What Is Eyelid Surgery?
Cosmetic eyelid surgery (also called blepharoplasty or eyelid lift) is a procedure that reduces skin and fat from the upper and lower eyelids for a more youthful, rested, energetic overall appearance to the face. Cosmetic eyelid surgery can correct drooping upper eyelid skin and remove puffy bags from below the eyes. These features make a person look older and have the potential to interfere with peripheral vision. The current state-of-the-art reinforces the surrounding eye tissue’s anatomical structure while removing less fat than was historically done in the past.
With the modern blepharoplasty techniques, the fat that is removed during cosmetic eyelid surgery is now relocated to a more youthful position. The goal is to prevent a hollow appearance of the eye over the long-term. Even though cosmetic eyelid surgery does not reduce fine lines around the eyes, chemical peels and laser treatments are beneficial for these, especially in combination with the surgical procedure. Cosmetic eyelid surgery can be done alone or in conjunction with other facial procedures, such as facelift or brow lift.
|Procedure||What It Does||Surgery||Recovery||Results|
Addresses excess skin and droopiness in the eyelids
7-10 days, scars fade 8-12 weeks
Smooths out crow’s feet and wrinkles around the eyes
*Results may vary.
If you are interested in cosmetic eyelid surgery, Dr. Miguel Delgado—our experienced plastic surgeon—is prepared to develop a unique treatment plan to get the results you desire. Our practice is dedicated to preparing our patients for the best surgical outcome possible. Post-operative care is also a vital part of any procedure, and patients often arrange for follow-up visits at either our San Francisco or Marin County office.
Eyelid Surgery Before-and-After Photos
Eyelid surgery gives a person a more youthful and rested appearance without changing the eyes’ shape or expression. In some cases, peripheral vision is restored to levels not enjoyed for many years. The results will appear natural and balanced without any surgical look.
While the vast majority of our patients live in or around the San Francisco and Marin County area, our practice has expanded to treat people from all over California and the United States. Please don’t hesitate to call or read through our “Out of Town Patients” section.
Who Is a Candidate for Eyelid Surgery?
The best candidates for blepharoplasty are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Many people feel their eyes are their most attractive feature. When aging starts to steal that away, cosmetic eyelid surgery is the most reliable and successful means of restoring a youthful appearance.
Even people in their early-to-mid 30s will begin to notice early changes around their eyes. These changes are caused by fullness or puffiness due to fat pads and progressive laxity of the skin. An increase in these fat deposits’ size is generally unrelated to weight gain or loss but is a result of genetics, facial anatomy, and time passage. Indeed, increases in salt intake, alcohol, and sleeping in a dependent position will affect fluid fluctuation in the fat pockets. The fat pads have an essential function; they act as shock absorbers around the eyeballs and provide vital protection to the globes. With time, the connective tissue that once held this protective fat in position begins to stretch and loses its tone. Although it appears as if the fat itself is bulging, this phenomenon is actually caused by the relaxation of the tissue that encompasses it.
How Do I Prepare for Eyelid Surgery?
The initial consultation for eyelid surgery can be scheduled at either Dr. Delgado’s San Francisco office near Union Square or his Novato office in Marin County. Dr. Delgado will discuss your concerns in great detail at this meeting, and your goals and expectations will be addressed. Digital photography may be used to put your image on the computer. Computer imaging can aid in evaluating your appearance and demonstrating the proposed changes that can be achieved. Your medical history will be reviewed, and a physical examination will be conducted. Dr. Delgado will determine if the upper eyelid sagging is due to the upper eyelid skin, laxity of the eyebrow, or a combination of both. He will also determine if there is laxity of the lower eyelids that could be improved with tightening or other procedures.
Dr. Delgado will advise you as to whether eyelid surgery is the best procedure. He will help you decide whether both the upper and lower eyelids need correction and whether a brow lift is advisable. At times, additional suggestions are made. For example, if you would like eyelid rejuvenation, which will make your face look significantly younger, he may suggest other procedures to balance the face and create harmony.
Lastly, you will be given a pre-operative instruction booklet that will explain medications that will be ordered and any preparations that need to be made at home for recovery. This pre-operative booklet provides a detailed list of aspirin and aspirin-containing compounds, including anti-inflammatory products, that must be discontinued two weeks before and two weeks after surgery to minimize bleeding. The booklet also recommends vitamin supplements and homeopathic remedies that can be taken to minimize bruising and promote healing.
ABSOLUTELY the best surgeon in the state of California, if not the United States or the world. One of the best decisions I’ve made as an adult was to choose Dr. Delgado to work on my eyes, before I hit the big five O. The entire process, from consultation to booking the appointment, the pre-surgery care, the surgery itself, and the post-op care, was professional, seamless, and painless.
What Does the Eyelid Surgery Procedure Involve?
Eyelid surgery occurs at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer personal, concierge medical care while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, Dr. Delgado goes over the operative plan. A felt-tip marking pen, specially designed for this purpose, is used to keep the anatomy. Dr. Delgado takes great care with the skin marking to create the most natural and balanced shape possible.
