Eyelid Blepharoplasty

If you are tired of the loose excess skin of your upper eyelids and/or the puffiness and bags of your lower eyelids causing you to look tired even when you're fully rested, you may be a great candidate for eyelid blepharoplasty. Over time, the eyelids will gradually begin to droop as the skin and muscles around the eye begin to loosen and sag, which can also affect your vision. Eyelid blepharoplasty is a form of cosmetic eyelid surgery that can restore a more youthful look and correct the signs of aging. As the procedure is specifically tailored to the needs of each patient, it is important to choose a skilled and experienced surgeon for the best possible outcome with minimal scarring. Dr. Robert M. Schwarcz, an oculoplastic surgeon in NYC who specializes in this procedure, offers a comprehensive review of each patient's goals in undergoing the procedure and will advise as to the best possible method of achieving that goal. Learn more below and schedule a consultation when you are ready to meet with Dr. Schwarcz to determine if this is the right procedure for you.

The Eyelid Blepharoplasty Procedure

Eyelid blepharoplasty is generally done under light sedation or general anesthesia and Dr. Schwarcz will determine which is the best for your particular case. In an upper eyelid blepharoplasty, incisions are made in the creases of the upper eyelids, so that any resulting scars can be hidden by the natural structures of the eyes. An incision for the lower eyelid is performed just below the lower lash line to minimize the appearance of any scars as they are covered by the eyelashes. These incisions allow the surgeon to move or reduce fat deposits, remove excess sagging skin and even tighten the muscles around the eye through a procedure called eyelid ptosis repair. Alternatively, a transconjunctival incision can be performed on the inside of the lower eyelid but does not allow for the removal of loose skin and tightening of muscle. However, this approach still allows the surgeon to move or reduce fat deposits and treat other eyelid problems.

Do You Qualify for the Blepharoplasty Procedure?

Unfortunately, having certain medical and ophthalmic conditions can exempt one from receiving a blepharoplasty treatment. Such conditions may increase the risks involved in surgery, and they can aggravate and complicate upper eyelid surgery. These conditions include dry eye and glaucoma.

Other medical conditions that can prevent one from receiving blepharoplasty include:

 High blood pressure

 Diabetes

 Cardiovascular disease

 Hyperthyroidism (such as Grave’s disease)

Ideal candidates for upper eyelid surgery include individuals who have:

 Puffy eyelids

 Excess upper eyelid skin

 Tired-looking eyes

 At least 18 years old

 In good physical and mental health

 Have realistic expectations of the procedure

Dr. Schwarcz Performing Eyelid Blepharoplasty Surgery

As lower eyelids could be plagued with excessive skin and protruding fat, solely reducing the amount of skin and fat is not the answer for many patients. Dr. Schwarcz evaluates the bony structure of the mid-face, skin quality and prominence of the eyeball. If there is poor mid-face support (sunken in, or flat bone) with a prominent eyeball, then fat must not be taken away because of the fear of looking skeletonized a few years after surgery or, even worse, the retracting or a pulling downward of the lower eyelid. These cases must be handled with care by repositioning the fat changing its contour so as not to look like bags, but rather a continuation with the cheek mound. Furthermore, fat can be harvested from other parts of the body and injected below the muscle to prevent a hallow look.

Each eye (including upper and lower eyelids) takes about 45 minutes to complete, totaling an hour and half for all four eyelids. After the procedure, we treat the area with the Total FX CO2 laser, which reduces fine wrinkles around the eyes, promotes collagen growth and resurfaces the skin of the lower eyelids.

Is Eyelid Blepharoplasty the Right Procedure for Me?

In many cases, it is not just the eyelids that are drooping, but the eyebrow is drooping and putting weight on the eyelid structures. Dr. Schwarcz can determine whether you can benefit from a brow lift in conjunction with eyelid blepharoplasty. There is also the issue of differentiating between excess skin and upper eyelid ptosis, which is the drooping of the eyelid caused by weakness and stretching out of the muscle that opens the eyelid, making one eye look smaller than the other.

Upper Eyelid Blepharoplasty

As the lower eyelids could be plagued with saggy excess skin, protruding fat, dark circles or a combination of these issues, solely removing the fat is not the answer for many patients. We must evaluate the bony structure of the mid-face, skin quality and prominence of the eyeball. If there is poor mid-face support (sunken in or a flat bone) with a prominent eyeball, then fat must not be taken away because of the fear of looking skeletonized a few years after surgery or, even worse, the retracting ora pulling downward of the lower eyelid. These cases must be handled with care by repositioning the fat changing its contour so as not to look like bags, but rather a continuation with the cheek mound.If the eyes appear bulging, the doctor must also evaluate the patient for disease processes such as thyroid disease or other orbital processes. Care must be taken with the lower eyelid skin, not removing too much to avoid a vertical shortening of the lower eyelids and not being able to close them.

Lower Eyelid Blepharoplasty

What to Expect After the Procedure

It is crucial for patients to follow every instruction provided by Dr. Schwarcz carefully.

One can expect bruising and swelling for up to one week, with sutures removed at five to seven days after the surgery. A patient who has undergone eyelid correction can generally return to work within one week.

You will be provided with post-operative care instructions including when to return for a follow-up visit. It is common for patients to experience irritation, bruising, mild pain and swelling at the incision sites. Patients may also have dry eyes for up to two weeks. If dry eyes persist longer than two weeks, patients should contact our office. In order to relieve discomfort, patients may apply cold compresses and lubricating ointment to their eyes, and some patients may need to loosely cover their eyes with gauze. Over-the-counter pain relief medication may also used with the exceptions of Advil, Motrin, Naproxen and Aleve as these pain relievers increase the risk of bleeding. The incisions must be kept safe from abrasion, motion and excessive force during the recovery period. Patients should also wear dark tinted sunglasses to protect their eyes from the sun until the surgery sites completely heal.

Oculoplastic surgery of the eyelids can permanently correct certain conditions, and the results will last a long time, especially if patients regularly practice sun protection. Although the end results of a rejuvenated appearance and more defined eyelids will become evident in several weeks after the bruising and swelling subside, the incision lines may not fully refine for a year. Most patients have a positive outcome after their eyelid surgery.

Postoperative Instructions

How to Prepare for the Surgery

Prior to surgery, patients need to arrange for someone to stay with them during the night of surgery and drive them home after the procedure. Patients should expect to be out of work and restrict their activities while the eyelids heal, which could take about a week.

Before surgery, patients should stock ice cubes, ice packs and small gauze pads at home. It is also recommended to have clean towels and washcloths as well as artificial tears or eye drops on hand.