Upper or Lower Blepharoplasty? Which Is The Right Surgery For You?


A cosmetic surgery to repair droopy eyelids is called blepharoplasty. In addition to correcting the appearance of eyelids, a plastic surgeon may remove excess muscle, fat and skin from the area. The reason for this is the excess fat that gathers above and below the eyelids as a person grows older. The extra causes bags under the eyes and droopy eyelids. In both situations, this can cause a person to look older than their true age.

Sagging skin around the eyelids may impact a person’s vision too. For instance, a person may have problems with their field of vision because their side vision is reduced.

Depending on their eyelid symptoms, the person can choose from: an upper or lower blepharoplasty. Each eyelid surgery is different.

Upper Blepharoplasty Procedure is for Droopy Eyelids

An upper eyelid blepharoplasty is one of the most common plastic surgery procedures performed in the U.S. The purpose of an upper blepharoplasty is to remove excess fat and skin from the eyelid area. The extra fat and skin on the upper eyelid are called dermatochalasis. The reason why this area shows the first signs of aging is because the eyelid has the thinnest skin on any part of the body. Some people may develop dermatochalasis in their 30s because of how they age or genetics.

Before an upper eyelid surgery, the individual is given local anesthesia. The local anesthesia is injected into the eyelid area for numbing purposes. It decreases bleeding in the eyelid area too. During the procedure, a plastic surgeon places a line in the crease of the eyelid about 8mm long. A special instrument is used to determine the amount of extra skin that must be removed. The plastic surgeon removes the extra skin with a laser or scissors. Any extra fat is also removed.

In certain instances, a surgeon must remove the nasal fat pad. This is only if the individual has a hollow upper eyelid called a deep sulcus. The reason the nasal fat pad is removed is to add volume to the eyelid and make it less hollow. Once the surgery is over, the eyelid skin is sutured.

It takes about three days, with the use of ice compresses over the eyelids, for the swelling, pain and bruising to decrease. For another three days, a person uses warm towels to aid their blepharoplasty recovery. During this time, a prescribed ointment is applied to the eyelid area three times each day. Full blepharoplasty recovery can take about six months.

Lower Blepharoplasty Eliminates Under Eye Bags

Fat around the eyes slowly begins to move forward and into the lower eyelids as a person grows older. This causes what we commonly call “bag” under the eyes. The bags create a shadow. This shadow may make an individual look like they have dark circles around the lower part of their eyes. Saggy lower eyelids can develop at any age, but it more common as a people age.

With a traditional blepharoplasty of the lower eyelids removes the extra skin and fat around the eyes. Unfortunately, this can cause the lower eyelids to become hollow or empty. This may cause the dark circles under the eyes to become even darker. It doesn’t happen all the time, but it can occur.

Another option is the repositioning blepharoplasty. The excess skin is removed, but not the fat. Instead, the fat is moved into the tear trough. This maintains volume in the lower eyelids. This also decreases the look of dark circles under the eyes.

Prior to surgery, a person receives local sedation anesthesia because local anesthesia is too uncomfortable. With the repositioning blepharoplasty, the eyelids are lowered so the insides are visible. The plastic surgery uses a laser to make an incision in the eyelids. Muscles and skin are moved up, and fat pads are located in the area. The fat is moved into the tear trough. The eyelids are returned to their normal position.

If the eyelids are still loose, the tendons located on the outer corner are tightened. All extra skin is removed, and the eyelids are sutured. The person may undergo laser resurfacing to make the skin lighter around the under eyes.

Bruising and swelling typically lasts for 10 days. However, this varies from patient to patient. Ice compresses are used for the initial three days, then warm compresses are used. Eye ointment is used three times per week. Stitches are removed about 10 days later. Swelling can last for some weeks. Laser resurfacing on the skin can cause redness on the affected area for several weeks.

Andres Bustillo, MD FACS is a board certified fellow trained in facial plastic and reconstructive surgeon who specializes in eyelid surgery in Miami, FL. This makes him one of the very few plastic surgeons in the South Florida who is a sub specialist. Dr. Bustillo is also one of the most sought out plastic surgeons in the world. He’s written numerous book chapters and articles about aesthetic facial surgery. Learn more, visit Dr. Bustillo’s Facebook page or www.drbustillo.com.


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