Upper Eyelid Surgery
The upper eyelid surgery procedure involves excising an ellipse of skin from the upper eyelid. The incision is made in the upper eyelid’s natural crease so that when the incision line heals, it will be virtually invisible. A section of muscle underneath is also excised to create a clean upper eyelid crease, and the fat distribution may be altered as well.
The aesthetics of cosmetic eyelid surgery have changed over the years—evolving from fat removal to fat preservation. As the face ages, it loses the fat that gives the face its youthful appearance. Therefore, the fat of the upper eyelid is often preserved, while the redundant skin is excised. The goal is to rejuvenate the eyelids and not create a deep-set or hollow appearance. Dr. Delgado specializes in natural-looking cosmetic surgery.
Lower Eyelid Surgery
The lower eyelid is the most sensitive area of the face to be operated on. The tearing mechanism is altered due to swelling, and this takes time to adjust back to normal.
Lower eyelid surgery is performed through an incision inside the eyelid (transconjunctival blepharoplasty) or through the skin underneath the eyelash line. The transconjunctival approach is especially ideal for younger patients when there is no skin or muscle laxity. Some people have puffy lower eyelids either prematurely in life or genetically, and this approach serves their purpose well. The procedure involves retracting the lower eyelid and making a minimal incision in the inner eyelid. The fat is dissected free and partially excised, and only the appropriate amount of fat is removed. The incision is closed, and it heals internally.
Many individuals require an external approach to lower eyelid surgery. This patient is usually older and displays loose skin, muscle laxity, and fat prominence. This procedure tightens the skin and muscle, as well as removes or re-positions the fat pads. After the incision, the fat pockets are trimmed or, in some cases, re-positioned. The muscle that attaches to the overlying skin is tightened and anchored to the eyelid’s outer corner. The skin may be treated with a chemical peel or laser resurfacing to reduce crepiness.
Cosmetic eyelid surgery can be done with local anesthesia or IV sedation. It may be performed in conjunction with other procedures, and if this is the case, general anesthesia is usually recommended. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. Dr. Delgado and the anesthesiologist assist the patient in determining the best choice of anesthesia for their procedure. Additionally, the anesthesiologist calls the patient the night before surgery to review their medical history, confirm last-minute instructions, and answer any questions related to the anesthesia.
What Is Recovery from Eyelid Surgery Like?
The first few hours after surgery are spent in the recovery room, and cold compresses are placed over the eyes. The head and back are elevated above the heart to reduce swelling. When full alertness has returned, you may be discharged to your home. It is necessary to have a responsible adult to assist in the first 24 hours. The surgery is not painful, but a sensation of tightness from the swelling can be uncomfortable. During the early 48 hours, ice compresses to the eyelids will significantly reduce this swelling. Some patients experience irritation and dryness after surgery, and in this case, an ointment or eye drops will be prescribed until the symptoms resolve.
It is recommended for both upper and lower eyelid surgery to take five to seven days off work. If only the upper lids are done, you can likely return to work after three to four days. The sutures are removed five days after surgery. The bruising resolves in seven to ten days, and at this point, the use of eye makeup and contact lenses may be resumed. The incisions remain pink for approximately four to six weeks, gradually fading to inconspicuous lines in about eight to twelve weeks. Strenuous exercise should be avoided for the first four to six weeks following surgery, as excessive exercise can cause unwelcome and persistent swelling.
What Results Can Be Expected from Eyelid Surgery?
Eyelid surgery gives a person a more youthful and rested appearance without changing the eyes’ shape or expression. In some cases, peripheral vision will be restored to levels not enjoyed for many years. The results will look natural and balanced without any surgical look. Although the results will last for many years, the aging process will continue. A small amount of excess skin or fat could be removed to extend the original procedure’s effectiveness in the future.
Will I Have Visible Eyelid Surgery Scars?
The upper eyelid incision is concealed within the natural crease fold and truly fades to the point of disappearing. The only way to see the incision is when the eyes are closed—this natural fold results in an excellent scar. For a lower lid blepharoplasty, potential post-operative scarring depends on the technique. If a patient has fat fullness, but the skin and muscle tone is tight, there is no incision outside the eyelid. This transconjunctival incision is on the undersurface of the eyelid—thus, no external incision or scar. The other lower eyelid technique is performed when the eyelid skin is loose or saggy, and there is muscle laxity and lid laxity. This requires an external incision below the eyelashes and usually extends out to the crow’s feet area. The incision below the eyelashes is an excellent scar. While the one that extends to the crow’s feet area takes more time to mature, it also typically results in a good-quality, inconspicuous scar.
Are There Potential Eyelid Surgery Risks or Complications?
As with any surgery, there are risks and complications with eyelid surgery—but in the hands of an experienced board-certified plastic surgeon, the procedure can be performed with excellent safety.
There are risks of infection, bleeding, scarring, prolonged swelling, and on rare occasions, even blindness with eyelid surgery. The most common side effect experienced is the eye irritation of healing with the tearing mechanism being interrupted—possibly causing dry or irritated eyes. This usually resolves as the swelling is reduced.
