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As we age the upper lid deflates laterally, and the skin loses elasticity, collagen, and muscle tone. The upper eyelid skin becomes heavy and droopy, obscuring the upper eyelid crease, and fat builds and bulges medially towards the nose. The youthful face has no clear delineation between the lower lid and cheek. With time and gravity the soft tissues of the cheek descend, the orbital septum and fat bulges and creates "bags" under the eyes, and a "tear trough" develops as a shadowed delineation between the lower eyelid and cheek.
Often this change in lower eyelid shape is accompanied by thinning of the skin, loss of elasticity, and decreased muscle tone. Drooping, sagging, and puffy eyelids are one of the first signs of facial aging, making people look tired, angry or haggard when that is not how they feel. Surgery can be performed on the upper lids (upper lid blepharoplasty) lower lids (lower lid blepharoplasty), and can, when necessary be combined with a brow lift.
Brow lift is a procedure that is performed when the eyebrows and forehead skin have fallen or become ptotic. For a woman, the eyebrows should rest above the bony ridge and have a youthful and beautiful curve outward. For a man, the eyebrows should rest at the bony ridge and be relatively straight. The eyebrow and forehead skin, like the upper eyelids, loose elasticity, collagen, and muscle tone.
The eyebrows and forehead can also become heavy and droopy, worsening the upper eyelid appearance as well, leading to a tired and aged appearance. Patients with brow ptosis or falling compensate by flexing their frontalis muscle to lift their eyebrows, which is exhausting, leads to forehead strain, and creates the problem of forehead wrinkles or creases (learn more about Botox or Dysport to treat forehead wrinkles). Some patients may benefit from a brow lift, or an upper eyelid lift, or both.
Upper lid blepharoplasty involves removal of redundant skin and sometimes a small amount of fat and muscle.
If the upper eyelid is droopy or ptotic, the levator muscle can be tightened to correct this. The scar is typically inconspicuous and hidden in the upper lid crease. The trade of contour for a scar, which is often very hard to find, tends to be a very good one. This simple high yield procedure brightens the eye and periorbital area without changing the look of a face or the shape of the eye. It can be performed under local anesthetic in the office, or with sedation in the operating room if preferred. While bruising and swelling for the first few days is expected, patients typically have very little discomfort. Cold compress or ice packs can reduce swelling and bruising. Sutures are removed at 5-7 days after surgery, and we follow you regularly thereafter. Some patients may also wish to combine upper lid surgery with other facial rejuvenation procedures such as Botox or Dysport, fillers, facial fat transfer, browlift, facelift or neck lift.
Lower lid blepharoplasty can be performed for people with bulging lower lids, fat pads, extra skin, and/or a prominent “tear trough” between the lid and the cheek. For patients with the appropriate anatomy, and without history of dry eye, lower eyelid blepharoplasty can be performed to reposition the fat, tighten and smooth the lower eyelid skin. Patients with a history of dry eye are considered poor candidates for lower eyelid surgery, as lower eyelid blepharoplasty can worsen dry eye. Patients with low muscle tone or delayed "snap back" test of the lower eyelid may require lower eyelid tightening with a lateral canthopexy and patients with very low muscle tone not be good candidates for comprehensive lower eyelid rejuvenation.
Lower lid surgery is more involved than upper lids surgery, and our preference is to perform lower lid blepharoplasty under sedation or general anesthesia.
We typically access the lower eyelid through incisions inside the eyelid, known as a transconjunctival approach. This approach allows access to release the septum and tear trough ligaments, reposition the fat, and smooth the contour between the lid and the cheek. A small amount of skin is then removed just beneath the eyelash line. In order to prevent lower lid malposition, often a tightening the lower eyelid horizontally with a lateral canthopexy is necessary.
The lateral canthopexy restores the shape of the eye, which should slope upward laterally in women and be straight across in men rather than sagging downward and looking tired. We often favor combining lower eyelid lift with fat grafting to the cheeks to restore midfacial volume, support for the lower eyelids, and blend the lower eyelid to cheek junction for a natural appearance. The procedure takes approximately one to two hours, and is done in the operating room.. While bruising and swelling for the first few days is expected, patients typically have very little discomfort. Cold compress or icepacks can reduce swelling and bruising. Sutures are removed at 5-7 days after surgery, and we follow you regularly thereafter.
