Eyelift

Quick Facts About Eyelift

Anesthesia: Local with sedation or general
Average Treatment Cost: $1,500-$3,500
Duration of Results: Long-lasting
In/Outpatient: Outpatient
Procedure Time: 1-3 hours
Recovery Time: 5-14 days; strenuous activity in 3 weeks
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What you should know

What Is An Eyelift

Recent years have seen a shift in eyelid surgery philosophies. Today’s cosmetic surgery aesthetic is more natural and even, unlike the looks of the past.

Whether performed on the upper eyelid, lower eyelid or both, eyelid rejuvenation surgery requires your plastic surgeon to make many small, precise incisions to remove and/or reposition fat and tissue, then reposition the underlying facial muscle. Overlying skin is re-draped and excess skin is removed.

Typical incisions for an eyelift include inside the natural curve of the upper eyelid, inside the lower eyelid or just beneath the lash line. An alternative may be incisions in the upper eyelid crease. Scars will be hidden in the lash line or the crease of the lid, leaving them virtually undetectable once healed.

“In a broad sense, blepharoplasty is used to make the eyes look youthful. The key is to customize an operation that addresses what the patient wants to accomplish,” says Las Vegas plastic surgeon Mary Herte, MD. “The upper eyelid serves a function and it needs to be long enough to cover the eyeball when closed; the issue may be how that skin folds when the lid is open. If it lies like an accordion on the outside, you see bunching. If it stores like a garage door on the inside you don’t see it,” adds Dr. Mary Herte.

And, according to Boca Raton, FL, oculoplastic surgeon Steven Fagien, MD, “It’s not so much about removing soft tissue and creating a high eyelid fold; rather, it is more about restoring youthful volume and smooth contours that are essential to producing the most natural-looking result.”

Common problems that may require some type of cosmetic eyelid surgery are:

  • Under-eye hollows
  • Under-eye bags or puffiness
  • Eyelid drooping or sagging
  • Eyelid wrinkling
  • Hooding of the upper eyelid

Types of cosmetic eyelid surgical solutions include:

  • Lower eyelid surgery
  • Upper eyelid surgery
  • Double eyelid surgery

Nonsurgical laser and injectable (Botox, Dysport and hyaluronic acid fillers) solutions are widely available as well. 

Lower Eyelid Surgery

While creams and serums with peptides, vitamins and fluid-eliminating ingredients may help alleviate the appearance of puffy under-eye area, Atlanta, GA, plastic surgeon Mark Codner, MD, says that the best surgical solution for persistent under-eye bags is lower blepharoplasty.

Traditionally, a small amount of fat and muscle is removed and the slack skin is tightened up. “The muscle is a deep tissue structure,” says Boca Raton, FL, oculoplastic surgeon Steven Fagien, MD. “In the past, muscle was removed, making the eyes look pulled. Today, lower eyelid surgery is not about removing the muscle, but rather using it as a bulking agent, like filler, to add fullness to the area, allowing your eyes to look more natural.”

Although it’s not necessary to always perform both upper and lower eyelid surgery, some doctors do advise it so that the eyes take on an overall refreshed and renewed appearance.

Lower blepharoplasty can help negate its effects on the under-eye area by reducing puffiness and bulging. The procedure involves removing or redistributing excess fat and skin through a small incision below the lower lashes or inside the lower eyelid.

Lower eyelid surgery can incorporate several different surgical techniques depending on your needs and desired outcomes. West Orange, NJ, plastic surgeon Mokhtar Asaadi, MD, says, “When it comes to eyelid surgery, we try to be conservative.” If a patient has good skin tone, you can just remove the fat.” But, for more complex issues, blepharoplasty can involve reshaping the anatomy by addressing muscles, tendons and skin.

The goal of lower eyelid surgery is to produce a smooth contour from the lower lash line down to the mid-face. Laser resurfacing at the time of eyelid surgery can improve some tone and tautness.

Lower Eyelid Nonsurgical Solutions

Injectables and fillers such as hyaluronic acids (Restylane, Juvéderm and Perlane) can be used off-label to fill in under-eye depressions and hollows and create a smooth contour from the lower eyelid down to the cheek. Results can last for about six months to upward of a year or more. According to Seattle plastic surgeon Jourdan Gottlieb, MD. “Botox is commonly used for the treatment of crow’s-feet.” Fat transfer is an option as well, with added benefits of long-lasting results.

Your doctor may also use a laser to resurface the skin and improve excess wrinkling and skin laxity. Fractional CO2 and fractional erbium lasers can address under-eye bag issues, since they smooth out the area while stimulating collagen production. “I use a CO2 laser to perform lower blepharoplasty,” says Toms River, NJ, facial plastic surgeon Wayne Foster, MD. “No incision is needed and the laser helps to control the bleeding.”  

Upper Eyelid Surgery

Blepharoplasty of the upper eyelids can reposition fat and muscle and reduce excess skin to correct the drooping and puffiness that can make a person look older and more tired and may also interfere with vision.

The procedure requires an incision that follows the natural contour of the upper eyelid and may extend to the outer corner. Once it has fully healed, the incision line is easily concealed with makeup. Over time, it will fade to a faint line that is camouflaged in your natural upper eyelid crease.