What Is the Cost of Eyelid Surgery?
At our San Francisco and Marin County practice, the cost of upper and lower blepharoplasty together is $6,500. Lower eyelids alone are $4,500, and upper eyelids alone are $4,000. This includes the surgeon’s fee, anesthesiologist, outpatient surgery facility, and all recovery appointments. In some instances, the upper eyelids can be done in-office under local anesthesia for $2,500. Note: lower eyelid surgery is performed in the operating room under general anesthesia.
Is an Eyelid Lift Without Surgery Possible?
There is no practical way to perform an eyelid lift without changing the fat, muscle, and skin components through surgery. That being said, there are non-surgical treatments that can be performed around the eyes to improve the appearance. One of the most common non-surgical treatments is BOTOX® Cosmetic, which smooths wrinkles and lines in-between and around the eyes. A chemical peel or laser resurfacing can also reduce wrinkles around the eyes and tighten the lower eyelid skin.
Additional Frequently Asked Questions About Eyelid Surgery
When should I have blepharoplasty?
In general, people start considering eyelid surgery in their mid-40s to early 50s. The eyes are a prominent feature and tend to be the first place to show signs of aging. This is especially true of people who have fair complexions and have had a lot of sun exposure.
The age to have an eyelid lift varies from person to person. People age at different rates, and indeed, all people do not feel the same about the changes that come with age. A person may also opt to have both upper and lower eyelids lifted, or simply an upper or lower eyelid lift alone.
What’s the difference between blepharoplasty and ptosis repair?
The blepharoplasty procedure improves the aesthetics of the eyelid region. Eyelid surgery removes redundant skin, muscle, and fat tissue to create more youthful eyelids.
Ptosis repair is performed when the actual eyelid does not open enough and begins to cause a visual issue by covering the pupil’s upper portion. Ptosis repair will shorten the eyelid’s muscle, which opens the upper eyelid to the appropriate position. Ptosis is commonly seen as people age.
What is the difference between lower eyelid surgery through an internal incision versus an external incision?
Eyelid surgery through an internal incision is called a transconjunctival blepharoplasty. This surgical approach means that the incision is made on the inside of the eyelid. Therefore, there is no external incision. The internal incision is an excellent technique to remove “fat bags” but does not tighten the skin. This procedure is appropriate for younger patients with a good-quality skin tone that is still elastic.
The external eyelid lift is through an incision made just below the eyelash line. The advantage is that more tissue layers can be treated. The fat can be removed, the muscle tightened or trimmed, and the fat re-positioned.
Dr. Delgado addresses each patient’s needs individually, explaining the advantages and disadvantages of each surgical approach.
Will eyelid surgery improve my vision?
In some cases, upper eyelid surgery can improve vision. The upper eyelid skin, mostly the outer eyelid area, can cause hooding of the eyelid, which can obstruct the periphery vision. Surgery becomes a medical necessity and may be covered by insurance.
Can other surgical procedures be done during the same operation?
Yes, patients who undergo blepharoplasty frequently choose to have additional facial procedures done at the same time. Some added procedures may be a complete facelift, including the eyelid lift, an endoscopic brow lift, and a lower face and neck lift. Other non-facial surgical procedures, such as breast surgery or body contouring, can also be done in conjunction with an eyelid lift.
Is there a chance that I could go blind in one eye?
Unfortunately, yes. This complication is infrequent but does occur with 0.02% of blepharoplasties. It occurs due to bleeding and is caused by a vein or artery that begins to bleed. The hematoma (bleeding) can be successfully treated if caught in time.
Is it a difficult recovery?
The upper eyelid lift is generally an easy recovery. The lower eyelid surgery is typically a more difficult recovery, mainly when an external incision is made and several layers are tightened. The eyes are very sensitive and highly reactive, and though pain is not the issue, the area becomes tight from swelling. At times, this swelling can temporarily affect tear duct function.
When can I return to work and exercise?
Following upper and lower eyelid surgery, the sutures are removed after one week, and bruising resolves within approximately 10–14 days. Patients typically can drive by the end of one week, work by the end of the second week, and exercise after four to six weeks. Over time, the incisions heal beautifully to become practically invisible.
How can I reduce swelling after eyelid surgery?
Swelling (edema) is a common element of any surgery. However, there are many ways to minimize edema. These are the most common suggestions:
- Ice or cooling to the area
- Elevation of the back to 60 degrees so that gravity drains the swelling down
- No exercise or increase of blood pressure
- Taking of Bromelain (a dietary supplement that reduces swelling)
- Reduction in salt intake
When can I wear contacts again after eyelid surgery?
The contact lens can be worn after surgery when the swelling reduces and the contacts can be inserted without pain or disruption of the incisions. Adequate swelling subsides in about 10–14 days.
When can I wear eye makeup after blepharoplasty?
Makeup can be worn to camouflage the bruising after the incisions have healed together and crusting is absent.