Eyelid Surgery (Blepharoplasty)

Introduction to Eyelid Surgery

Your eyes are often the first feature people notice about you, and they are the focal point of your face during a conversation. As we age, the structures of the eyelid lose tone and sag leading to a change in the shape of the eyes. This process can be accelerated by environmental (i.e. sun damage and smoking) and hereditary factors. These changes can lead to crepiness and laxity of the eyelid skin combined with unwanted fullness (from fat protrusion) around the eyes creating a more tired or aged appearance. An “eyelid lift” is a commonly used term to describe surgery performed to rejuvenate the eyes/eyelids. At Seattle Face & Skin, we strive to provide our patients with the best eyelid lift and surgery results that not only improve appearance, resulting in a more refreshed look, but may also help enhance visibility.

What is Eyelid Surgery?

The medical term used to describe this procedure is “Blepharoplasty.” Pronounced “blef-a-ro-plasty,” this is the most commonly performed facial cosmetic procedure for both men and women. As we age, eyelid skin becomes thinner and more redundant. Blepharoplasty procedure can give the eyes a more rested or rejuvenated look by removing excess skin and re-positioning bulging fat from the upper or lower eyelids.

The medical term used to describe this procedure is “Blepharoplasty.” Pronounced “blef-a-ro-plasty,” this is the most commonly performed facial cosmetic procedure for both men and women. As we age, eyelid skin becomes thinner and more redundant. Blepharoplasty procedure can give the eyes a more rested or rejuvenated look by removing excess skin and re-positioning bulging fat from the upper or lower eyelids.

Upper Eyelid Surgery (Upper Blepharoplasty)

The main component of an upper blepharoplasty is the removal of excess skin, a condition named dermatochalasis. This will decrease the “hooding” of the eye and present more of the eyelid platform, which women often appreciate as it facilitates the application of eyelid makeup.

The excess skin is removed through an incision hidden in the natural eyelid crease, rendering an almost invisible scar. In years past, upper eyelid fat and muscle were often removed in addition to skin, but we have since recognized that this eventually may lead to a deep upper eyelid “sulcus”, a more hollowed, aged appearance. We now strive to retain as much upper eyelid volume as possible, including muscle. Removing muscle not only leads to loss of volume but can also harm the blink strength of the eyelid, potentially leading to dry eye symptoms.

During the evaluation process, careful attention is given to the eyebrow position, as brow descent may contribute to the appearance of excess eyelid skin. A brow lift may then be indicated in addition to, or instead of, removing eyelid skin.

Lower Eyelid Surgery (Lower Blepharoplasty)

Lower blepharoplasty is a more complex procedure. In addition to prolapsed fat, stretched-out eyelid muscle, and skin may compromise the appearance of the upper and lower eyelids together. Furthermore, cheek descent can worsen this appearance by creating a groove below the eyelid, often termed the “tear trough” and “infrarorbital hollow.” Swelling in the cheek/eyelid transition zone, termed “festoons”, can further complicate treatment.

These features may require a combination of approaches: fat may need to be removed or repositioned through an incision hidden on the inner surface of the eyelid (transconjunctival), or through an eyelid incision just below the lashes (subsciliary) if removing skin and tightening muscle is also planned. If skin creping or festoons are present, laser resurfacing or a chemical peel can be performed to smooth and tighten the lower lid skin.

What are the Benefits of Eyelid Surgery?

Our Eyelid Surgery patients in Seattle consist of men and women of all different face types and Dr. Bhrany will address each surgery with the proper attention it needs. Some of the benefits a Blepharoplasty can provide include:

• Expanded the visual field for improved vision
• Enhanced eye shape for a refreshed appearance
• Reduced skin irritation from excess folds rubbing together
• A more youthful and rested appearance
• Removal of dark under-eye circles

Who are the Best Candidates for Eyelid Surgery?

Patients with excess upper eyelid skin that is encroaching on lashes, with crepey skin that has lines and wrinkles, would be good candidates for upper blepharoplasty.

Individuals with bulging lower eyelid fat, sometimes termed “bags,” excess or wrinkly skin would be good candidates for lower blepharoplasty. “Tear troughs,” the name describing the area of the hollow between the eyelid and cheek, can be problematic for some patients. This hollow area can be filled with the excess eyelid fat from above. This is called “fat repositioning blepharoplasty.”

