Cosmetic Blepharoplasty: Best Solution for Eyebags and Hanging Eyelids

Definition: The term Blepharoplasty is used to denote a Plastic Surgery of the upper or lower eyelid. In simple words, any surgery done on the upper or lower eyelids to correct its shape is called blepharoplasty. Eyelid surgery may be done to correct Ptosis, remove eye bags or treat upper eyelid sagging which causes a reduced field of vision.

Cosmetic Blepharoplasty is performed to reverse the change of aging such as droopy upper eyelids or puffy lower lids also called Eyebags.

Incision site for Blepharoplasty Eyelid correction Surgery

As we age the collagen and elastin ligaments of the skin reduce making the skin lax this creates excess skin. Simultaneously soft-tissue volume loss along with gravity brings the eyebrow and upper lid downwards resulting in hanging upper eyelids and drooping eyebrows. Excess fat then deposits in skin bags.

Our eyeballs rest inside the eyesockets made up by our facial bones. The eyeballs rest on pillows of fat all around. These fat pads are secured inside the orbits by a taught membrane called the orbital septum. As we age the orbital septum also becomes loose and hangs like a hammock filled with orbital fat. At the same time, soft-tissue volume loss from the cheeks causes the lower eyelids to bulge out causing puffy eyes or eye bags.

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Cosmetic Upper Eyelid Blepharoplasty

Drooping upper eyelids fall like a curtain over the eyes and make a person look tired and sleepy. Upper blepharoplasty opens up the eyes to make you look more awake and attentive.

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Cosmetic Lower Eyelid Blepharoplasty

Loose skin of the lower eyelids cause bulging called commonly Puffy eyelids. Puffy eyelids make you look old and sad. A lower eyelid blepharoplasty can easily treat this.

The main focal point of a face is the eyes. Technically called the ocular or periocular region is the first part of a face that a person notices in routine person to person interaction.

The region around the eyes is dynamic. And essential to convey mood and emotion. Any disharmony is immediately noticed.

Factors affecting the Face Aesthetics

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Aging

During the natural process of aging, the skin gradually loses collagen and elastin fibers which give strength elasticity and tightness to the skin. Along with this the soft tissue and fat also disappear. Earlier fat loss from the cheek makes the eyelid fat prominent and bulging forwards.

There is normally healthy fat present below the eyeballs to cushion the eyes. This orbital fat is kept in check by an ‘Orbital Septum’ which keeps it tucked inside the orbit. Aging loosens this septum and orbital fat starts to bulge outwards causing puffy eyes.

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Genetic Makeup

shape and position of various parts of the face are also linked to our genetic traits. like the shape of the nose, eye color, eyebrows, lips etc. Some people are just born with it. This is a very important cause and very easily correctable.

Muscle Activity

Aging of the skin along with muscle activity creates various wrinkles and distortion of the youthful anatomy.
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Smoking

Smoking accelerates the natural aging process by restricting the blood flow to the skin. This increased aging of the skin caused as decreased collagen and elastin fibers results in a loose wrinkled skin.
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Diseases

A few diseases result in increased water retention in the skin tissue between the cells such as renal problems or heart problems. Puffy eyes in such patients disappear once the ailment is cured. Usually, additional treatment for puffy eyes is not required.

What is Blepharoplasty?

Blepharoplasty is basically an Eye Surgery of the eyelids. Upper lid Blepharoplasty is done to remove excess skin to correct the droopy eyelids. Lower lid Blepharoplasty is done to remove excess fat and get rid of the eyebags. This cosmetic procedure removes excess fat and skin from the eyelids to correct hanging upper eyelids and lower eyelid bags.

Blepharoplasty is routinely performed by Facial Plastic Surgeons as it is a type of Cosmetic Surgery.

What are the benefits of Blepharoplasty surgery?

  • Sagging skin of the upper eyelids may interfere with peripheral vision. Blepharoplasty surgery is the only option to restore the visual field by removing the excessive skin.
  • It rejuvenates the eye area making the eyes more open and wide and makes you look younger.
    Removing lower eyelid bags sheds off years from the face.
  • Removes the fine lines and fine wrinkles around the eyes.
  • Many patients have eyebrow ptosis along with sagging of upper eyelids. Blepharoplasty may also be combined with an Eyebrow Lift surgery or a forehead lift procedure to rejuvenate the peri-orbital area and the entire upper face.
  • The surgical scar of upper lids blepharoplasty remains hidden because it coincides with the eyelid crease. The Eyelid crease is a line of the skin fold on the upper eyelids when the eyes are open. Similarly, the incision marks of the lower blepharoplasty procedure remain inconspicuous because they lie very close to the lower lid margin or the lash line and are covered by eyelashes. Lower lid blepharoplasty incision can be easily camouflaged with eye makeup.
  • Blepharoplasty may also be combined with Face Lift Surgery for full facial rejuvenation.

