- Why Choose Blepharoplasty?
- What is Blepharoplasty?
- The Blepharoplasty Procedure
- Candidates for Blepharoplasty
- The Blepharoplasty Consultation
- Preparing for the Eye Lift Procedure
- Anesthesia Used For Blepharoplasty
- Blepharoplasty Risks and Potential Complications
- Recovering from Eyelid Surgery
- Blepharoplasty FAQs
Why Choose Blepharoplasty?
The eyelids have the thinnest, most delicate skin on the body and can significantly affect a person’s appearance. Fine lines, crow’s feet, and saggy eyelid skin make you look older or more tired than you actually are. Genetics and sun damage may also lead to cosmetic concerns around the eyes and take a toll on your self-confidence.
Aside from aesthetic issues, drooping eyelid skin can present a functional problem. Excess skin around the eyes may obstruct your ability to see and is generally permanent without surgical intervention.
If sagging eyelids are affecting your vision, blepharoplasty can also eliminate excess skin and allow you to open your eyes more fully. The results of eyelid surgery are life-changing and often help patients feel more confident in their overall appearance.
* Each patient is unique and individual results may vary.
What is Blepharoplasty?
Blepharoplasty, also known as cosmetic eyelid surgery, is a surgical procedure that rejuvenates the eyelids. It can be performed on the upper eyelids, lower eyelids, or both. This is perhaps the area in plastic surgery that requires the surgeon to be the most “ultra-conservative.” Aggressive surgery in the eye can leave the patient with irreversible changes that may severely affect the function and the aesthetics of the eye.
Dr. Bustillo customizes the blepharoplasty surgery for each individual. He avoids the removal of too much fat to avoid the “sunken eye” look. On certain patients, he uses fat to fill the tear trough and smooth the eyelid-cheek junction. He is meticulous and conservative so that the shape of your eyelids will never change.
Upper Eyelid Aging
The upper eyelid begins to show evidence of aging almost before any other facial feature. Excessive sagging skin is first seen as it crowds and hides the crease of the upper eyelid.
In the area near the nose, a small amount of fat often bulges out. When evaluating the upper eyelid, it is important to differentiate between the aging upper eyelid and descent of the eyebrow.
The eyebrow also descends with time. As it does, the brow skin crowds the upper eyelid, adding to the fullness in the area. The surgeon must differentiate between a low brow and an aging eyelid, in order to counsel the patient correctly (Figures 2, 3). Occasionally, patients may need both blepharoplasty and brow lift surgery to rejuvenate the eyelid-eyebrow area.
Lower Eyelid Bags
The lower eyelid may age in one of two ways. There may be premature eyelid aging, which is hereditary. People with this hereditary condition begin to demonstrate lower eyelid “bags” during the late twenties and early thirties. Most people, however, begin to show signs of eyelid aging in their early forties.
As the lower eyelid ages, the fat that surrounds the eye begins to accumulate under the eye and develop the “bags” that are visible. The skin also begins with age and develops wrinkles. The eyelid muscle can descend and give the eyelid a droopy look (Figure 4).
As the malar fat (cheek fat) pad descends, a loss of volume can develop between the lower eyelid and the cheek. This creates a line that sharply demarcates the lower eyelid from the cheek.
The Blepharoplasty Procedure
The purpose of the upper blepharoplasty surgery is to remove the redundant skin that overhangs the upper eyelid crease. The procedure is performed through an incision that is placed at the eyelid crease so that it is completely hidden. The skin is marked carefully before surgery to ensure that the exact amount of skin is removed.
The skin is removed and then a small amount of fat is removed in the medial area (next to the nose). The incision is then closed with a tiny continuous stitch that is placed inside the skin to ensure that the incision heals well and is virtually invisible. The stitch is then removed on postoperative day five. The blepharoplasty scar will not be visible once it completely heals.
The goal of the lower blepharoplasty surgery is to provide a smooth lower eyelid contour that blends with the cheek. This is done by removing the fat that protrudes underneath the eye, removing some of the excess skin, and then elevating and repositioning the eyelid muscle.
This must be done in a manner that will maintain the patient’s natural eyelid shape and avoid any malposition. Malposition is the name given to describe the change in the lower eyelid position that can occur from a poorly performed blepharoplasty.
