You might consider an upper blepharoplasty if you have excess eyelid skin and/or puffy upper eyelids. Excess lid skin can interfere with your field of vision. Puffiness is usually caused by herniated orbital fat. Upper blepharoplasty can be performed in-office with minimal discomfort under a local anesthetic injection and takes just under an hour. The incision is made along your existing upper eyelid crease.

 

A common upper blepharoplasty misconception is that there will be no scarring. Scarring will occur but will dissipate over time, leaving just a hint of a scar. Recovery for upper eyelid blepharoplasty usually takes one to two weeks.

 

The surgeon, preferably a board-certified oculoplastic surgeon, should carefully evaluate the amount of upper eyelid skin and fat to remove. Removing too much skin could interfere with the blinking function of your eyes, or cause dry eye syndrome and other serious complications. Removing too much fat can result in a hollow appearance, called a superior sulcus deformity; most board-certified oculoplastic surgeons will sculpt the fat instead of removing it.

 

There are multiple approaches to lower blepharoplasty. Lower eyelid surgeries are safest done in an outpatient surgical center under a mild anesthetic and take about an hour. Some lower eyelids need only fat removed; this is done through an incision in the conjunctiva (inside the lower eyelid) resulting in no visible scarring. The ideal patient for fat removal surgery is younger, with minimal lower eyelid skin aging and laxity. The procedure can be combined with laser treatments and/or chemical peels to reduce fine lines and tighten the under eye skin.

 

Another approach to lower blepharoplasty is a subciliary incision along the lower eyelid margin below the eyelash line. This approach addresses the laxity of the lower eyelid skin along with fat removal. It heals beautifully with minimal scarring. The fat can be repositioned to correct for tear trough deformities, an indentation at the orbital rim or the lower eyelid connection to the cheek. The deformity becomes more prominent as you age and the cheeks drop causing dark circles. Injecting dermal fillers (Juvederm Ultra, Perlane, Restylane) in this area, along with cosmetic lower eyelid surgery, can improve this deformity. Some eyelashes may be lost during a cosmetic lower blepharoplasty, and usually re-grow with time. Due to the area's vascularity, bruising is likely, and recovery takes two to three weeks.

 

As with any surgical procedure, risks and complications are associated with upper and lower eyelid blepharoplasty and should be discussed with your surgeon. For the best outcome, choose a board-certified oculoplastic surgeon - typically an ophthalmologist certified in plastic surgery in and around the eyes - as it's important to be familiar with the eyes and their functionality.