The eyes are perhaps the most expressive part of the face. They reflect happiness, sadness, pain, anxiety, worry, confidence, tiredness, general health, etc. They also reflect your age. Is it therefore any wonder that cosmetic eyelid surgery, technically termed a blepharoplasty, is one of the most popular cosmetic procedures for both men and women?
For many people, the first signs of aging appear around the eyes. One may develop excess skin of the upper eyelids, wrinkling, bags and an overall tired appearance. There may be drooping of the eyebrows as well, which will accentuate the excess skin on the upper eyelids (see our description of Browlifts). Smoking, excess sun exposure, poor hydration, lack of sleep, use of illicit drugs, chronic tension and anxiety are other contributing detrimental factors. Women may have difficulty in applying make-up and men may have extreme hooding which can obscure the field of vision. All of these factors may result in conveying a non-verbal message to others of tiredness and old age which is not consistent with what you truly feel.
Properly performed eyelid surgery can address many of these problems to restore your energetic, youthful appearance. It is a subtle operation, designed to improve, restore and reveal what was originally there and not to substantially change the eye shape or contour. These changes, despite their subtlety, can have a dramatic impact on your appearance, self image and self confidence.
In essence, we want your eyelid surgery to restore the “twinkle” to your eyes!
Philosophy of Eyelid Surgery
There are some operations in plastic surgery where you want to see substantial differences, such as making a breast larger or smaller. There are other procedures, such as cosmetic eyelid surgery, where subtlety is absolutely essential. One wants to end up looking normal – not overdone. In eyelid surgery, the difference between success and failure is measured in tiny millimeters of tissue removed or changed. All of this requires a surgeon to have astute artistic judgment and extensive surgical experience.
Dr Jacobs’ philosophy is to be very conservative in this type of delicate surgery – we seek to rejuvenate and restore so that your eyelids look youthful and normal and your eyes look “bright and alive.” Overly tight eyelids or “cat-like” distortion are to be avoided and over-zealous removal of fat bags can leave you looking hollow and emaciated. In fact, preservation of fat or re-positioning of fat can be amazingly effective in providing a youthful appearing result.
For women, eyelid surgery is designed to reveal the delicate contours of the upper eyelid and particularly to enhance the application of make-up. Therefore, the skin excess is totally removed. Lower eyelids should be smooth as well, with no bags, lines or wrinkles to deal with.
For men, the goals of eyelid surgery are quite different. Men naturally have a small crease of extra skin on the upper lids. And in fact, if they have ultra smooth and tight skin, they appear less masculine. Therefore, Dr Jacobs will deliberately leave a small amount of excess skin on the upper eyelids to appear more natural. Lower eyelids on men need not be totally wrinkle-free either – but bags should be removed. Again, Dr Jacobs will deliberately leave a slight excess of skin in order to prevent an overly tight and un-naturally smooth appearance of the lower eyelids. For men, a residual small line or wrinkle is perfectly acceptable and perhaps distinguishing.
Consultation: The First Step
If you have a concern about your eyes, the first step is a consultation. We will initially request your concerns, examine you and discuss possible treatment options. Sometimes surgery may not be necessary at all! There are many non-surgical treatments, such as Botox, skin fillers, laser treatments, peels, etc, which can help to stave off the need for an operation – sometimes for years.
On the other hand, sometimes surgery is the best option. We will examine your brows, upper and lower eyelids and midface, all of which contribute to your eyelid appearance. If the brows are droopy and adding to the excess skin of the upper eyelids, then a browlift may be suggested.
Examination of the upper eyelids will reveal any excess skin, fat deposits, hollow eyes, asymmetry of the eyelid levels, and frown/worry lines. Recommendations may include removal of excess skin and fat, correction of the eyelid levels, augmentation of tissue to disguise hollow eyes and deliberate weakening of the muscles which cause frown lines.
Examination of the lower eyelids will reveal any excess skin, fat bags, eyelid laxity, deep lines below the fat bags (commonly called “tear troughs”), and any descent of the midface cheek area. Recommendations may include removal of excess skin, removal or re-positioning of excess fat, tightening of the eyelid edge itself, smoothing of the junction of the eyelid and cheek to eliminate the tear trough and consideration of a midface lift to elevate the cheek structures (see our description of the Midface Lift).
In addition, if there are any moles or other skin lesions present, an attempt will be made to remove them if possible.
How Is The Operation Performed?
