Eyelid Lift
(Blepharoplasty)
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The “eyes” have it

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 of the shape of the eyes. This process can be accelerated by environmental (i.e. sun damage and smoking) and hereditary factors. This leads to excess, puffy or lax skin, and stretched out muscles leading to a more tired or aged appearance. An “eyelid lift” is a commonly used term to describe surgery performed to rejuvenate the eyes/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 redundant. Blepharoplasty procedure can give the eyes a more rested or rejuvenated look by removing excess skin and re-positioning bulging fat or lax muscle from the upper or lower eyelids.

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Upper Blepharoplasty

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

The excess skin is removed through an incision hidden in the natural eyelid crease, rendering the resultant scar virtually invisible. 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 can lead 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 give the appearance of excess skin. A browlift may then be indicated in addition to, or instead of, removing eyelid skin.

Lower Blepharoplasty

Lower blepharoplasty is a more complex and potentially risky procedure. In addition to prolapsed fat, stretched out eyelid muscle and skin may compromise the appearance of the lower eyelids. Furthermore, cheek descent can worsen this appearance by creating a groove below the eyelid, often termed the “tear trough”. Swelling in 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 (subciliary) 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.

Frequently Asked Questions

Can Upper and Lower Blepharoplasty be done during the same surgery?

Upper and lower blepharoplasty are often performed together and also can be combined with other procedures such as eyebrow or forehead lift, midface lift, face lift, neck lift, or laser skin resurfacing.

Who is an ideal candidate for Blepharoplasty?

Patients with excess upper eyelid skin that is encroaching on lashes, with crepey skin that has lines and wrinkles, would be a good candidate with 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 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 are some procedures for conditions that can be confused with blepharoplasty (sometimes known as "eyelid lift")?

Ptosis repair

Eyelid ptosis describes the condition where the entire upper eyelid, not just excess skin, is drooping down along the surface eye. This severity of ptosis is determined by measuring the distance from the eyelid margin (where the eyelashes are located) to the center of the pupil. Eyelid ptosis repair is a separate procedure than upper blepharoplasty and involves tightening the muscles that elevate the eyelids

Retraction repair

Eyelid retraction usually refers to the condition where the lower eyelid is drooping low on the eyeball. The term “scleral show” often is used when describing this condition and describes the white of the eye that shows between the lower eyelid margin and the lower edge of the cornea. Though eyelid retraction often describes the lower eyelid, it can also refer to the upper eyelid being too open, a condition seen in Thyroid Eye Disease. 

Will Blepharoplasty be covered by insurance?

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.

What are the risks/complications of Blepharoplasty?

Though with any surgery, there are possible risks and complications, surgery performed by an experienced and knowledgeable surgeon minimizes these risks. The risks/complications of blepharoplasty include dry eye, poor blink, eyelid asymmetry, eyelid retraction, “rounding” of the eyes (loss of “almond shape” of the eye), excess tearing, inability to fully close eyelids, and, extremely rarely, loss of vision.

 

 

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