The lower eyelid blepharoplasty can be performed via two different methods. The skin muscle flap technique is performed through an incision just underneath the eyelashes (Figure 5). The skin and muscles are elevated to reach the fat pockets. The fat pockets are then removed.
The amount removed must be just the right amount. If too much is removed, the eye may appear hollow after surgery (Figure 6). If too little is removed, then bulges will still be visible after surgery.
After the fat is removed, the surgeon tightens the eyelid muscle. This allows the contour of the eyelid to blend with the cheek (Figures 7, 8). It also tightens the eyelid to prevent any eyelid malposition. The incision is then closed with a tiny continuous stitch.
This is Dr. Bustillo’s preferred technique for most patients who have lower eyelid aging. The technique allows him to remove the excess fat and tighten the eyelid muscle. The combination of these two rejuvenates the lower eyelid and cheek complex.
The second technique is the trans-conjunctival technique. The doctor prefers to use this technique for young patients who need little to no skin removal or patients with very prominent eyes.
The trans-conjunctival technique involves an incision inside the eye to access the fat. The fat is then removed and a small pinch of skin may be removed, if necessary, from underneath the eyelashes.
Dr. Bustillo often combines fat transfer with the lower blepharoplasty. This allows him to carefully blend the eyelid-cheek junction to make it as smooth as possible.
Fat transfer also allows him to fill in the tear-trough. The tear trough is that valley that runs from the inner corner of the lower eyelid to the cheek.
Candidates for Blepharoplasty
The ideal patient for an upper eyelid blepharoplasty is a woman or man that has begun to show the signs of upper eyelid aging. Typically, the excess upper eyelid skin hangs or “hoods” over the eyelid.
The ideal patient for a lower eyelid blepharoplasty is one who has developed lower eyelid “bags” and/or has significant wrinkling of the lower lid skin. Patients with these physical characteristics often report having a “tired” look.
Many of these patients may also demonstrate a deep tear trough and hollowing of the eyelid-cheek junction. This hollowing is often treated at the same time as the eyelid surgery with fat transfer.
Patients can undergo surgery of the upper, lower, or both the upper and lower eyelids at the same time. This provides excellent rejuvenation of the eyelid and cheek area, giving the patient a very rested appearance.
The Blepharoplasty Consultation
Dr. Bustillo begins the blepharoplasty consultation in Miami with a frank discussion about the specific issues and concerns that the patient has. He will want to know whether the eyelid aged from early on, has it recently aged, or has the aging been progressing for a long time. Any ocular diseases, including symptoms of dry eye, must be discussed.
The doctor then performs a thorough facial and eyelid physical examination. The upper eyelid is examined for skin redundancy.
The brow position is also examined. A brow that has descended may mimic upper eyelid redundancy. This is important, as performing an upper blepharoplasty on a normal upper eyelid with a low brow, can essentially pull the brow even lower. Patients with a low brow should consider a brow lift (Figure 9, 10).
The lower eyelid is then examined. The amount of fat herniation is examined as well as the strength of the lower eyelid. Weak lower eyelids may require an additional lid tightening procedure. The position of the eye in relationship to the bony rim is then examined to help determine the technique that should be used for the surgery.
The patient and Dr. Bustillo then have a discussion about the result that he believes can be achieved with surgery. The patient should understand exactly what the blepharoplasty procedure will achieve for them so that an informed decision can be made. The procedure is explained in detail and all questions are answered.
Preparing for the Eye Lift Procedure
Dr. Bustillo requires that all patients obtain pre-operative labs. If the patient is older than 45 years, a medical clearance is required. The patient should stop taking any anti-inflammatory medications (such as aspirin, ibuprofen), vitamin A, and St. John’s wort ten days before the surgery. These medications can affect blood clotting and may cause excessive bleeding or bruising.
Patients should avoid alcohol five days before surgery to avoid swelling. Patients are required to start high dose vitamin C two weeks before and two weeks after to help with the healing and to reduce bruising.
Anesthesia Used For Blepharoplasty
Blepharoplasty procedures in Miami can be performed under different anesthesia types, depending on the patient and the adjunctive procedures being performed. If the patient is having the upper blepharoplasty operation alone, it is Dr. Bustillo’s preference to do this with local anesthesia and light oral sedation. It can also be performed with IV sedation anesthesia if the patient prefers.
