lower eyelid blepharoplasty, Dr. Bray, Jr. will remove the excess fatty tissue causing the bags and in many cases remove excess or sagging skin.  Dr. Bray Jr.’s credentials as a facial plastic surgeon and a plastic surgeon assure his patients that they are receiving the most advanced and highest quality care.

Upper Eyelid Blepharoplasty Techniques

Traditional Blepharoplasty: An incision is made in the supratarsal crease of the upper eyelid. This crease is usually about 10 mm above the eyelashes. A superior incision is then made to remove the excess skin in the upper eyelid. After removal of the skin, redundant muscle and excess fat may be removed. The amount of skin, muscle, and fat removal should be based on the patient’s anatomy and concerns. Dr. Bray, Jr. will discuss these options with you at your consultation.

Asian Blepharoplasty: Dr. Bray, Jr. will utilize many different techniques in order to achieve the goals of the Asian patient. In some cases the incision is made 6mm above the eyelashes. This incision is lower than the incision used for the western eyelid. This will help to maintain the ethnic characteristics of the eyelid. The incision will also allow Dr. Bray Jr. to create a double eyelid and supratarsal crease. For patients who desire a more westernized appearance the incision may be made higher at 8 or 10mm above the eyelashes. The amount of skin excision will also be determined by the desires of the patient. The epicanthal fold must also be addressed. Depending on the patient’s concerns the epicanthal fold may be modified. An inside fold or an outside fold may be achieved with the surgery, and the fold position will be based on the interests of the patient.

Ptosis Surgery: Some patients who present for upper eyelid surgery have eyelid ptosis. These patients require additional surgery at the time of blepharoplasty. This surgery usually involves plicating or shortening the levatoraponeurosis. The levator muscle is the muscles used to open the upper eyelid. Shortening this structure elevates the eyelid and in some cases can correct eyelid ptosis.

Lower Eyelid Blepharoplasty Techniques

Patients seeking lower eyelid surgery will usually have “bags” in the lower eyelids. During lower eyelid blepharoplasty, Dr. Bray, Jr. will remove the excess fatty tissue causing the bags and in many cases remove excess or sagging skin.

Traditional Blepharoplasty: An incision is made below the eyelashes and the skin and muscle are elevated to expose underlying fat. The fat lies in three compartments and may be removed or repositioned depending on the patient. When the fat is repositioned it is moved over the orbital rim. This helps to fill in the concave tear trough. When fat is removed or repositioned the bags of the lower eyelid are improved. After treating the fat the excess skin and muscle are removed.

The Transconjunctival Approach: The incision is made on the inside of the lower eyelid. Through this incision the excess fat may be removed, however excess skin is not removed. This procedure may be ideal for patients who have excess fat or bags, but who do not have significant excess skin of the lower eyelid.

Canthal Tightening: In many patients lateral canthal tightening is required. If the lower eyelid has significant laxity or poor position, a canthal tightening procedure may be necessary. The canthopexy procedure involves placing a suture through the lateral canthus and the lateral orbital rim in order to tighten the lower eyelid. Lateral canthoplasty involves dividing the lateral canthus and reattaching the canthal ligament in order to tighten and reposition the lower eyelid.

The Surgery

The procedure may be performed with local anesthesia, local anesthesia with IV sedation, or general anesthesia. This procedure is performed on an outpatient basis. It is important to arrange for care after the surgery. Someone must drive you home and be available to care for you for the first 24 hours.

Complications are unlikely when performed by a surgeon with experience in blepharoplasty. These include: bleeding and swelling, delayed wound healing, infection, drooping of eye upper or lower eyelid, asymmetry, change in vision, double vision and dry eyes.

Recovery: What to Expect

The area surrounding the eyes will remain swollen in the days following the surgery. It should begin to subside after the first day. Some vision blurring is normal.

The stitches will be removed in 4-5 days. Swelling and bruising will persist for about 10 days, but you can begin wearing makeup to help conceal these concerns.   Dr. Bray, Jr. will inform you when you may return to more strenuous activities after the procedure.