“After this procedure, the upper lids look more open and alert, and people don’t look sad, which makes a dramatic difference in the overall look of the face,” says Daytona Beach, FL  plastic surgeon Carl Lentz, III, MD. Upper blepharoplasty removes excess skin on the eyelids. Blepharoplasty (both upper and lower) can be performed under twilight sedation (it can also be performed under general anesthesia) and has a fairly easy and quick recovery.

Hands down, upper blepharoplasty is the most effective way to correct an upper eyelid that has become slack. “To avoid a sunken in or skeletal look, it’s important that not too much fat is removed,” says Richmond, VA, facial plastic surgeon Alan Burke, MD. 

Ask your doctor about whether blepharoplasty is right for you.

Who It Is For

Eyelid surgery corrects droopy lids, sagging tissue and tired or puffy eye conditions.  Most people seeking this treatment are showing signs of aging in this area but certain hereditary conditions like under-eye bags or so-called “sad eyes” may be present in people of all ages, which may require eyelid surgery.

You might want to look into eyelid surgery to fix one or more of these problems:

1.  Under-eye hollows: Under-eye hollows are caused by loss of fat or fat bulging above the eye hollow due to weakening support structures that hold fat in place.

In many patients, the eyes are often the first part of the face to fall prey to visible signs of aging, and changes in facial volume are one of the biggest causes. Hollows under the eyes can be addressed with surgical or nonsurgical solutions.

2.  Under-eye bags: Caused by fat collecting under the eye, under-eye bags are caused by too much volume or weakening of tissues over the fat, which causes it to bulge. Some women are prone to an accumulation of fat under the eyes, and these bags can be improved through lower eyelid surgery, either by itself or in conjunction with a facelift.

3.  Sad or Sleepy Eyes: To correct sad eyes (where the outer corner of the eye is turned downward), canthoplasty or canthopexy techniques can be used during upper or lower eyelid surgery to gently reposition the tendons of the eyelid to a more natural, lateral and alert position.  

4. Eyelid Droop: Droopy eyelids, which get more pronounced with age, can be corrected with a blepharoplasty to remove excess skin and/or fat on the upper lids and bags on the lower lids.

Who It Is Not For

“Eyelid surgery is a targeted procedure that delivers dramatic results within a week or two,” says Los Gatos, CA, plastic surgeon Matthew Mingrone, MD. Though age-related changes like fine lines and looseness of the upper eyelid begin to appear by the mid-30s, eye surgery isn’t just for those looking to erase the signs of time.

Eyelid surgery is a highly-individualized procedure. “Under-eye bags in a 25-year-old will be treated differently than bags in a 50-year-old,” says to Boca Raton, FL, oculoplastic surgeon Steven Fagien, MD.  Because the individual cause of the bags or puffiness differs, he cautions that the most appropriate procedure must be matched to the individual problem.

Consult with your ophthalmologist or oculoplastic surgeon before surgery.

What to Expect

  • Plastic surgeons, facial plastic surgeons and oculoplastic or ophthalmic plastic surgeons are the only appropriate providers if you are considering blepharoplasty.
  • Although blepharoplasty can be performed in your surgeon’s in-office surgical suite, it is still surgery and all the proper accreditation standards and safety precautions must be met.
  • Many blepharoplasty patients find they don’t need to take the prescribed pain medication to manage their discomfort.
  • Both lower and upper eyelid procedures can be performed on an outpatient basis under general or local anesthesia with sedation. Expect a week or more of swelling and several weeks for any bruising or discoloration to fully diminish.
  • The actual techniques used are based on your particular issues. While upper lid incisions are placed in the eyelid crease, lower lid incisions can be placed inside the eyelid or along the lash line—all incisions are nearly undetectable once healed.
  • An eye procedure alone takes less than three hours, and the recovery period for eyelid surgery is relatively brief.
  • Whether you opt for upper or lower eyelid surgery, or both, post-procedure you may experience some dryness in your eyes or discomfort for a few days, and you’ll need to sleep with your head elevated to reduce any swelling. 

 

Post-Treatment Care

Eyelid surgery is most often performed as an outpatient procedure with local anesthesia and sedation or in some cases general anesthesia. You may feel some discomfort at the incision sites for a day or two and may wish to wear dark sunglasses in the days that follow for enhanced comfort. Your vision may also be slightly blurry due to the temporary swelling.

Expect to sleep with your head elevated on several pillows for a few days to reduce swelling, and keep cold compresses on hand for at least the first 24 hours after surgery. Special drops and ointment will keep you comfortable, and may be required as you heal. Within five to seven days of surgery, any or all of the stitches will be removed. When your incisions are completely healed, you are ready for a little concealer and eye contact with the world. 

Inside Tips

  • After eyelid surgery, you shouldn’t wear makeup until 24 hours after all sutures are removed. To be on the safe side, have new eye makeup so you don’t risk contaminating incisions with bacteria.
  • When it comes to treating hollows, fat transfer and injectables and fillers only address a lack of volume. If your hollows are accompanied by baggy skin, lower blepharoplasty can help eliminate the excess skin.

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