If the patient is having either lower eyelid surgery or upper and lower eyelid surgery, the doctor’s preference is IV sedation anesthesia. If the patient is having eyelid surgery in combination with a facelift or other procedure, then either IV sedation or general anesthesia may be required.
Dr. Bustillo performs blepharoplasty surgery in his state-of-the-art certified surgical suite. Because he believes that patients recover the best outside of a medical environment, they are allowed to return home or to their hotel room the same day after they recover. All surgeries that require anesthesia are staffed by board-certified anesthesiologists (M.D.), who are part of the Baptist Hospital Anesthesiology Department.
Blepharoplasty Risks and Potential Complications
The surgical risks associated with blepharoplasty are rare. The risk of a hematoma, or collection of blood under the skin, is about one percent. If this occurs, it can be drained in the office under local anesthesia.
Chemosis, or swelling of the inner lining of the eyelid, also rare, occurs less than 1% of the time. If it does occur, it is easily treated with steroid drops and lubricating eye drops and usually resolves in a week or so.
Occasionally millia, or small cysts, may form on the incision. If these occur, they can easily be removed under local anesthesia in the office. Infections are extremely rare in the eyelids.
When a skilled surgeon who routinely performs eyelid surgery performs blepharoplasty, the rate of complications is very low. During eyelid surgery, it is extremely important to be conservative in removing tissue, however.
The surgeon may sometimes be faced with a decision during the surgery… should they take more skin or fat or leave it behind? Because the margin for error is very small in the eyelids, Dr. Bustillo believes it is always better to take less than more.
For this reason, the judicious surgeon may go back several months later and take a little more skin and fat if necessary. This is Dr. Bustillo’s philosophy regarding eyelid surgery, and he sees very few blepharoplasty complications in his practice as a result.
Recovering from Eyelid Surgery
The patient is discharged home the same day as their blepharoplasty surgery. The first night should be spent with the patient quiet and relaxed.
It is best to keep a liquid diet for the first twelve hours. The patient should keep the head elevated with two pillows. Small zip-lock bags filled with peas should be placed on the eyes for 10 minutes at a time for the first two days.
Most patients who undergo a blepharoplasty do not have any pain. Tylenol is usually enough to control any minor discomfort that may be present. Dr. Bustillo will provide you with additional pain medication, just in case, it’s needed.
Dr. Bustillo should be made aware of any significant pain, as this may signal bleeding under the skin. Some mild bruising may be visible around the eyes.
The surgeon will see you on the fifth day after the surgery. The tiny stitches will be removed on that day. Patients can usually wash their eyes after the visit. They can also wear makeup again if they wish.
Most patients return to work on the seventh day after surgery. It is safe to resume exercise three weeks after the blepharoplasty surgery.
Seventy percent of eyelid swelling resolves in the first two weeks after the surgery. The remainder of the swelling can take eight to twelve weeks to completely resolve. This last bit of swelling is imperceptible.
The final results of the blepharoplasty may not be completely evident until two to three months after the surgery. The results of a blepharoplasty operation usually turn back the clock approximately five to seven years. Most patients who undergo the blepharoplasty operation are extremely happy with the results.
Blepharoplasty, or cosmetic eyelid surgery, is a plastic surgery procedure that improves the upper and lower eyelids. The upper blepharoplasty is aimed at correcting the sagging skin that overhangs the upper lid. The surgery for the upper eyelids removes mostly skin and a small amount of fat from the inner corner of the eye.
The lower blepharoplasty is aimed at correcting the ” bags” that form underneath the eye. The surgery can be done from an incision underneath the eyelashes (subciliary approach) or through one inside the eye (transconjunctival). Miami plastic surgeon Dr. Bustillo will inform you which is the best approach for you. The fat is then gently removed and a small amount of skin is the removed. The result is a natural and refreshed look.
Blepharoplasty refers to eyelid surgery. Many times, patient may have brows that have descended and are low. These patients may need a browlift procedure to elevate the brows. Patients that may have puffy lower eyelids due to allergies will not achieve improvement with the blepharoplasty procedure.
