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Upper and Lower Eyelift
(Upper and Lower Blepharoplasty)
In blepharoplasty or eyelid-lifting, excess fat and skin and, sometimes, excess muscle are removed from the upper and/or lower eyelids. Skin thins as it ages, becomes loose and is affected by the force of gravity. With time, eyelid skin stretches, muscles weaken, and fat that cushions the eyeball moves forward around the eyes, causing "bags". Sagging upper eyelids may result in hooding over the eyes.
Blepharoplasty can tighten droopy or hooded eyelids, restore the contour to the lids and eliminate bags under the eyes. This procedure, however, does not correct for dark circles under the eyes caused by dark pigmentation of the skin or by very thin, translucent skin, nor does it smooth fine lines and wrinkles around the eye or “crow’s feet”, nor can it lift sagging eyebrows.
This procedure is sometimes performed in tandem with a brow (forehead) lift or facelift. It can also be combined with laser skin resurfacing or a chemical peel to smooth wrinkles or BOTOX® injections to prevent further wrinkling. While most people who seek eyelid lifts do so purely for cosmetic reasons, the procedure corrects severe hooding of the upper eyelids, which can obstruct peripheral vision and reduce the range of upward vision.
What does it cost?
The average cost for blepharoplasty in the US is 1,800 but this varies from surgeon to surgeon and according to where they practice. In Canada, the cost ranges from $3,000 to $8,000 CDN for upper or lower eyelid lift. There may be additional costs such as anesthesia, operating room facility, prescription medicines, etc.
What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility. Blepharoplasty takes about 2 to 2 1/2 hours for both upper and lower lids. If you are having another procedure such as a facelift at the same time, then overnight hospitalization may be required.
Before your surgery, your surgeon may require you to be examined by an ophthalmologist to perform glaucoma testing and measure tear production. Dry-eye condition can inhibit healing and could result in injury and infection of the cornea after surgery. Your surgeon may recommend not to operate if your dry-eye condition is very severe, or the surgeon may perform an additional procedure to tighten the lower eyelid horizontally.
Blepharoplasty is usually performed under local anesthesia. First, eye drops are used to anesthetize the eyes, then protective contact lenses may be placed over the eyes during the surgery. Depending on your health and whether you are having other procedures at the same time, your surgeon may advise undergoing general anesthesia.
Upper eyelid blepharoplasty involves an elliptical incision across the eyelid crease, in the natural skin fold. Excess skin is removed and a thin strip of muscle is also removed to give eyelid crease more definition. Excess fatty tissue is also removed or may be reduced with cautery. The incision is then closed with a single layer of sutures, hiding the scar within the natural fold of the upper eyelids. Very fine electrocautery is used throughout the operation to minimize bleeding.
The two most common methods of performing lower eyelid blepharoplasty are: the traditional approach and transconjunctival blepharoplasty.
For the traditional approach, an incision is made just below the lower lashes. The surgeon lifts the skin and muscle to remove a small amount of fat. Excess skin and muscle are then trimmed from the lower lid. Fine sutures are used to close the incision and are removed 3-5 days after the procedure.
If you have a pocket of fat beneath your lower eyelids, but do not have any loose skin, your surgeon may recommend a transconjunctival blepharoplasty. It is usually performed on younger patients with fatty lower eyelids.
Considered an "incisionless" blepharoplasty, the transconjunctival method does use an incision but it is hidden inside the lower eyelid and leaves no visible external scars. Through this incision, the surgeon exposes and trims the excess fat. The incision is closed with self-dissolving sutures or is left to heal naturally. A lid tightening procedure may be recommended and can be performed at the same time.
Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications following blepharoplasty, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.
Certain medical conditions, including dry eyes or lack of sufficient tears, thyroid problems like hypothyroidism and Graves' disease, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes can add to the risks associated with this procedure. Furthermore a detached retina or glaucoma require extra caution and, in any case, a visit to an ophthalmologist before surgery is advised.
Some minor complications like double or blurred vision for a few days, temporary swelling of the eyelids, and a slight asymmetry in healing occasionally follow blepharoplasty. Tiny whiteheads (mila) may appear after the sutures are removed, which can easily removed by your surgeon.
A more serious but rare complication is bleeding behind the eye (retrobulbar hematoma). Other complications include decreased sensation in the eyelid, dry eyes or dryness (burning, stinging, gritty sensation in the eye), temporary problems with excessive tearing, difficulty closing eyes completely, prominent or hardened scars or a pulling down of the lower lids (ectropion) which may require further surgery.
What to expect post-procedure?
Thin sterile bandages will be applied to the incision area after the surgery but is not in the case of transconjunctival blepharoplasty. An ointment to prevent dryness of the area may be applied but it is not necessary for the eyes to be covered. Some swelling and bruising is to be expected and while it reaches its peak in the first week, it can last for over two weeks. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling.
After surgery, your eyelids may feel tight and sore as the anesthesia wears off and may feel a mild to moderate burning sensation around the eyes. There is some pain and discomfort following the procedure and your doctor will prescribe medication to alleviate it. After the first 48 hours, you may only need an over-the-counter pain medication or nothing at all.
It is a good idea to have some books on tape to listen to for the first few days. Although you will be able to read, using a computer or watch television after two or three days, however, it is recommended that these activities be avoided as they tend to dry the eyes. For a week and a half following the procedure, the eye area will need to be cleaned and the eyes may feel sticky, dry, and itchy. In some cases, your surgeon will recommend using eyedrops. Contact lenses should not be worn for about two weeks and may feel uncomfortable for a while when you resume wearing them. Excessive blinking, which leads to increased swelling, should also be avoided.
As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.
How soon does normal life resume?
Most people feel ready to go out in public and be seen in a week to 10 days. By then, depending on your rate of healing, a little make-up should be sufficient to camouflage the bruising. Because the eye area will be sensitive to sun, wind, and other irritants for several weeks, sunglasses and a special sunblock made for eyelids should be worn when going out. After five days, you should be able to return to normal activities but for the first three or four weeks after surgery, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and exercise or sports. Check with your surgeon about resuming such activities and avoid drinking alcohol, which dries the eyes, causes fluid retention and can prolong recovery. For several weeks after the procedure you may find that your eyes tire easily. Healing is a gradual process, and although your scars can remain slightly pink for six months after surgery, they should eventually fade to a thin, barely visible white line.
Who performs it?
Blepharoplasty is usually performed by a plastic surgeon, an otolaryngologist (ENT) or an ophthalmologist who specializes in oculo-plastics.
Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the appearance of your eyes or are having a facelift, then eyelid surgery may be appropriate, especially if:
- You have no known ophthalmic problems like a detached retina, nor any medical condition such as high blood pressure, diabetes, circulatory problems, hypothyroidism or other thyroid related conditions.
- Your surgeon is aware of any and all medical conditions and any allergies you may have and whether you are a smoker. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You are not prone to scarring problems such as keloids
- You have a good understanding of the healing process and the limitations of the procedure.
How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol both before and after surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Are there alternatives to this procedure?
Laser skin resurfacing, a chemical peel or BOTOX® injections can reduce fine lines and wrinkles near the eye are but will not correct hooded or drooping eyelids nor reduce under-eye bags. These techniques are, however, often performed in conjunction with blepharoplasty to further enhance the results.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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