Blepharoplasty (Eyelid Surgery)

The Procedure

Before and After

Eyelid Surgery - Blepharoplasty

This is one of the most common procedures performed for both men and women alike. A blepharoplasty can be done for either the upper eyelids or lower eyelids or both upper and lower eyelids and is then known as a Quad Blepharoplasty.

Upper Blepharoplasty

The upper eyelid blepharoplasty addresses the drooping skin over the supratarsal fold (the demarcation line where the skin begins to fold over itself). The supratarsal fold in Caucasians is 8-12mm in height and in Asians 2-6mm in height. The anatomy is slightly different here between the races and so how the blepharoplasty is done is also modified. The desired effect is to obtain a crisp distinct fold and remove excess fat from the 2 fat pockets most notable near the nose and redundant overhanging skin and muscle.

The shortcoming of this procedure is that it doesn't correct the upper lid drooping out laterally (towards the side of the face). This drooping or ptosis as it is known as is due to the falling down of the eyebrows which causes sagging of the upper eyelid in the outer area. If the brow is raised to its normal position it may be noticed that there is relatively little excess on the upper eyelid. If the excess is still notable with the lateral brows raised then the patient will need an upper eyelid lift and forehead lift to correct this (see Forehead Lift/Endoscopic and Forehead Lift and Coronal Lifts).

Asian Eyelid Lift

The Asian eyelid differs slightly in that the supratarsal fold is fixed lower down near the eyelash line then in the Caucasian eyelid. Also there is often an epicanthal fold in the medial corner closest to the nose which presents itself as a slight web.

This anatomical variation between the races requires some alteration in techniques to perform the upper lid blepharoplasty. Depending on the patients desires they may want to keep the Asian eyelid as is or make it more Caucasian-like. The degree of alteration desired will dictate what techniques are employed to get the optimum results. There are some minimally invasive techniques that only require some sutures and not larger incisions but these may not achieve permanent results. Usually skin needs to be excised as with the standard blepharoplasty but the suturing of the layers is different to get the appropriate desired results. Additional incisions are required to correct the epicanthal fold.

Lower Blepharoplasty

Like its upper eyelid lift counter part there are a number of techniques available depending on individual anatomical consideration rather than racial ones however.

Some surgeons will offer a conjunctival incision approach where the incision is made on the inside of the lower lid in the pink lining that touches the eyeball rather than on the outside of the lid below the eyelash line. The reasons for this are that 1) there are no visible scars 2) less chance of an ectropion (pulled down lower lid). Unfortunately I do not see this approach as a good one because it is primarily designed to avoid two relatively rare problems. By the nature of the technique however it can correct only one of the three or four issues a patient may have with the lower eyelids. Therefore by its very nature this technique cannot correct all issues so why even do it?

The lower eyelid has usually 3 problems and sometimes 4 or more. First there is puffiness from three fat pads to varying degrees. These pads are located on the inner and outer sides and in the middle of the lower lid. The conjunctival incision can address these as will an outer eyelid incision. The next is excess skin with laxity and sometimes this is so severe that it has festoon folds (like curtains or drapery). Only by excising this will there be a correction. Some physicians may recommend lasering the skin to tighten the loose skin but this will have a very minimal effect at best. In most cases a moderate amount of skin removal is needed. Thirdly many patients have thickened (hypertrophic) muscle and this can only be reduced by an open approach. Fourthly some patients have ectropion (drooping lower eyelid border) and this can be corrected with a canthopexy (repositioning of the outer corner) to tighten the eye lash line and lift it. Only an open approach can correct these 4 problems.

Adjunct procedures that may need to be considered are Botox, peels, laser, filler injections and fat grafts. These are use in conjunction with the blepharoplasty to correct the fine wrinkles and pigments around the eyelids. Filler injections and fat grafts maybe used to soften depressions below the eyelids. All this should be discussed at your consultation.

Your Consultation

During this visit you will first meet with our consultant, view several "before" and "after" photographs, and have all of your questions answered. You will be introduced to your surgeon, permitting you the opportunity to learn and discuss the technical aspects of the surgery you are interested in. At the time of your visit our staff will provide you with a price quote and scheduling information. We believe the quality of our service is foremost; however, we also recognize that cost is a valid concern to everyone. Upon request we can refer several finance companies to choose from. All you have to do is ask!

For a complimentary preliminary evaluation without having to leave the comforts of your home simply submit any photos of the areas of concern and attach them via e-mail for our surgeons to review. The photos would be most helpful if you can emulate the samples enclosed in our before and after sections. Please make them comparable in composition of the photos you see throughout our site. Email photos to info@oceansplasticsurgery.com and include a phone number and the best time of day for our consultant to contact you.

Have fun! We look forward to helping make your plastic surgery experience a happy and gratifying one!

Click here to contact Dr. '90210' William P. Aiello, experienced plastic surgeon with plastic surgery centers in Los Alamitos and Newport Beach, CA specializing in various plastic & cosmetic surgery procedures.

Plastic surgery in Los Alamitos, Newport Beach, Long Beach, Huntington Beach, Costa Mesa, Cypress, Fountain Valley, Los Angeles, Orange, California.

|| Back to Top ||