Blepharoplasty and Eyelid Options

Why do my upper lids look heavy and tired?

Many patients complain of heavy tired appearing eyes. Early in the aging process people often experience extra folds of skin in the upper lid. In addition, the brows may drop with age, leading to thicker and heavier brow tissue descending over the lid. Both of these problems are usually best corrected by eyelid surgery. When the upper lids have an excess fold of skin there is really no effective option other than and upper eyelid blepharoplasty. Fortunately, this is a procedure that is well-tolerated, has an easy recovery, and often may be performed in the office.

What is a blepharoplasty surgery?

A blepharoplasty is a surgical procedure to recontour the upper or lower eyelids and improve appearance. In the upper lid this usually involves removing excess skin in a way that the healed incision lies within the natural crease of the lid and becomes essentially invisible. In some cases there is also excess muscle or fat which needs to be removed or reshaped. In the lower lids the problem is more complex, often involving excess skin, bulging fat, and lengthening of the lid with formation of a depression between the lid and cheek. The approach to the lower lid may be from either the outside or inside of the lid depending on the specific problem involved. I heard brows can be raised with botox, is that true? It is true that brow position can be altered by both botox and fillers though the amount of change that can be accomplished is limited. When the brows have descended beneath the orbital rim or if there is significant asymmetry between the brows, surgery is usually indicated. Using modern techniques, incisions for browlifting are hidden within the hairline and control over repositioning of the brows is precise, allowing for very natural results.

What should I look for or ask about in an upper eyelid blepharoplasty?

One of the key components in a good upper blepharoplasty is understanding how to design the incisions and skin removal to keep the scar imperceptible. At Beaty Facial Plastic Surgery, our surgeons meticulously design and mark incisions which are then closed using a single suture to align the skin edges without penetrating the surface. This method ensures that the incision resolves into a fine line directly in the upper lid crease. It is essentially invisible.

What is a transconjunctival blepharoplasty?

A transconjunctival blepharoplasty is an approach used primarily for the lower eyelid where the incision is made on the inside of the lid. This has two main advantages. First, the incision is completely invisible since it is on the inside of the lid. Second, the muscle surrounding the eye does not have to be incised, eliminating the risk of changing eye shape. When the main problem is the lower lid is bulging fat, this is the preferred approach.

What are common complications of lower eyelid surgery?

Healing from a lower lid blepharoplasty can place downward tension on the lid. If the lid has poor support, it can change shape, usually by rounding or pulling away from the eye. Your surgeon should recognize if you are at risk for this due to your anatomy or lid laxity and adjust the procedure accordingly. Frequently, a canthoplasty may be performed as part of the lower lid procedure which adds support to the lower lid and prevents rounding. This procedure may also be done to correct changes in lid shape from aging or previous procedures.

What are the most important considerations in choosing an eyelid surgeon?

While eyelid surgery seems conceptually simple, it is a nuanced procedure which must be done meticulously. Choose an experienced facial plastic surgeon, such as Mark Beaty MD or Celeste Nagy MD, or an oculoplastic surgeon who performs the procedure regularly. In addition to having an eye and feel for best results, these surgeons have the best training to manage any of the infrequent complications which may arise.

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