Blepharoplasty, more commonly known as an “eyelid lift”, refers to procedures of the upper and lower eyelids where skin and fat are removed or re-draped to create a natural, rejuvenated appearance. Sun damaged and sagging skin due to age-related changes, or asymmetric fullness of the lids, can lead to unwanted redundancy and wrinkles around the eyes.
Upper and lower blepharoplasty can be performed under local anesthesia, however, many patients prefer the addition of some form of sedation. Both the right and left sides are typically performed at the same time, and patients often elect to combine these procedures with other surgeries, such as ptosis or brow lift.
Upper Eyelid Blepharoplasty
Upper lid blepharoplasty removes excess skin and bulging fat through a small incision along the natural eyelid crease. It may help to improve peripheral vision and restore a more youthful, less tired, appearance.
Lower Eyelid Blepharoplasty
Lower lid blepharoplasty addresses puffiness, hollowness and skin wrinkles of the lower eyelids. This procedure can be performed through the inside of the eyelid, otherwise known as a transconjunctival approach, or through an incision just below the eyelashes of the lower lid. Although the transconjunctival approach leaves no visible scars on the eyelids, lower lid blepharoplasty with a skin incision allows for fat removal and skin tightening when necessary. The fat from the lower eyelid is removed, and depending on the patient’s anatomy, repositioned to create a smooth, refreshed, and natural appearance.
Eyelid ptosis refers to “droopy upper eyelid(s)”, and can occur on one or both sides. Ptosis can cause difficulty with peripheral vision, and aesthetically, can cause someone to look inadvertently inattentive or sleepy. The most common cause of ptosis is weakness of the levator muscle, which is the main muscle responsible for opening the eyelid. Ptosis can also be present from birth (congenital ptosis), or be caused by various neurologic disorders, muscular conditions, surgery, or trauma. The surgical correction of ptosis typically requires tightening of the muscles that open the eyelid, either through an incision along the upper eyelid crease, or through a hidden incision on the back surface of the eyelid. An upper lid blepharoplasty is commonly combined with ptosis repair to address excess skin. Ptosis repair can also be performed in combination with lower lid blepharoplasty or brow lift procedures.
Double Eyelid Surgery (Asian Eyelid Surgery)
Upper lid blepharoplasty in the Asian population requires expert attention to the unique differences in the Asian eyelid anatomy. The upper lid skin may not form a crease or may form an incomplete or low lid crease. Additionally, the lid is often fuller in appearance due to the location of fat along the lid. The goal in eyelid crease revision is to create a change in the position of the crease while maintaining the natural and full contour of the Asian eyelid.
Congenital and gravitational settling of the brows (brow ptosis) causes forehead lines, low or asymmetric brows, and redundancy in skin of the upper eyelids. With age, the temporal, or outermost, aspect of the brow is the first to succumb to weakness and brow ptosis, leaving heavier skin sagging on the outside of the upper eyelids. This can also create deep wrinkles at the outside corner of the eyelids. Neuromodulators, such as Botox®, can be useful in helping manage mild brow ptosis and forehead wrinkling. However, with time, this becomes less effective, and surgical options must be considered.
Various surgical approaches exist to modify the height of the brow. These include browpexy through an upper eyelid crease incision, direct brow lift, temporal brow lift, endoscopic brow lift, and pretrichial brow lift. Each approach has its individual advantages and disadvantages, but it is important to have a proper consultation and discussion to find the approach best suited for you.
A brow lift may be combined with other cosmetic procedures including upper and/or lower blepharoplasty, ptosis repair, liposuction or rhytidectomy (face lift).
Browpexy is typically used to stabilize the brow, and has little effect on the position of the forehead. This technique uses a suture or bioabsorbable device to fixate the deep brow tissue to an improved position through an upper eyelid crease blepharoplasty incision.
Direct Brow Lift
This direct brow lift removes tissue above the brow, and is used to raise the brow when there is significant ptosis. The incision is hidden in the upper-most brow hairs. The direct brow lift scar can be more noticeable immediately after surgery, but typically heals well with proper post-operative care after a few weeks to months. The direct brow lift provides a long-lasting and powerful lift and is a great approach in the right patient.
Endoscopic Brow Lift
The endoscopic brow and forehead lift is performed through small incisions that are behind the hairline, concealing any incisions and scarring. Endoscopic instruments are used to elevate the forehead and fixate the brows in a more appropriate and aesthetically pleasing anatomic position. The forehead is fixated with sutures and bio-absorbable implants. This approach can also be useful to raise the hairline in those with a short forehead.
Pretrichial Brow Lift
The pretrichial brow lift is performed through an incision just behind the hairline, and is a powerful approach to lift the brows. The pretrichial brow lift scar can be more noticeable immediately after surgery, but typically heals well with proper post-operative care within a few weeks to months. This approach is the most advantageous for those who wish to shorten an otherwise high forehead, in addition to lifting the brows to a more anatomic and aesthetically pleasing position.