What is a Blepharoplasty?

Over time, gravity and age—along with other factors such as genetics and environmental exposure—can cause the upper and lower eyelids to sag, creating the illusion of tired, or “sad” eyes. A cosmetic blepharoplasty—also known as eyelid surgery, or an eyelid lift—addresses the issues associated with aging eyes by removing excess skin or sculpting fat deposits in the upper and lower eyelids. It’s not uncommon for a patient to undergo additional procedures in conjunction with a blepharoplasty, such as an endoscopic brow lift, liposculpture (fat transfer) and injectable fillers or Botox®.

How We Treat Baggy Eyelids

We perform blepharoplasty using a minimal incision technique. The operation is usually performed in a local outpatient surgery center while under localized anesthesia with sedation or in our Philadelphia office surgery suite.

For some patients, the appearance of under-eye bags cannot always be resolved with a blepharoplasty. Sometimes, under-eye bags are caused by a drooping or sagging of the midface. As the cheeks begin to lose skin elasticity and volume, they lose elevation, pulling the under eyelids downward. This creates depressions under the eyelid while emphasizing bulges caused by fatty deposits. Severe under-eye bags with bulging fat pockets could also be known as malar bags or festoons. These kinds of eyelid bags may not be treated with a blepharoplasty alone.

Depending on your goals and other factors, Dr. Wulc will discuss the best treatment solution for you. He may recommend an alternative surgery or additional eyelid treatments with a blepharoplasty.

Upper Blepharoplasty

In the upper eyelids, an incision is made in your eyelid crease. The incision is 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 dissolvable sutures, which disappear in short period of time.

Lower Blepharoplasty

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, removed, or sculpted as in upper eyelid surgery. If necessary, loose lower eyelids can be tightened simultaneously, and redundant skin and muscle can 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.