Lower eyelid surgery carries the risks of lower eyelid malposition and exacerbation of dry eye.
Lower lid surgery can change the shape of the eye more than upper lid surgery. We will carefully evaluate your individual anatomy and medical history to determine if lower eyelid blepharoplasty is a good idea for you. A brow or forehead lift can involve endoscopic approaches with incisions placed on the scalp and hidden in the hair or direct removal of skin along the hairline.
The scars will always be there though they typically heal inconspicuously. Brow lift surgery is usually performed under sedation or general anesthetic while gentle and precise eyebrow position is restored. The procedure takes approximately one hour and when combined with eyelid lift may take two hours. While bruising and swelling for the first few days is expected, patients typically have very little discomfort. Cold compress or icepacks can reduce swelling and bruising. Sutures are removed at 5-7 days after surgery, and we follow you regularly thereafter.
Upper eyelid blepharoplasty is one of the highest yield ways of brightening a face that is starting to look tired. It is a relatively painless procedure, that can be done under straight local anesthetic in the office. For some patients a brow lift can help elevate the brows and reduce the fullness of the upper lids. Lower lid blepharoplasty in the right patient, can smooth the junction from the lower lid to the cheek, but is more involved, and carries more risk than upper lid surgery.
For patients who are not ideal candidates for a safe and natural appearing result with eyelid lift or brow lift surgery, Dr. Taylor and Dr. Sullivan may offer some alternatives. Muscles that pull the eyelids down, the corrugator muscles along the medial eyebrows and the orbicularis muscles along the lateral eyebrows, can be treated with botulinum toxin such as Botox or Dysport to soften the muscles.
This allows the eyebrows and upper eyelids to drift up and open the eyes. At the same time the heavy wrinkles around the eyelids and eyebrows are reduced. The tear trough deformity and heavy shadows of the lower eyelids can be filled with fat grafting or fillers such as Restylane, Juvederm, or Versa. Filling the tear trough blends the eyelid to cheek junction and also helps support the lower eyelid. Topical treatments such as Retin A may be helpful with fine wrinkles and Preparation H may be helpful with swollen bags under the eyes.
Most patients with extra upper eyelid skin can consider upper lid blepharoplasty. Patients with dry eye, poor elasticity, and recessed cheeks may not be ideal candidates for lower lid surgery.
The eyelids tend to make better scar than almost anywhere else on the body. While everyone scars differently It is often hard to find the eyelid scars.
Although the surgery is not typically painful, it may look like it should be painful! While everyone bruises differently, a fair amount of bruising and swelling the first week is common. The sutures are removed at 5-7 days, and while you may look much more presentable by then, some patients have residual bruising for another week or two. Lower lids often take longer to fully recover.
Bruising and swelling are expected and occur in everyone to some extent. For some upper lid surgery patients there may be temporary inability to completely close the lids (lagophthalmos), which typically resolve in a day or two. Poor scarring, lower lid malposition, significant bleeding, or changes in vision are the dreaded risks of eyelid surgery which we work hard to avoid.
It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 5 to 7 days, 3 to 6 months, and 1 year or as often as needed post-op. Call Taylor & Sullivan Plastic Surgery to schedule your appointments at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.
Download our Blepharoplasty (Eyelid Lift) Instructions
Dr Taylor and Dr Sullivan are plastic surgeons who are also both fellowship trained in facial plastic surgery and often work together during operations. They will carefully evaluate your eyelids for an eyelid lift (blepharoplasty) to remove excess skin or ptosis repair to correct sagging eyelids. If Dr. Taylor and Dr. Sullivan consider you to be a good candidate for an eyelid operation or a brow lift, they will customize a surgical plan for you. If you would like to learn more please contact us and we can evaluate you in our Cambridge Mass office at Mount Auburn Hospital.
Call Today 617.492.0620
To schedule a private consultation with Dr. Taylor or Dr. Sullivan, please call the office or request an appointment using our form. We welcome your visit and your questions.
300 Mount Auburn St. Ste 304, Cambridge, MA 02138