Recent Advances in Cosmetic Eyelid Surgery (Blepharoplasty)

Blepharoplasty (Blepharo- means “eyelid”, and -plasty means “change”) is the most commonly performed facial plastic surgery procedure. This is because the eyelids account for a large part of the expressiveness of the face. When you look at someone, you look at his or her eyes. If the eyelids are sagging, droopy, or puffy, the face will look fatigued, sad, and tired despite good health and adequate rest. If the eyes look bright and alert, an otherwise aging face will appear rejuvenated. Thus, blepharoplasty is a procedure that can rejuvenate the face as well as the eyes.

Years ago, treatment focused on aggressive skin and fat removal on every patient. This approach lead to unnecessary complications, such as lid retraction after excessive skin removal, causing chronically irritated eyes, and a sunken (skeletonized) appearance to the eye socket after excessive fat removal. These results, unfortunately, created a more aged appearance – the direct opposite what was intended.

Today, blepharoplasty is tailored individually for each patient. The right combination of skin removal, skin resurfacing, fat removal, fat repositioning, and lid tightening is applied to achieve a more rejuvenated and youthful appearance in each individual patient. Sometimes, less is more.

Modern day upper lid blepharoplasty is typically performed as a same day surgery under light sedation and local anesthesia. An incision is made in the natural upper-lid skin crease, across the lid. Excess skin is removed using an advanced electrocautery device with the precision of a laser. Bulging orbital fat may be removed, sculpted, or repositioned. Lateral sub-brow fat that contributes to upper lid fullness may be removed and/or sculpted. The incision is closed using a fine, absorbable suture.

Modern day lower-lid blepharoplasty is performed to soften the puffiness of the lower eyelids caused by prolapsed orbital fat. An incision is made across the length of the inside of the lower lid to remove or sculpt the fat (transconjunctival blepharoplasty). Fat may be repositioned to improve a tear trough deformity. Excess skin is removed, if necessary. Lower lid laxity or droop may be simultaneously corrected. Blending of the lid-cheek junction is performed with a lateral canthoplasty and orbicularis muscle suspension.