Named Among the Best Plastic Surgeons in Boston
Helena O. Taylor MD, PHD, FACS & Stephen R. Sullivan MD, MPH, FACS
As we age the upper lid deflates laterally, and the skin loses elasticity, collagen, and muscle tone. The upper eyelid can become heavy and droopy, obscuring the upper eyelid crease, and the lower part of the lid.
In the lower lid, with time and gravity the soft tissues of the cheek descend, the orbital septum and fat bulges and creates "bags" under the eyes, and a "tear trough" develops as a shadowed delineation between the lower eyelid and cheek.
These changes in the lid can make people look tired, angry, or haggard when that is not how they feel. Our Boston Blepharoplasty surgery can be performed on the upper lids (upper lid blepharoplasty) and lower lids (lower lid blepharoplasty).
Upper lid blepharoplasty involves the removal of redundant skin and sometimes a small amount of fat and muscle from the upper lids. The scar is usually well hidden within the creased skin of the lid.
Upper Blepharoplasty
While most surgery is a trade of shape for scar, the scar in upper lid blepharoplasty is typically inconspicuous and hidden in the upper lid crease. The trade of contour for a scar, which is often very hard to find, tends to be a very good one. This simple high yield procedure brightens the eye and periorbital area without changing the look of a face or the shape of the eye. And the risks are modest.
It can be performed under local anesthetic in the office, or with sedation in the operating room if preferred. While bruising and swelling for the first few days is expected, our Boston and Cambridge Blepharoplasty patients typically have very little discomfort. A cold compress or ice pack can reduce swelling and bruising. Sutures are removed at 5-7 days after surgery, and we follow you regularly thereafter. Some patients may also wish to combine upper lid surgery with other facial rejuvenation procedures such as Botox or Dysport, fillers, facial fat transfer, facelift, or neck lift. On occasion a formal lid ptosis repair may be required if the upper lid muscle (levator muscle) has stretched out and the lid margin is obscuring the pupil.
Lower Blepharoplasty
Lower lid blepharoplasty can be performed for people with bulging lower lids, fat pads, extra skin, and/or a prominent “tear trough” between the lid and the cheek. For patients with the appropriate anatomy, and without a history of dry eye, lower eyelid blepharoplasty can be performed to reposition the fat, tighten and smooth the lower eyelid skin. While upper lid surgery is low risk and high yield, we often advise that lower lid surgery is more complicated.
Patients with a history of dry eye are considered poor candidates for lower eyelid surgery, as lower eyelid blepharoplasty can worsen dry eye. Patients with low muscle tone or delayed "snap back" test of the lower eyelid may require lower eyelid tightening with a lateral canthopexy and patients with very low muscle tone are not good candidates for comprehensive lower eyelid rejuvenation. This surgery can change the shape of the eye, and is not for everyone.
Typically we perform lower lid Blepharoplasty in the operating room under some anesthesia. There are typically internal incisions in the lower lid as well as a skin resection below the lashes. These skin stitches are removed 5-7 days after surgery, and lid taping may be required for some weeks after surgery. During surgery the tear trough ligament is released, fat is repositioned and occasionally removed, the lid margin is tightened and any extra skin conservatively removed. It is important to note that no surgery changes skin quality, so the fine lines in the skin are often present still after surgery.
Double Blepharoplasty
Combining upper and lower blepharoplasty in the same procedure can provide more comprehensive results and reduce the overall recovery time. Blending these surgeries allows for more comprehensive results and a more balanced appearance. For the right patient, combining upper and lower Blepharoplasty allows the surgeon to create a more balanced and natural-looking result, white limiting recovery time and cost to the patient.
