Upper and lower eyelid blepharoplasty

Blepharoplasty "eyelid lift"

Upper and lower eyelid blepharoplasty are procedures that involve sculpture of the upper and lower eyelids. The upper eyelid crease can be recreated and made more graceful; the corners of the eye can be gently elevated if desired, and bags and wrinkles can be removed.

The incisions are hidden in the eyelid creases, or on the back surface of the eyelid (conjunctiva), using a transconjunctival approach.

If desired, the hollow beneath the lower eyelids (the tear trough) can also be filled in with fat.

The procedure can be accomplished in our office or in an outpatient operating suite, and generally takes one to two hours. Postoperatively there is surprisingly little pain, and sutures are placed that usually dissolve on their own. Bruising can last up to one week. Full activities may also be resumed after a week.

These Photos Have Not Been Retouched In Any Way

Questions commonly asked about blepharoplasty (and their answers….)  

Dr. Wulc has been performing eyelid surgery, also known as blepharoplasty surgery, for patients with droopy eyelids, puffy eyelids, hanging upper eyelid skin, wrinkled eyelids, and bags under their eyes in the Philadelphia area for over 25 years.  Here are some of the most common questions we are asked in our Plymouth Meeting, suburban Philadelphia practice. 

Do I need a blepharoplasty? 

No one needs a blepharoplasty. A blepharoplasty is an elective procedure performed to reduce skin excess in the upper eyelids, and to sculpt fat in the upper and lower eyelids. 

If you have skin excess in the upper eyelids, recurrent upper or lower eyelid edema (swelling), or bags and wrinkles under your eyes, you are a candidate for this procedure. 

How is it done? 

We perform blepharoplasty using a minimal incision technique.  The operation is usually performed in a local out patient surgery center under local anesthesia with sedation, or in our office surgery suite.   

In the upper eyelids, an incision is designed  in your eyelid crease.  This is the location in the upper eyelid up to which you would wear eye makeup if you were a woman.  In a man, the incision is hidden in a natural upper eyelid fold.  The incision is then drawn out beyond the corner of the eyelid in a natural laugh line.  Local anesthesia is used, and then a small segment of skin is removed.  We address the fat by moving it, removing it, or gently sculpting it.   Droops of the eyelid are addressed if necessary, and the lid crease is balanced, or deepened, or its position is changed, based on the patient’s preference.  The wound is then closed using absorbable sutures which disappear in short order. 

In the lower eyelids, an incision is made on the back surface of the eyelid (transconjunctival blepharoplasty), so that no external visible scar is apparent.  Fat is moved ore removed or sculpted as in upper eyelid surgery.  If necessary, loose lower eyelids can be tightened simultaneously, and redundant skin and muscle can also be removed.  If these latter procedures are performed, sutures are also used to close the incision sites where skin was removed so that no scar remains visible once healing is complete. 

Does it hurt? 

Blepharoplasty should not hurt.  The vast majority of our patients brag that they didn’t need to take more than a few Tylenol to control their postoperative pain.  Ice compresses alone generally provide even more relief than pain medicines. 

 If you have pain after blepharoplasty, something is very wrong.  A serious hemorrhage could be present. We advise our patients to contact us immediately should there be pain, b ecause it could mean either bleeding within a fixed space as in a hemorrhage, or that something got in your eye after surgery.  Rarely, the ice compresses you use after your surgery can scratch the cornea if your eye is not closing after surgery.   

Will I leave the OR with bandages on? 

Some surgeons use bandages.  We don’t.  We’ve done informal studies in our practice that have shown us that icing immediately after surgery is better than eye patches for swelling after these procedures.  Bandages may be dangerous because they may conceal a hemorrhage.   

Most patients get ointment in their eyes immediately after surgery.  This is because the eyes don’t close after the procedure while the anesthesia is still working (it affects sensory nerves and motor nerves as well, so when you can’t feel an area, you can’t move it, either)  For this reason, we use ointment in our patient’s eyes for 1 to three days following surgery. 

Take the fat out, or leave it in? 

More and more, we leave the fat in.  Facial plastic surgeons are coming to realize that fat in the face is precious—we lose it as we age.  So it makes little sense to remove it.  However, many patients do have an excess of lower eyelid fat, and in those cases, we move it, or remove it.   

Often, we add fat with the technique of liposculpture. Fat is taken from another site, such as the belly or the hips, saddlebags or knees, and placed in the face after being treated.  Much of the fat survives as a living graft that replaces the volume that has been lost with age. 

What about the wrinkles? 

This is a common fallacy about blepharoplasty.  Blepharoplasty alone, the removal of excess skin, will  not  rid someone of wrinkles.  The texture of the skin is still affected no matter how much is cut away.  What remains stays wrinkled.  Removal of too much skin in an effort to lessen wrinkles often results in a pulling down of the eyelids, along with dryness of the eyes and a funny, sad look that is one of the complications of blepharoplasty.   If wrinkles are a problem, some type of resurfacing procedure is required, either a fractional laser resurfacing or a full facial laser resurfacing. 

