Eyelid Lift Surgery (Blepharoplasty)

Eyelid Surgery (Blepharoplasty) is one of the most effective techniques for facial rejuvenation. Drooping, sagging, and puffy eyelids are one of the first signs of facial aging, and also the first area others notice when having a conversation and making eye contact. Connecting with others happens with our eyes. Eyelid lift (blepharoplasty) rejuvenates the upper eyelids, the lower eyelids, or both. Upper eyelid lift is one of the most common and high yield procedures in plastic surgery. Dr. Helena O. Taylor and Dr. Stephen R. Sullivan have been named some of the best board certified plastic surgeons in the Cambridge and Boston Mass area. They 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. For many patients, despite other signs of facial aging, lifting the eyelids and removing excess skin alone can transform and restore appearance. Some patients may also wish to consider additional facial rejuvenation procedures such as Botox or Dysport, fillers, facial fat transfer, browlift, facelift or neck lift. With aging and sun exposure, the skin of the eyelids can sag and leave you looking tired, sad or old. To restore a youthful, awake and rested appearance, consider an evaluation for eyelid lift with Dr. Taylor and Dr. Sullivan.

Each patient is carefully evaluated and if Dr. Taylor and Dr. Sullivan consider you to be a good candidate for an eyelid operation, they will customize a surgical plan for you, with care taken to hide surgical approaches inside the lower eyelid or in the upper eyelid crease. When you are ready for eyelid rejuvenation, contact us and we can evaluate you in our Cambridge Mass office at Mount Auburn Hospital.

Upper Eyelid Lift Surgery

Upper Eyelid Surgery (Blepharoplasty) can be an safe and effective way of brightening the face while maintaining a natural appearance. Some extra skin in the upper eyelid is natural and necessary to allow the eyelid to close. As we age however the upper lid deflates laterally, and the skin looses 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. This leads to a tired and aged appearance. In severe cases, the skin can rest on the upper eyelashes or even hang in front of the eye and impair vision. For women, applying makeup can become difficult, as the redundant skin obscures the natural lines and mascara smears on the excess skin. Patients often compensate for sagging eyelids by lifting their eyebrows, which can be exhausting and also creates yet another problem with forehead wrinkles or creases (learn more about Botox or Dysport to treat forehead wrinkles). For the right patients who want to brighten their eyes, an upper eyelid blepharoplasty can be a safe, high yield procedure. Patients with migraine headaches with forehead tension may also consider simultaneous migraine trigger point release through the same incision used for eyelid lift.

An upper lid blepharoplasty typically involves removal of skin and a small amount of muscle, and often some medial fat. Occasionally the levator muscles of the upper lid are tightened for an eyelid which has become droopy or "ptotic." The upper eyelid scar will always be there though it typically heals inconspicuously, and is often barely perceptible even with close examination. Upper eyelid surgery can be performed under local anesthetic alone; patients are awake and very comfortable while gentle and precise upper eyelid appearance is restored. The procedure takes approximately one hour. 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.

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Preoperative Upper Eyelid Lift

Before upper eyelid lift (blepharoplasty), excess skin and fat weigh down the eyelid and in severe cases can obstruct vision. The skin also creates harsh shadows and gives the appearance of being tired and aged.

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Postoperative Upper Eyelid Lift

The same patient as the preoperative photo is seen here after upper eyelid lift (blepharoplasty). The eye is open and visible while the surgical scar is carefully hidden in the upper eyelid crease. The operation is performed under simple and gentle local anesthesia with the patient wide awake and comfortable.

Lower Eyelid Lift Surgery

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 collagen elasticity, and decreased muscle tone. For patients with the appropriate anatomy, and without history of dry eye, lower eyelid blepharoplasty can be performed to tighten and smooth the lower eyelid skin. Patients with a history of dry eye are sometimes 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.