IDEAL BLEPHAROPLASTY CANDIDATE
WHAT BLEPHAROPLASTY DOES
DURATION OF RESULT
Years
LENGTH OF PROCEDURE
1-2 hours
TYPES OF ANESTHESIA
Local for upper eyelids
Sedation (sleepy) or General Anesthesia (asleep) for lower eyelids
RECOVERY
TIME OFF WORK
5-7 days
TIME OFF ACTIVITIES
We typically access the lower eyelid through incisions inside the eyelid, known as a transconjunctival approach. This approach allows access to release the septum and tear trough ligaments, reposition the fat, and smooth the contour between the lid and the cheek. A small amount of skin is then removed just beneath the eyelash line.
In order to prevent lower lid malposition, often a tightening the lower eyelid horizontally with a lateral canthopexy is necessary. The lateral canthopexy restores the shape of the eye, which should slope upward laterally in women and be straight across in men rather than sagging downward and looking tired. Lower lid surgery is more involved than upper lid surgery, and our preference is to perform lower lid Blepharoplasty under sedation or general anesthesia.
We often favor combining lower eyelid lift with fat grafting to the cheeks to restore midfacial volume, support for the lower eyelids and blend the lower eyelid to cheek junction for a natural appearance. The procedure takes approximately one to two hours and is done in the operating room. While bruising and swelling for the first few days can be expected, patients typically have very little discomfort. Cold compresses or icepacks can reduce swelling and bruising.
Sutures are removed at 5-7 days after surgery, and we follow you regularly thereafter. Lower eyelid surgery carries the risks of lower eyelid malposition and exacerbation of dry eye. Lower lid surgery can change the shape of the eye more than upper lid surgery. We will carefully evaluate your individual anatomy and medical history to determine if lower eyelid Blepharoplasty in Boston is a good idea for you.
For patients who are not ideal candidates for a safe and natural appearing result with Blepharoplasty Boston plastic surgeons, Dr. Taylor and Dr. Sullivan may offer some alternatives.
Muscles that pull the eyelids down, the corrugator muscles along the medial eyebrows and the orbicularis muscles along the lateral eyebrows, can be treated with botulinum toxins such as Botox or Dysport to soften the muscles. This allows the eyebrows and upper eyelids to drift up and open the eyes. At the same time the heavy wrinkles around the eyelids and eyebrows are reduced.
The tear trough deformity and heavy shadows of the lower eyelids can be filled with fat grafting or fillers such as Restylane, Juvederm, or Versa. Filling the tear trough blends the eyelid to cheek junction and also helps support the lower eyelid. Topical treatments such as Retin A may be helpful with fine wrinkles and Preparation H may be helpful with swollen bags under the eyes.
Upper eyelid blepharoplasty is one of the highest yield, and lower risk, ways of brightening a face that is starting to look tired. It is a relatively painless procedure, which can be done under straight local anesthetic in the office. Lower lid Blepharoplasty in the right patient, can smooth the junction from the lower lid to the cheek, but is more involved, and carries more risk than upper lid surgery.
During the first few days after the surgery, patients may experience swelling, bruising, and discomfort around the eyes. Strenuous activities, including heavy lifting and exercise, should be avoided to minimize swelling and speed up the healing process. The surgeon will remove any non-dissolvable stitches within a week or so after the surgery. Most patients will see noticeable improvements within a few weeks.
The full downtime for blepharoplasty may vary depending on the extent of the procedure, but most patients can resume their normal activities within around two weeks with surgeon clearance. Be aware, it may take several months for the swelling to fully subside and the incisions to fade.
To maintain the results of Blepharoplasty Boston patients should avoid excessive sun exposure, wear sunglasses when outside, and maintain a healthy lifestyle. Patients may benefit from non-surgical treatments, such as Botox or fillers, to enhance and maintain the results of the surgery.
Dr. Helena Taylor, MD, PhD, FACS, and Dr. Stephen Sullivan, MD, MPH, FACS, are highly esteemed plastic surgeons based in Boston who have been recognized with multiple accolades from Castle Connolly Top Doctors and Boston Top Doctors. Their superior training at Harvard University and board certifications speak to their unwavering commitment to providing top-quality aesthetic surgery and patient care. In addition to their expertise in cosmetic procedures, Dr. Taylor and Dr. Sullivan specialize in the correction of congenital abnormalities and injuries caused by trauma. They stay up-to-date with the latest advances in their field by pursuing continuous education, ensuring they implement the safest and most effective techniques in their practice. If they think surgery is not for you, they will candidly tell you that.