For the upper eyelids, two very carefully measured parallel incisions are made in the upper lids. They are designed to follow the natural contours of the crease fold of the eyelid. The excess skin and muscle between the two incisions is then removed and the wound edges carefully sutured together. When the wound is open, any excess fat can be removed. In addition, surgery can also be directed to the muscle which contributes to the “worry/frown” lines between the brows. The muscle can be weakened so that the “worry/frown” lines are less apparent. In rare cases, stitches can be done which will elevate the eyelid to match the level of the other eyelid. In cases where there is extensive lateral hooding, the incision may be carried further out, concealed in a natural skin crease, in order to encompass the excess hooded skin.
For the lower eyelids, an incision is made just below the eyelashes. Through this incision, excess fat bags are either removed or re-positioned in order to provide a smooth lower eyelid contour. The skin is pulled up and excess tissues carefully measured and then removed. If eyelid edge laxity is present, then this is corrected simultaneously utilizing one of several possible techniques. The wound is then carefully sutured closed. This operation will improve the half-moon crescent of the lower eyelid only. If there is additional laxity and descent of the midface (the cheek tissues adjacent to the side of the nose), this too can be lifted as well and is performed through the same incision. This is known as a Midface Lift, or, it may be considered as an extended lower eyelid tuck. Please read about this in the description of the Midface Lift.
In younger patients who have large lower eyelid bags but no excess skin, a hidden incision can be made on the inside of the lower eyelid. This surgical approach can only allow for removal of bags – it cannot be used if there is excess skin to be removed.
In The Operating Room
All of the above procedures are performed on an out-patient, ambulatory basis in our fully accredited (by The Joint Commission) office operating room suite. Most operations take about 90 - 120 minutes. Safe, sedation anesthesia (“twilight sleep” not general anesthesia) is provided by our board-certified MD anesthesiologist. You will be sleeping gently during the procedure, with no pain and no awareness. And you will awaken quickly and gently, with no nausea, hangover, grogginess or sore throat. You will then be taken to the recovery room for post-operative observation and then ultimately discharged in the care of another responsible adult.
After surgery, there will be no dressings applied – you will leave the office wearing a pair of large sunglasses. There may be some feelings of swelling, pulling and tightness – but no pain. There may be some swelling and bruising of the eyelid areas – but these disappear rapidly. Stitches are removed about five days after the operation. At home, you will be applying eye drops, eye ointment and cold compresses to your eyes for several days.
You can return to sedentary-type of work within a week to ten days. Most healing is accomplished in the first 3-4 weeks after surgery. But there is continued healing which may take several more months. You should be able to return to exercise within 3-4 weeks.
The surgical scars will be pink for a while but can be covered with make-up. Ultimately, 3-4 months after surgery, the scars heal so very well that they will be difficult to find!
FREQUENTLY ASKED QUESTIONS
What Age Is Best To Have This Surgery?
There is no “best” age. There are some teens and twenty-somethings that can benefit from removal of hereditary lower eyelid bags. For others, there is a gradual aging of the eyelids so that somewhere in the forty’s or fifty’s might be an appropriate time. Women, with thinner skin than men, tend to need eyelid surgery about ten years earlier than men. Bottom line: you are ready for it when you are ready for it – age is not a factor.
How Long Will The Results Of Eyelid Surgery Last
This is one of the longest lasting operations that plastic surgeons perform. Unfortunately, though, the aging process continues – even as the last stitch is being placed. Your results should keep you satisfied for at least ten to fifteen years – at which time one may elect to have just a small amount of accumulated excess skin removed. If fat bags have been removed, they are usually gone forever, but the skin itself will continue to age.
Will There Be Pain After Surgery?
No! This operation is remarkably pain free. There will be feelings of swelling, pulling and tightness – but no pain.
Is Pre-Operative Eye Testing Required?
Absolutely yes! We require an examination and clearance from your eye doctor prior to surgery. In particular, we want to make sure that your vision is stable, that there is no glaucoma present, that there is no ptosis (a discrepancy in the levels of the upper eyelids) present and that you have no dryness or lack of tear production. In essence, for a cosmetic procedure, we want to operate on healthy eyes to assure the best possible result!
When Can I Apply Make-Up After Eyelid Surgery?
Normally, one should not apply make-up until about ten days after surgery. Do not try new make-up at this time – you may be allergic! Use your old, tried and true make-up. Apply your make-up very gently and remove it even more gently. Dr Jacobs will advise you when you can do this.
Can I Get A "Preview" Of My Eyelid Tuck Operation?
Yes you can. Look in a mirror and pull up very gently on your eyebrows. Your upper eyelid will be revealed. For the lower eyelids, grasp some skin just below the outer corner of your eye and lift gently upward and slightly outward – and voila!.
What Is The Difference Between An Eyelid Lift And An Eyelid Tuck?