What’s the First Step?

The first step in getting upper or lower Blepharoplasty in Seattle is to contact Seattle Face & Skin to schedule your consultation. When you come into our clinic for this appointment, you will be able to meet with Dr. Bhrany and express your desires for this surgery. He will answer any questions you may have, evaluate your eyelids, and ask you some questions regarding your medical history.

Dr. Bhrany will partner with you to make informed decisions creating your surgical plan and prevent any unnecessary risks. If you agree with the plan, our Patient Coordinator will be able to help you schedule your surgery date and provide you with some instructions to follow to ensure successful results.

What to Expect on the Day of Eyelid Surgery

When you come in for your Blepharoplasty, we want all of our patients to feel as comfortable and confident as possible while undergoing eyelid surgery. For upper eyelid surgery, you usually have just local anesthesia around your eyes and mild to moderate sedation during the procedure. To address the upper lids, Dr. Bhrany cuts along the natural lines of your eyelids and then removes any excess tissue. He uses extremely small stitches to close the incisions. The stitches stay in place for three to six days.

For lower Blepharoplasty, greater sedation or general anesthesia is provided, and Dr. Bhrany uses one of two approaches to address the lower eyelids. He may make an incision on the inside of your lower eyelid (transconjunctival approach). The advantage of this procedure is that the cut will be invisible. Alternatively, he may make an incision just below the eyelash area (subciliary approach), which has the advantage of allowing removal of excess lower eyelid skin to decrease wrinkling. The subciliary incision fades in a short time and essentially invisible.

If both your upper and lower lids are done at the same time, the entire eyelid surgery procedure usually takes around 3 hours.

Eyelid Surgery Recovery

Most people can get back to their regularly scheduled activities in about 10-14 days after Blepharoplasty, but you should be prepared to take time off to let your eyelids heal correctly. Within this healing time, we advise that you must protect your eyes from sunlight and other elements. Wear dark sunglasses that cover your eyes from the sides and a hat, and follow your post-surgery instructions from Dr. Bhrany about applying sunscreen.

Post-surgery, it is common for your eyelids to be puffy, as your incisions will emerge red, and the swelling and bruising may resemble that of a black eye. Once you are fully healed, you’ll look younger and your eyes will look brighter.

How Much Does Eyelid Surgery Cost in Seattle?

The cost of Blepharoplasty in Seattle is determined by multiple factors, including if you’re getting both lids worked on. The best way to learn how much your treatment will be is to come in for your consultation with Dr. Bhrany. After he creates your procedure plan, our Patient Coordinator will be able to provide you with a price breakdown for the treatment.

If the sagging upper eyelid skin falls over the eyelashes and obstructs peripheral vision to a severe enough degree, blepharoplasty may be covered by insurance and will eliminate the obstruction and expand the visual field. Formal visual field testing and photography will be required to document the patient’s condition for the insurance company, and prior authorization is often required. It should be noted that insurance companies are making it exceedingly difficult to get blepharoplasty approved, and sometimes even deny payment when giving preauthorization. In these cases, the patient will still be responsible to cover the cost of the procedure.

Why Choose Us?

Amit D. Bhrany, MD is a double-board certified plastic surgeon whose goal is to partner with his patients to provide the best possible care for aesthetic facial rejuvenation and reconstruction, and head and neck surgery. He has been a faculty member of the University of Washington (UW) since 2008 and trains other surgeons in Facial Plastic Surgery and Head and Neck Surgery, both at the UW School of Medicine and as an invited speaker around the country. In addition to taking care of our patients at Seattle Face & Skin, Dr. Bhrany cares for patients at UW Medicine, the Seattle Cancer Care Alliance, and Seattle Children’s Hospital. From the moment you contact our office, we focus on your needs to ensure you fully understand the possibilities, limitations, and opportunities available to produce the best outcome for you. Dr. Bhrany is an active member of the AAFPRS (American Academy of Facial Plastic & Reconstructive Surgery).

Schedule Your Consultation

If you are unhappy with your eyelids’ appearance or are having vision problems due to their structure, a Blepharoplasty in Seattle could open up your world. Call Seattle Face & Skin at (206) 599-3223 to schedule your consultation today to find out if you’re a good candidate for Eyelid Surgery. You can also use our website to request an appointment and a member of our team will be in touch with you shortly.