If you think you need Blepharoplasty, How to proceed further?

The first step is to consult a Facial Plastic Surgeon. Your surgeon will physically examine you and ask a couple of relevant questions for medical history documentation. Please be truthful and try to answer to the best of your knowledge. Standard pre-operative photographs will be taken for the medical records.

If you have any eye conditions, such as glaucoma, retinal detachment, dry eye, or epiphora (wet eye), and thyroid eye disease, such as Graves’ disease and hyperthyroidism or hypothyroidism, cardiovascular disease, high blood pressure, or if you have diabetes, you must tell your surgeon. Inform your doctor about any medications you are now taking or have recently taken like blood thinners, including over-the-counter medicines such as fish oils and vitamin supplements. Also, tell your surgeon if you’ve ever had a negative response or a side effect from any medicine, including anesthetic preparation medication.

eye examination – you may need to be assessed by an ophthalmologist (eye specialist) for an eye checkup and documentation of eye health.

The surgeon will then order some routine investigation from a surgical point of view and discuss the reports with an anesthesiologist prior to the surgery. You may need to visit again for a pre-anesthetic checkup.

If everything remains fine then we may proceed with surgery.

How is the Blepharoplasty surgery performed?

The surgery is commonly performed under general anesthesia where the patient is asleep throughout the procedure. Sometimes though the procedure may be carried out under Local Anesthesia as an outpatient procedure with sedation as well with or without intravenous sedation. The patient may go home the same day.

There is no pain during the procedure. The procedure takes around two hours. Before the procedure, the patient is asked to lie down. A bandage contact lens is placed to protect the cornea during surgery.

 

Upper eyelid surgery

  • The main objective of cosmetic eyelid surgery of the upper lid is to remove the sagging eyelid skin.
  • Before infiltration of local anesthetic skin marking is done.
  • Then the skin is carefully incised along with the markings. Sometimes additional fat removal may be required. Extra skin and fat are trimmed.
  • If required eyebrow elevation surgery (eyebrow lift) may also be performed from the same incision.
  • The incision lies in the natural crease also known as the upper eyelid crease and is well hidden.

Lower eyelid surgery

  • The primary goal of the lower lid blepharoplasty is to remove puffy eyebags.
  • Before infiltration of anesthetic eyelid incision is marked.
  • The cosmetic surgeon makes an incision near and along the lower eyelid margin starting from the tear trough region and reaching the sides. Sometimes this incision may be advanced sideways beyond the eye.
  • The skin is separated from the underlying Orbicularis muscle. The muscles are carefully separated to reach the orbital septum. The orbital septum is opened and any extra fat is carefully trimmed away. Then all the structures are repaired from inwards to outwards.
  • In patients with redundant skin and drooping outer angle of the eye further tightening of the eyelid is done to give a youthful appearance.
Dr. Vishal Purohit

Dr. Vishal Purohit

Cosmetic & Plastic Surgeon

Dr. Vishal Purohit is a board-certified Plastic Surgeon practicing in the Pink City Jaipur, Rajasthan. He is well versed in Cosmetic Surgery, Facial Aesthetic Surgery, Reconstructive Surgery, Hand Surgery, Microvascular Surgery, and Burns Surgery.

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Frequently asked Questions

Who are the best candidates for Blepharoplasty surgery ?

Individuals with mild to severe lid laxity are the best candidates for blepharoplasty surgery. There is no age limit. It is preferable for the patient to be in good physical health without any preexisting medical conditions or eye diseases like dry eyes or infections. Most importantly a good candidate must have realistic expectations.

Quite often drooping eyelids are accompanied by brow ptosis. Due to the effects of aging eyebrows migrate downwards. A diagnosis of eyebrow sagging is made at the time of physical examination by the surgeon.

Most people opting for blepharoplasty do so for cosmetic reasons. So, to get the best results the brow ptosis needs to be corrected along with blepharoplasty otherwise post-surgery eyebrow ptosis gets exaggerated.