Visit us for your personalized Blepharoplasty plan. Our highly experienced administrative staff can assist through the process from start to finish. Call today at 617.492.0620 or schedule online!
Most patients with extra upper eyelid skin can consider upper lid blepharoplasty. Patients with dry eye, poor elasticity, and recessed cheeks may not be ideal candidates for lower lid surgery.
The eyelids tend to make better scar than almost anywhere else on the body. While everyone scars differently it is often hard to find the eyelid scars.
Although the surgery is not typically painful, it may look like it should be painful! While everyone bruises differently, a fair amount of bruising and swelling the first week is common. The sutures are removed at 5-7 days, and while you may look much more presentable by then, some patients have residual bruising for another week or two. Lower lids often take longer to fully recover.
Bruising and swelling are expected and occur in everyone to some extent. For some upper lid surgery patients there may be temporary inability to completely close the lids (lagophthalmos), which typically resolve in a day or two. Poor scarring, lower lid malposition, significant bleeding, or changes in vision are the dreaded risks of Blepharoplasty which we work hard to avoid.
Yes, Blepharoplasty is becoming quite common. According to the American Society of Plastic Surgeons, blepharoplasty is one of the top five most commonly performed cosmetic surgical procedures in the United States.
For upper lid surgery, during the surgery itself, patients are typically given local anesthesia or sedation to numb the area around the eyes so they do not feel any pain or sensation. Like any surgical procedure, it can cause some discomfort and pain during the recovery period, but most patients are pleasantly surprised by the lack of pain.
Blepharoplasty is considered a permanent procedure in the sense that the results are long-lasting. However, it does not stop the natural aging process and may not prevent the need for future touch-up surgeries.
Yes, you will need to have someone drive you home after undergoing Blepharoplasty, as you will still be recovering from the anesthesia or sedation, and your eyes will be bruised and swollen.
In general, it is recommended to avoid applying makeup or lotion to the eye area for at least a week after surgery in order to allow the incisions to heal and to prevent any irritation or infection to the surgical site. It is always best to check with your surgeon to be cleared.
Yes, there are several options that could be utilized, including fillers, laser treatments, or chemical peels. These are all best administered by a qualified professional, especially in the delicate eye area.
The cost of blepharoplasty can vary depending on several factors, including the surgeon's experience and qualifications, the geographical location of the practice, and the extent of the procedure. The average cost in the US can range anywhere from $5,000 to 10,000.
Insurance typically does not cover cosmetic blepharoplasty, which is performed solely for aesthetic reasons. In some cases, insurance may cover the cost of Blepharoplasty if the procedure is deemed medically necessary to improve vision or alleviate discomfort caused by drooping eyelids. This is rare in our practice.
Download our Blepharoplasty (Eyelid Lift) Instructions
Dr Taylor and Dr Sullivan are plastic surgeons who are also both fellowship trained in facial plastic surgery and often work together during operations. They will carefully evaluate your eyelids for an eyelid lift (Blepharoplasty) to remove excess skin or ptosis repair to correct sagging eyelids. If Dr. Taylor and Dr. Sullivan consider you to be a good candidate for an eyelid operation, they will customize a surgical plan for you. If you would like to learn more please contact us and we can evaluate you in our Cambridge Mass office at Mount Auburn Hospital.
Call Today 617.492.0620
To schedule a private consultation with Dr. Taylor or Dr. Sullivan, please call the office or request an appointment using our form. We welcome your visit and your questions.
300 Mount Auburn St. Ste 304, Cambridge, MA 02138
300 Mount Auburn St. Ste 304, Cambridge, MA 02138
Monday - Friday 8:30am to 5:00pm — 617.492.0620
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