Is Laser blepharoplasty right for me? 

A laser can be used in eyelid surgery to tighten and resurface the surface of the skin. Laser resurfacing employs the laser to treat the entire skin surface or a fraction of it to a certain depth, based on the depth of the wrinkles and the thickness of the involved skin.  Both the C0₂ laser and the Erbium Yag laser can be used.  Postoperatively, after wrinkles are resurfaced, the skin needs to be kept moist  till it heals.  Erbium laser resurfacing is not as painful, and patients  can wear makeup to conceal their laser treatment and bruising about one week following lower eyelid laser resurfacing  

The laser can also be used as an incisional tool.  We use a C0₂  laser for this.  The laser is used to make the cuts.  Despite its high precision, we have found that healing is slightly slower after laser than after using electrosurgery or radiofrequency surgery, so that we prefer to use cutting tools that allow quicker healing. 

What’s Smart blepharoplasty? 

Lots of names get branded and sound exciting.  We’re actually not sure what’s so smart about it.  A laser can be introduced under the skin and used to try to attempt to remove the fat.  Through a small incision, sounds smart, but there are problems in our view. 

Certainly, placing a laser that close to the eye and firing it without knowing exactly where it is relative to the eye poses some risks, including eye injury and orbital (behind the eye) hemorrhage.  Also, the fat of the orbital tissues is connected to deep blood vessels that also supply the eye.  So it’s not a good idea to pull on that fat, to suck it out, or, in our view to try to laser it.  In addition, you don’t know how much you are taking out by turning on the laser when you are there.  

In addition, we want to keep that fat in there (see above).  Orbital fat is precious and we don’t really want to lose it. 

Does blepharoplasty last? 

Blepharoplasty is a procedure that once performed to the surgeon’s and patient’s satisfaction no longer needs to be performed.  So, technically, it lasts a lifetime.  The tissues around the eyelids, however, continue to age.  Sagging occurs in the cheek and brows and might require a procedure if it wasn’t previously performed.  Wrinkles continue to form and require treatment with other modalities like Botox^TM  or Laser resurfacing.  But the reformed eyelid crease and the resculpted fat don’t change that much with time. 

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How long will I be black and blue and swollen?
One, maybe two, and rarely three weeks. 

When do the stitches come out? 

In general, the stitches dissolve within a week.  Rarely, we will use sutures that dissolve in a month or so, or use sutures that we need to take out. 

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When can I go back to work?  

Most people are back to work one week after surgery.  Many patients feel great and are back to work sooner.   

One week after surgery, though, some patients are wearing makeup to conceal their bruising, swelling or redness.   

When can I shower? 

We allow our patients to shower one day after surgery. We prefer that the shower water does  not hit the incision lines. 

When can I exercise? 

We allow our patients to exercise one week after surgery if they feel up to it. As in everything in life, common sense is the key.  Listen to your body. 

My friend had a blepharoplasty and she looked terrible, like a deer in the headlights, and I don’t have the courage to tell her. How can I be sure I won’t have the same problem? 

You may want to tell her that she can be fixed, if she’s a good friend! 

This type of problem occurs in the hands of an overaggressive or an inexperienced surgeon, or if the patient actually asked for it.  It shouldn’t happen.  Period. But, if it did happen, it is correctable with outpatient surgery.. 

My aunt had the procedure and her eyes were dry after that.  She is still suffering, 5 years after the procedure, and  she constantly has to put drops in her eyes.  I am afraid of this happening to me… . 

This is a terrible, but common complication after this surgery in some surgeon’s hands.  It haunts all surgeons that perform this surgery. 

If skin is overaggresively removed, or if the eye blink muscle becomes paralyzed with the surgery, the cornea becomes improperly lubricated because the eyelid surface does not maintain strong contact with the eyeball to allow the tears to wash over the cornea, 

This is a treatable problem!  Send your aunt in to an oculoplastic surgeon, and something can be done to help her with closure of her eyelids.  Eye plastic surgeons have experience in eyelid surgery especially, and because they commonly diagnose and treat eye conditions, tend to respect the extremely delicate tissues around the eyelids and are conservative in skin and muscle removal.  That’s what you want, conservative.   

And so it shouldn’t happen to you.    

Are there other complications? 

Complications of blepharoplasty include:  blindness, double vision, scarring, infection, asymmetry, droopy lid, dry eye, swelling of the eye, and dry eye. 

Will insurance cover this? 

It depends on the type of insurance you have and the magnitude of your problem and how it impacts your vision and your life.  Discuss this with us (or your doctor) on your visit.   

Why should I come to you and your office for this procedure? 

We are confident that you will find a visit to our office both educational, and fun.  We are passionate about plastic surgery, as is everyone in our office, and about helping you look and feel your best.  We have years of experience in techniques of eyelid surgery and are relentless critical of our technique and results.  In our office, you will see many examples of patients that have had problems similar to yours, and how their problems were solved.  We will then formulate a potential solution to your problem as well.