Karan Chopra™ M.D.

The Ultimate In-Depth
Guide to Eyelid Surgery:
Why It Exists, Types of Blepharoplasties,
the Procedure, and Recovery

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 Eyelid plastic surgery, also known as blepharoplasty, is a minor procedure with a significant aesthetic impact that can brighten up your gaze, make you feel and look younger, and even positively impact your visual health. In this article, I will guide you through the existing types of blepharoplasties so you may understand which one is right for you. I will also give a general description of the procedure and the recovery phase.  

The eyes are one of the most important parts of our face. They aren’t just –literally– right in the middle, but we evolved to identify and read eyes. In the wild, an animal might save its life just by avoiding something with eyes that might be ready to attack or fight back. But, also, as mammals, eyes give us lots of important information for social interaction: they help us understand if our babies are in pain or at ease, they tell us if someone is upset with us or thinks about us with tenderness, they let us know when someone feels a danger coming or if something funny is going on. So, there is no wonder why they have such a huge impact on our social life, self-esteem, and aesthetic appeal 

However, their crucial role in our lives doesn’t make them immune to aging; quite the opposite. As sensitive as we are to their expressive qualities, we also quickly identify how time impacts the eyelids, making us look dim, tired, older, or even sad, even though we might not feel that way.  

This happens because gravity impacts the skin of the lower and upper eyelids, dragging them down. The natural hormonal changes that cause us to lose muscle as we age also affect the orbicularis oculi, the circular, thin muscle surrounding the eye. That’s an unfortunate combination. And, let’s face it: we all know how to train our biceps to maintain our arm muscles, but your facial muscles? That’s trickier. 

 

 

 
To make things worse, as part of the natural aging process, we tend to have fat start to herniate forward around the eyes in places where there used to be none. This means additional fat may appear in the upper or lower eyelids, making them bulky and lowering them, creating a look of profound exhaustion or even of feeling unwell. Also, as we lose muscle with time, we may have the double impact of having specific areas of our faces thinning out too much while accumulating fat in others.  

This trifecta explains why blepharoplasty exists: saggy eyelids, loss of muscle tone, and fat accumulation. This surgical procedure addresses all these factors, restoring patients’ expressively and youthful look.  

Before discussing the specifics of each procedure, I want you to remember that the correct surgery depends on your very particular conditions: your bone structure, general health conditions, skin type, and visual health, to mention a few factors. We will discuss these thoroughly in your initial consultation and the days before your procedure as you prepare for it.  

Types of blepharoplasties

As you probably already know, there are two main types of blepharoplasties: upper and lower eyelids. 

 Upper eyelid blepharoplasty

This surgery may be done as an exclusively aesthetic procedure or to enhance peripherical vision, whether because skin excess may obstruct one’s sight or because the loss of muscle may be causing the eyelid to hang too low, also known as ptosis. The great thing about an upper eyelid lift is that it can be performed painlessly and awake, with just local anesthesia and mild sedation. 

When performing surgery on the upper eyelid, we might try various procedures. For instance, if the problem is excess skin and there is not much extra fat, then I prefer a pinch upper eyelid blepharoplasty to remove the skin and maintain the youthful fullness around the eye.

Instead, if there is a combination of upper eyelid excess skin, fat herniation and muscle, then I like to target all three with my open sky upper eyelid blepharoplasty technique.  The open sky technique allows comprehensive rejuvenation of the skin, orbicularis muscle, septum, and fat. 

In this type of surgery, the risk of visible scaring is minimal, as the incisions are done precisely over the line where the eyelid naturally folds. This, paired with finding an excellent surgeon and following post-surgery care, will guarantee you recover in the best possible way. 

A subcategory within upper eyelid blepharoplasty is usually known as “Asian blepharoplasty.” Since the eyelid structure of people of Asian descent (both from the Middle and Far East) tends to be somewhat flatter than that of people from other origins, this procedure fabricates a curve the eyelid naturally lacks to make the eye look bigger and more open. Of course, this procedure is always done with great care to respect each person’s structure and create a natural, harmonious final look.

 

Lower eyelid blepharoplasty

This surgery is usually performed for aesthetic reasons, such as lower eyelid bags with or without excess skin. However, it may also be helpful in cases of extreme lower eyelid issues such as scleral show, lower eyelid retraction, ectropion or entropion. These other entities may lead to issues like dry eye, tearing or wind intolerance because they expose delicate eye areas.

There are two options for lower eyelid blepharoplasty – one is a scarless lower eyelid blepharoplasty also known as a transconjunctival blepharoplasty. 

The best candidates for this have excess fat without much extra skin, and therefore removal of the fat through an incision hidden on the inside of the lid is sufficient. 

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Other times, when a patient needs some skin improvement I like to combine it with CO2 laser resurfacing to tighten the skin without a scar. Lastly, depending on your case, we might need to make a tiny incision the incision is made along the lower eyelash line to help disguise it. I use this entrance point to contour the herniating fat pads, tighten the muscle and also remove extra skin.

Here’s an example of a patient where I performed upper and lower eyelid rejuvenation in the same patient. 

Here’s a different patient where I only performed Lower eyelid rejuvenation surgery: 

Recovery

The recovery phase tends to be simple when the doctor’s instructions are followed. You will need a ride home from the procedure. Patients are usually feeling back to themselves by the next day and can shower and fly back if they are from out of town within 24-48 hours. 

 

It is normal to expect some swelling and bruising as this area is very sensitive and irrigated. However, it should improve within 1 week by using cold compresses, sleeping with one or two extra pillows, and taking the prescribed medications. Some mild swelling can  persistfor up to three months and still be within the normal parameters. However, you will have regular follow-up appointments to ensure the evolution goes as smoothly as possible. 

If you quit smoking before surgery and go on without cigarettes during the recovery phase, the scarring process will be quicker and more subtle.

It would also be normal if you experience some of the following symptoms after your blepharoplasty: 

  •       Hazy vision due to the lubricating eye cream
  •       Dual sight
  •       Mild Sensitivity to light
  •       Some mild discomfort 
  •       Numbness from the surgery numbing medicine for about a day
  •       Eye itchiness

All of them should subside within a couple of weeks and will be addressed during our follow-up appointments. 

However, you should refrain from using makeup or contact lenses until your recovery is complete, which means until I give you a green light to resume them. 

Please reach out if you have any additional questions or would like to schedule an appointment to get more detailed information on what a blepharoplasty would entail.

Further Reading about Facial Plastic
Surgery Procedures

Ready to Discuss Next Steps? Book Your Consultation!

Are you ready to take the journey towards a more youthful, refreshed look? I invite you to reach out to me and my team. Let’s discuss your goals and how facial fat grafting can help you achieve them. Remember, the first step is just a conversation. Let’s start that conversation today.

Or you’re welcome to call us at +1 (305) 209-881

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