Nothing – they both describe the same operation. The operation is also technically known as a blepharoplasty or, in the surgeon’s vernacular, a “bleph.” An extended lower eyelid tuck, called a Midface Lift, will improve both the lower eyelid and as well as lift the cheek adjacent to the side of the nose simultaneously. Please read the section on Midface Lift elsewhere on this website.
Can I Just Have My Upper Or Lower Eyelids Done Alone?
Yes! At your consultation, there will be an examination and discussion with you. Recommendations may be made for either upper or lower eyelid tuck – or both. Yet, you will make the final decision.
What About Cheekbone Implants?
Cheekbone implants, usually made of soft silicone rubber, can be combined with a lower eyelid tuck. They will add highlights and definition to your cheekbone area. These implants come in a multitude of shapes, styles and sizes. Dr Jacobs will demonstrate examples to you at your consultation. Although many surgeons prefer to place these implants through an incision in the mouth, Dr Jacobs prefers to place them through the lower eyelid incision. This allows him to position them precisely so there is no asymmetry. Then, the implants are stabilized in place by suturing them to the bone so that they do not move or twist after surgery.
What Can Be Done For Dark Circles?
Dark circles are due to hereditary hyper-pigmentation of the lower eyelid skin. Dark circles are NOT due to leaking blood from capillaries – that is a MYTH! There are no truly successful surgical treatments for this condition. The best alternatives for treatment are to use concealing makeup or to consider a moderate strength chemical peel, whose beneficial side effect is bleaching and lightening of the skin. Sometimes dark circles are merely shadows produced beneath large, protruding eyelid bags in certain lighting conditions. If the shadow-producing bags are removed, the dark circles will be gone! Dr Jacobs may demonstrate this at your consultation.
Can An Eyelid Tuck Be Combined With Other Facial Operations?
Absolutely yes – this is done all the time! Each procedure will improve a particular part of the face – but they all complement one another. They can be performed separately or all at once – the end result, after all procedures are performed, will be the same. Combined procedures result in “facial harmony,” in which all parts of the face appear age-appropriate to one another. Procedures which are commonly performed together are eyelid tuck, facelift, browlift and sometimes chin augmentation. Also, other procedures such as otoplasty (ear tuck) and rhinoplasty (“nose job”) may be combined as well. If a browlift is to be performed in conjunction with an upper and lower eyelid tuck, then the browlift should always be performed first. Some of the upper eyelid skin will be improved by the browlift so that less skin need be removed from the upper eyelids. The results of these combined procedures can sometimes take 10 – 15 years off your appearance -- absolutely spectacular!
Will Eyelid Surgery Totally Rejuvenate My Eyelid Area?
Sometimes. But more often than not, small ancillary procedures may be recommended to enhance and complement the surgical results and to help to maintain those results for year to come. For example, Botox (to relax the forehead lines, soften frown lines between the brows and eliminate crow’s feet on the sides of the eyes) can do things that surgery cannot do – and vice versa. Appropriate injections of skin fillers (such as Restylane, Juvederm, Evolence, Radiesse, Sculptra, Artefill and the like) can fill in small lines, hollows or depressions either before or after surgery. And fillers which can restore larger volumes (such as fat grafts, Radiesse and Sculptra) can be used to subtly enhance cheek bones and restore fullness to the brow areas. The skin surface may require attention as well. The use of skin peels and lasers will contribute to smoother skin. And the continued daily use of appropriate skin creams, such as Retin-A, will aid in maintaining the skin tone. Perhaps most important, maintaining a healthy life style will sustain your surgical results for many years.
Will Smoking Affect The Results Of Eyelid Surgery?
Absolutely yes! Smoking (really the nicotine in the smoke) has an immediate and direct deleterious effect on the small blood vessels which provide blood for proper healing. We insist that you stop smoking for at least two weeks prior to surgery and two weeks following surgery. Any cheating will harm no-one but yourself. And if you have succeeded in stopping completely for one month, you have also essentially quit – perhaps the best thing you could have done for yourself long term. Bravo!
Can I Have Eyelid Surgery If I Have Had Previous Eyelid Surgery?
Frequently this is possible. This is called secondary or revision surgery. By definition, it is much more difficult to do (due to natural internal scarring that occurs after any operation) and less predictable. Each case requires careful evaluation as to what can be accomplished and what might be best left alone. However, in most cases, particularly if there are distortions of the eyelids, some improvement can be obtained. These are discussed on a case by case basis with Dr Jacobs.
Does Insurance Cover Eyelid Surgery?
No, it does not – it is a cosmetic procedure.
Can Eyelid Surgery "Westernize" An Asian Eyelid?
Yes it can. The Asian eyelid is characterized by a lack of a fold or crease in the upper eyelid. Utilizing special techniques, this fold can be created for an Asian eyelid.