What Is the Goal of Eyelid Surgery?
The goal of eyelid surgery is to rejuvenate the upper face by creating a refreshed, natural appearance around the eyes—without altering their expression or shape. This procedure helps patients look less tired, often without visible signs of surgery.
How Is Eyelid Rejuvenation Accomplished?
Surgical improvement of the eye area may involve removing excess upper eyelid skin and fat, reducing lower eyelid fat, repositioning fat to address under-eye circles, and tightening loose lower eyelid skin. Additional techniques may include chemical peels to smooth skin texture, tightening the lower eyelids if they are lax, weakening the muscles that create vertical frown lines, and lifting the brows. Each treatment is selected based on the individual’s needs and enhances the final result.
Who Is a Candidate?
Aging around the eyes often begins in the mid-thirties. Most women seek surgery in their early forties, while men tend to wait until their fifties. Women often notice upper eyelid wrinkles that interfere with makeup, while men become concerned about heavy eyelids later on. Both genders may be troubled by under-eye bags, circles, or excess skin, all of which can be effectively treated.
Do I Need Surgery on Both Upper and Lower Eyelids?
Some younger patients may benefit from surgery on just the upper or lower eyelids. For example, younger people with hereditary lower eyelid bags may only need treatment on the lower lids. However, older individuals usually show aging in both areas and benefit most from a combined procedure.
Where Are the Incisions Made?
Upper eyelid incisions are placed in the natural crease, making scars nearly invisible with eyes open. Lower eyelid fat removal can be done through an incision inside the eyelid. If loose skin is present, an incision just beneath the lashes allows for removal and heals very well.
Understanding Browlifts
When sagging eyebrows contribute to upper eyelid hooding, a browlift may be recommended alongside eyelid surgery. While more involved, a browlift can create a more balanced, natural result by restoring the brow’s youthful position and arch. There are two main approaches: the less invasive endoscopic browlift and the traditional open method. The endoscopic option involves small incisions and temporary anchors, but results tend to fade. The open technique, which removes scalp skin, offers more durable results and is preferred for significant brow sagging.
Other Techniques: Temple Lifts and Fat Grafting
Temple lifts use small incisions in the scalp to lift the outer brow but often produce subtle and short-lived results. Fat grafting, where fat is transferred from another area of the body to the brow, can improve volume and contour in select patients. However, results vary due to unpredictable fat survival.
Do I Need a Browlift?
Most women do not require a browlift. Only about 10% benefit, and even fewer men are candidates since browlifts can create a feminizing effect. The procedure is reserved for more severe cases of brow sagging.
Addressing Frown Lines Between the Brows
Deep vertical lines between the brows are caused by overactive corrugator muscles. These can be treated non-surgically with Botox or similar agents, though results are temporary and must be maintained every few months. A more permanent option involves surgically removing these muscles through upper eyelid incisions or during a browlift.
Nonsurgical Rejuvenation Options
otox and similar agents can soften expression lines, especially around the outer eyes (crow’s feet). For crepey or discolored lower eyelid skin, a chemical peel with trichloroacetic acid (TCA) may help. Injectable fillers such as Restylane and Juvederm can improve hollow lower lids, particularly in younger patients. While effective, fillers may cause lumps or puffiness if not expertly applied.
Understanding Dry Eyes
Some individuals are prone to dry eye symptoms, such as irritation or watery eyes, especially with age. Eyelid surgery can worsen these symptoms in susceptible patients. Preoperative screening by an ophthalmologist may be recommended for those with a history of dryness or LASIK.
Lower Eyelid Malposition
Loose lower eyelids or prominent eyes can lead to drooping, which imparts a sad expression and contributes to dry eyes. In such cases, a tightening procedure called canthopexy may be added to support the eyelid and prevent complications.
What Are Malar Bags?
Malar bags are puffy areas on the cheekbones beneath the lower eyelids that are not caused by eyelid fat. Unfortunately, there is no reliable treatment for malar bags at this time.
Longevity of Results
The results of eyelid surgery are long-lasting. While some patients may notice minor skin laxity years later, most are satisfied after a single procedure. Browlifts rarely need to be repeated.
Surgical Details and Recovery
Eyelid and browlift surgeries are performed on an outpatient basis in Dr. Weinstein’s office. Surgery duration depends on the extent of the procedure. Upper eyelids typically take 30 minutes, lower lids up to an hour, and browlifts add about 90 minutes.
Anesthesia involves deep sedation or general anesthesia monitored by a board-certified anesthesiologist. After surgery, patients use cold compresses and may experience mild swelling and blurred vision for a few days. Stitches are removed within six days, and bruising resolves within two weeks. Most makeup can be resumed after one week.
Light activity can begin within days. Strenuous exercise and flying should be avoided for two weeks, and intense workouts should be postponed for six weeks.
Limitations and Considerations
Surgical outcomes may be influenced by factors like skin quality, sun damage, deep under-eye hollows, prior injections, or dry eye symptoms. Browlift options may be limited by a high hairline or thinning hair.
Risks and Complications
Though rare, complications can include hematoma, infection, scarring, or drooping eyelids. Dry eye symptoms may worsen in some patients. Browlifts can cause forehead or scalp numbness and slight hair loss, but these effects are usually temporary.
Costs and Next Steps
Fees cover the surgeon, anesthesia, facility use, labs, and photos. Private nurses are not typically required. During your consultation, Dr. Weinstein will evaluate your eyelids and forehead to create a personalized plan. If you're a good candidate, we’ll schedule surgery and any necessary medical clearance.
Contact us today to begin your rejuvenation journey with Dr. Andrew Weinstein.