Question: What is the first part of the face to show signs of aging?
Answer: The eyes are typically the first place to show signs of aging. The upper eyelid skin begins to droop as early as age 30, making the eyes appear smaller and tired. By age 40, fine wrinkling and unattractive pouching may appear below the eyes, and "crow's feet" (or, more optimistically, "laugh lines") begin to form. The eyebrows may droop along with the eyelid skin, which also makes the eyes appear smaller.  The aging process continues and these changes progress into the 50s and beyond.

Question: What is cosmetic eyelid surgery?
Answer: Blepharoplasty  (pronounced bleh-fah-row-plas-tee) is the cosmetic surgical treatment of aging changes around the eyes.  As with any patient concern, the first step is to learn from you what specific aspects of the aging changes cause you concern.  Then, the facial plastic surgeon performs a careful examination to determine the exact reasons your eyes look like they do.

If - as is most common - there is simply excess upper eyelid skin, then this can be removed in an operation called an "upper eyelid blepharoplasty" :

If - as is also common - there is sagging or puffiness of  the lower eyelids, then a lower eyelid blepharoplasty is recommended.

Question: Where are the incisions made?
Answer: Sometimes, the only part of the lower eyelid that is sagging or bulging is the fat that surrounds the eye.  In this situation, the incision may be hidden inside the eyelid where it is not visible to any observer.  This is the so-called "incision-less" eyelid surgery.

When the skin and muscle of the eyelid are sagging as well, some of it must be removed, so an incision is made just beneath the eyelid.  This incision allows the surgeon to tighten the eyelid skin to achieve a refreshened, smoother appearance.  The incision  is hidden in a natural crease just 1-2 millimeters beneath the eyelid, and is extremely difficult to see.  The patient at the top of this page had both an upper blepharoplasty and also a lower eyelid blepharoplasty to remove a little excess skin - try to find her incision!

Question: I went to see a doctor once for cosmetic eyelid surgery, and he started talking about my brows! What was that all about?
Answer: Many patients do not realize that with aging, the eyebrows sag along with the eyelids.  Therefore, the eyebrows may also require a lift (click on BROWLIFT). In some patients, this is the main problem, while in other patients this is a secondary problem whose correction is therefore optional.

Browlifting elevates the skin above the eyebrow, and also the eyelid skin beneath the eyebrow, so after a browlift less skin needs to be removed from the upper eyelid.  For this reason, the patient needs to decide before the blepharoplasty whether he or she would like a browlift too!

Question: Why is cosmetic eyelid surgery so popular?
Answer: The eyes are often a person's most attractive feature, and the most often noticed. It is therefore unfortunate that the first signs of aging appear around the eyes.

Happily, a number of conservative procedures are available that can address these inevitable changes.

Question: My eyes get tired at the end of the day. Could this be related to my eyelids?
Answer: There are several other things that you should check first, with your family doctor and your optometrist or eye doctor. However, sometimes heavy excess skin, as in the patient shown below, can weigh down your eyelids and put extra strain on them, so that they can tire out by the end of the day.

Question: What are the risks of this surgery?
Answer: The most common patient worry during their initial visit is that they have heard that cosmetic eyelid surgery can cause them to be permanently unable to close their eyes.  The technical term for this is lagophthalmos (lag-off-thal-mose) which means "inability to close the eyelids."  If too much skin is removed from the upper eyelid, then it will not be able to close.  There are a number of special precautions that the wise surgeon undertakes before and during surgery to minimize this risk.  Happily, thanks to these precautions, no patient of mine has ever had lagophthalmos.

During the initial examination, I direct special attention to certain aspects of your eyelids to minimize the risk of problems.  For instance, before surgery I will  assess the strength of your lower eyelids - if they are weak or loose then they will require tightening during surgery.  As long as this is tested and assessed before surgery, this should not be a problem.

Also, if you have dry eyes, then I will be more conservative than usual in removing excess skin.  Occasionally, the swelling after surgery may cause the eyelids not to close completely for a few days, and this can rarely cause problems in a patient with dry eyes.  It is better to be conservative in these cases - safety first!

There are other risks of this surgery that are not common in our practice, but that we will discuss in detail with you during your office visit.

Question: Can this surgery fix the fine wrinkles around my eyes?
Answer: No. Cosmetic eyelid surgery does not correct or improve the fine wrinkling that can occur with aging.  In this situation, laser resurfacing (or some other resurfacing procedure) may be the best option (click on LASER RESURFACING).

Question: Have you published any scholarly writings on this subject?
Answer: I was the co-guest editor of an edition of Facial Plastic Surgery, a quarterly scientific journal, on the subject of Surgical Rejuvenation of the Orbital Region.  In this edition, we reviewed the state-of-the-art of Rejuvenation Treatment of the eyes and surrounding structures.  The information in this journal is highly technical, but the interested reader may order this journal from Thieme Publishers at 1-800-782-3488, e-mail custserv@thieme.com.  The specific journal information is Volume 15 Number 3, 1999.