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.