What are the before procedure (Pre-Op) instructions ?

You are asked to come to the surgery center at least 2 hours before the time slot allotted for surgery.

It is essential to come empty stomach.
Please carefully read and follow all the pre-operative instructions given to you at consultation.

Before leaving for the operation theatre you will be given time to discuss any last-minute doubts with the surgeon.

Once you are ready you will be taken to the operating room.

When will I see the results ?

Results are best appreciated around 3 weeks after the surgery. Tissue healing takes 1 to 2 weeks. There will be mild swelling around the eyes for 1-2 days. Sutures are removed on the 5th day after surgery. 

Does blepharoplasty treat Dark Circles?

There are three main reasons for dark circles. First is shadowing caused by eyelid bags above the dark area, Secondly the blood supply of the fat showing through the thin eyelid skin, and thirdly, the actual pigmentation in the epidermis and dermis. Blepharoplasty improves dark circles caused because of the first two reasons.

Pigmentation is not reduced by surgery. Pigmentation is treated with other treatments modalities like chemical peels, laser skin resurfacing, IPL hyperpigmentation treatment, and topical treatments.

What are the risks, side effects, and safety considerations?

Like all surgical procedures, there are risks related to surgery, anesthesia, and sutures. Please read the Blepharoplasty Informed Consent document thoroughly and completely to understand the risks involved.

 

Temporary side effects or potential complications may include

  • Swelling of both upper eyelids. Swelling of the eyelids is managed by a cold compress i.e. applying ice packs for 2 to 4 days.
  • Inability to open the eyelids because of heaviness due to swelling.
  • Irritation to bright light may require wearing sunglasses even in shade.
  • Stickiness or watering of eyes. Treated by prescription eye drops
  • Bruising or hematoma or blood clot especially below the lower eyelids is also a temporary side effect that looks like “Black Eye”.
  • Double vision or Blurred vision due to swelling eventually corrects on its own in a few days.

Long-term side effects are extremely rare.

  • Lower lid ectropion – It is outwards tuning of the eyelid and can cause wet eyes or epiphora.
  • Entropion – the inward turning of either of the eyelids can cause eyelashes to rub against the cornea causing pain and ulceration.
  • Inability to close the eyes fully. Scarring, Visible scar, lid malposition due to overcorrection, eyelid retraction.
  • Visual impairment (vision loss) due to retrobulbar hemorrhage – is extremely rare. Most patients report an improvement in vision in the long run.

What are the After-Surgery instructions and precautions ?

Our patient care provider will provide you with a detailed post-operative eye care instruction sheet and discuss it in detail.

  • If the surgery is performed under general anesthesia you would be required to stay at the hospital for at least 1 day. If Blepharoplasty is performed as an outpatient surgery you may go back home the same day.
  • Maximum discomfort occurs in the first few days, improving each day thereafter. The recovery period differs for each patient. A cold compress with ice packs is advised for the first 48 hours after surgery.
  • You will need to prop your head up with pillows for a few days when resting to reduce swelling.
  • Expect temporary swelling of the eyelids, tightness of lids, bruising, dryness, or itching. The eyes may feel sticky. A few eye drops are prescribed for two weeks to help with dryness and itching. Cleaning the eyes and proper skin care is essential.
  • Usually, there is minimal pain which is alleviated by simple painkillers like tablet paracetamol. Pain medication may be taken twice or thrice daily for a week.
  • Antibiotic ointment is prescribed to be topically applied over the suture line till suture removal.
  • Intense physical activities, sports, jogging, aerobics, swimming are to be avoided for a week.
  • Please avoid smoking as smoke will irritate the eyes.
  • You may not be able to wear contact lenses for several weeks after surgery as they may irritate the eyes.
  • You will need to prevent sun exposure by wearing sunglasses at least for the first 10 days.
  • Sutures are removed in 5 to 7 days of surgery.

Please read and follow the post-procedure instructions carefully and completely.

Is Blepharoplasty covered by insurance?

The blepharoplasty surgical technique to do an eyelid lift is a type of facial plastic surgery that is also considered cosmetic surgery. Cosmetic surgeries are generally not covered under insurance.

Blepharoplasty may also be performed for ptosis repair. Ptosis is drooping of the upper eyelid due to eye muscle paralysis. Ptosis repair is considered reconstructive surgery and may be covered under insurance.
Please contact your insurance agent in regards to what is and what is not covered in your insurance plan.

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