Dr. Bustillo performs the upper blepharoplasty via a small incision in the crease of the upper eyelid. This incision heals very well and will be imperceptible once healing has occurred. The skin is removed and then a small amount of muscle and fat are removed. The skin is then closed with small stitches. These are placed in a way that they can be removed without pain.
The lower eyelid is performed in a different way. A small incision is made under the eyelashes. He skin and muscle are elevated, and the fat is removed. A tiny strip of skin is then removed and the muscle is then tightened. The incision is then closed with small stitches. These stitches are also placed so that they can be removed without causing pain.
Dr. Bustillo performs the upper blepharoplasty in one hour and the lower blepharoplasty in one hour.
The incision for the upper blephroplasty is made in the natural crease of the upper eyelid. This incision heals well. The lower blepharoplasty incision is made just under the eyelashes (subciliary) or inside the eye (transconjunctival).
The skin in the eyelids is the thinnest skin in the body. The incisions, when placed well, will heal well and be imperceptible.
The blepharoplasty procedure is not painful. Patients typically complain of a burning sensation in the eyelids one hour after the procedure. The discomfort will generally last about 1 hour.
The recovery for blepharoplasty is rather mild. The surgery is ambulatory, meaning that the patient is allowed to return home the same day of the surgery. The patient returns to see Dr. Bustillo at the fifth post-operative day. At that time, the sutures are painlessly removed. From that point on, any bruising will start to quickly subside. Women can wear make up after the sutures are removed. About 70% of the swelling resolves in the first 2 weeks. The remainder takes about 2 months to resolve. However, this is mild swelling that is not perceptible. Most patients are well enough to return to work by the seventh post-operative day.
Patients are generally able to return to work about one week after the blepahroplasty procedure.
Dr. Bustillo recommends that patients do not return to exercise for three weeks after their procedure.
Dr. Bustillo will remove the stitches on the fifth post-operative day. The removal will be painless, as they are placed in a way that they simply slide out.
The potential complications that may occur with blepharoplasty include the following: bleeding, dry eyes, slight asymmetry in healing or scarring, swelling at the corners of the eyelids, temporary blurred vision, and whiteheads.
The blepharoplasty procedure, or eye lift, is performed to improve the look of the eyelids. When done on the upper eyelids, the excess skin is removed to give the eyelid a more rested appearance. The lower eyelid surgery is done to remove the “bags” under the eyes. These bags are composed of fat. I now remove some of the fat and actually preserve and “relocate” some of the fat. This procedure also gives the eyes a more rested appearance. These procedures should not change the shape of the eyelid.
If is still early in the recovery period and would ask that you allow everything to heal. Lower blepharoplasty is a good procedure to rejuvenate the lower eyelids, by removing the lower eyelid fat and some of the wrinkles. However, it will not remove all of the wrinkles.
No. Both procedures need to be separated by at least 6 months. Performing blepharoplasty too soon after lasik may damage the flap that is made during lasik.
Well, the first thing I would find out if this is water retention or actual orbital fat. There is a subset of patients that have hereditary pseudo-herniation of orbital fat. That just means that the fat is creeping out under the eyeball, something that happens with age. However, some patients can have it begin in their late twenties. If this is your case (fat), then I would have it removed surgically. This will give you a permanent treatment, which will be better and more economical over the long run. If the puffiness is due to water retention or allergies, then I would have the tear trough filled with a filler to camouflage the puffiness.
The bags you are seeing in the lower part of your eyes is actually fat that has sagged from the inside of the orbit, or eye socket. Liposuction can be used to remove the fat because it is in a very delicate area. In order to remove it, I make a small incision underneath the eyelashes or inside the eye, and gently remove the fat. We then remove a small amount of skin so that it does not sag.
Why Choose Miami plastic surgeon Dr. Bustillo?
- Castle Connolly Top Doctor for more than 10 years
- American Board of Facial Plastic and Reconstructive Surgery
- American Board of Otolaryngology-Head and Neck Surgery
- Facial Plastic & Reconstructive Surgery Fellowship at The New York University
- Otolaryngology – Head & Neck Surgery Residency at The University of Miami, Jackson Memorial Hospital
- General Surgery Internship at The University of Miami, Jackson Memorial Hospital