Our preference is to perform lower lid blepharoplasty under sedation or general anesthesia, as we often access the lower eyelid through incisions inside the eyelid, known as a transconjunctival approach. The conjunctiva, or pink lining of the eyelid, is opened and the underlying muscle layer, known as the capsulopalpebral fascia, is separated, to allow access to the excess fat of the eyelid and orbit. Meticulous care is taken to safely preserve and protect the eye and eyelid layers. Our goal is to re-drape the soft tissue and orbital fat to smooth the contour, and tighten the skin. This often requires tightening the lower eyelid horizontally with a lateral canthopexy, as well as repositioning eyelid and orbital fat, and excising a small amount of skin just under the eyelash line. 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. 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. We will carefully evaluate your individual anatomy and medical history to determine if lower eyelid blepharoplasty is a good idea for you.

Brow Lift or Forehead Lift Surgery

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.

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.

Alternatives to Eyelid Lift and Brow Lift

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.


BLEPHAROPLASTY (EYELID LIFT) INSTRUCTIONS

• In the week before your operation:

o Consider eating pineapple, it may help reduce bruising

o Consider supplementing with Arnica montana, it may help reduce bruising

o Complete household chores and prepare meals for the first few days of postoperative recovery

o Follow preoperative instructions with eating, drinking, and medications

• Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.

o Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours

o Ibuprofen (Motrin) 800 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours

o Vitamin C 500 mg daily for 50 days

o Eye drops

o Eye ointment

• During the day, apply eye drops (available over the counter such as Refresh Plus) in each eye (2-3 drops) at least 5-7 times daily. Eye drops moisturize the eyes and provide soothing relief for dryness and irritation.

• At bedtime, apply eye ointment (available over the counter such as Refresh PM) in each eye inside the lower. The ointment helps protect the eyes from nighttime dryness and exposure. It may make your vision temporarily blurry, but it will resolve as the ointment washes away during the night.

• We may prescribe Tobradex eye drops - 3 drops in each eye 3 times per day for the first 5 days if we think it would be helpful.

• After surgery it is best for you to keep your head elevated when in bed.

• You may apply ice packs to the area around the eyes for the first 48 hours to reduce swelling and bruising. Bags of frozen peas and corn make for excellent ice packs. You might also consider Icewraps Gel Packs or Swiss Safe gel packs, which can be ordered from Amazon or online. Apply the ice packs for 20 min of each hour while awake.

• You may shower the day after the operation and wash your face gently with soap and water. Avoid soaking the incision, although It will not hurt to get a splash of water on the stitches or in the eyes. Do not rub the stitiches or Steristrips. Gently pat dry after washing.

• Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.

ACTIVITY

• For the first few days following surgery, avoid raising your blood pressure or heart rate as it can cause bleeding. In the 2nd week you can gradually increase your activity back to normal.

• Please do not drive until you can see fully (usually 3 to 5 days). Do not drive while taking pain medications such as oxycodone.

GENERAL OUTCOMES

• Tearing and dryness of the eyes is common after eyelid surgery. These symptoms normally stop as the swelling subsides over the first few weeks. Eye drops and ointment help moisturize the eyes.

• Tightness of the eyelids is a normal after eyelid surgery. This may make it hard to close the eyelids completely and they may not close completely while sleeping. This will relax with time.

• Red discoloration of the whites of the eyes is normal as well. This is painless, will not harm your vision, and will disappear. Swelling may also cause the lower lid to pull away from the eye. This will subside as the swelling goes down.

• Contacts can be worn when the eyes start feeling normal and the majority of the swelling has subsided. This is approximately 1 to 2 weeks after surgery. Wear glasses until then. It is common to have blurred vision after your procedure as the cornea can swell or be compressed from eyelid tightening – it can take several weeks to resolve – be patient, it will go away.

• Cosmetics can be worn on the face the day after surgery, but should not be worn on the eyelids or eyelashes until after the eyelid sutures have been removed and wounds are healed.

• Scars take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. All incisions will be sensitive to sunlight during the healing phase. Direct sun contact or tanning booths are to be avoided. Wear sunglasses and use a sunscreen with SPF of 30 or more. The scars can be massaged starting 3 weeks after surgery. This may promote early softening and maturation of these areas.

• A small amount bleeding from the incision and swelling of the eyelids is expected. Please call our office (617-492-0620) if you have:

o Continuous bleeding

o Significantly more swelling on one side when compared to the other

o Worsening eye pain

o Changes in vision

o Fever, spreading redness or irritation around the eyes

o Yellow crusts or discharge from your eyes

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