Your eyes are typically the first thing that someone notices about your face. This is why Shakespeare referred to them as the “windows to your soul”. As a natural reflection of your emotions, they are often considered the best representation of you and your personality. They are also, unfortunately, one of the first areas to show the signs of age. The skin around the eyes is extremely thin and delicate. In addition, our eyes are always moving — stretching the skin. This makes them particularly susceptible to not just the ravages of Father Time, but also certain lifestyle choices like sun, smoking and living in a polluted, urban environment. The result may be sagging or heaviness in the upper eyelids, droopy lower lids, dark hollows under the eyes and the dreaded under eye bags. All of this can make you appear tired, sad, and older than your true age. For some people, loose skin in the upper eyelids can even impair their vision.
Eyelid surgery or blepharoplasty is a surgical procedure to remove excess skin and fat, lifting droopy eyelids in order to restore a more fresh, well-rested, and alert appearance. It’s a procedure that can take years off your face. Board certified plastic surgeon Dr. Sean Doherty believes strongly in rejuvenating the eyes, not changing them. To do this, he always takes a comprehensive approach with his eyelid surgery patients. No part of the face lives in isolation. The eyes intersect with the forehead, upper cheeks and temples. You cannot treat one without looking at the others. This is why it is so important that you be assessed in person.
Eyelid Surgery Consultation
During your initial blepharoplasty consultation at one of his Boston area offices, Dr. Doherty will listen carefully to what bothers you about your eyes. Then, he will perform a full physical exam. He will assess your skin tone and texture, the amount of ptosis or droop in your upper lids as well as the position of your eyebrow in relation to your upper lid and forehead. He will check for any fat pad protrusion beneath the lower eyelid, muscle atrophy and loose skin. He will come up with a treatment plan that best suits your goals and lifestyle. Eyelid surgery can be performed alone, but Dr. Doherty will often combine it with fillers and/or another surgical procedure such a facelift or brow lift or laser resurfacing or a chemical peel. All of these options will be discussed with you in detail.
Eyelid Surgery Candidate
The ideal eyelid surgery candidate is someone in good health who does not smoke and is bothered by the appearance of their eyes. Ideal for both men and women, an upper blepharoplasty is probably one of the simplest surgical procedures. It also has a substantial amount of gratification for the patient. It is a quick, easy way to completely rejuvenate your face. Because many upper eyelid surgeries can be performed in the office under local anesthesia, they have a faster recovery. This makes them especially appealing to men who often don’t want to deal with the downtime associated with most surgical procedures.
Eyelid surgery can treat:
- Excess, sagging skin on the upper lids
- Skin folds that impair vision
- Puffiness caused by excess fatty deposits
- Droopy lower lids that expose the white beneath your iris
- Under eye bags
- Wrinkly skin beneath the lower lids
Eyelid Surgery Procedure
Eyelid surgery may entail an upper blepharoplasty, a lower blepharoplasty or both. The right treatment is going to depend on your anatomy and needs. Upper eyelid surgery is designed to remove the excess skin that is making your lids look droopy and which may be interfering with your vision. It may also address any excess fat that is leading to upper lid puffiness. During your upper eyelid surgery, Dr. Doherty will make a very fine incision in the natural crease above the eye. He will then remove the excess skin and fatty tissue, if necessary, before closing the incision. Since the incision is located inconspicuously, the scar is hard to detect once it has healed completely.
If you need your lower eyelids corrected, Dr. Doherty may make an incision just below the lower lash line or inside the eye, known as the conjunctiva. He may remove excess skin, tighten the underlying muscle if necessary and address excess fat under the eyes. The fat may be removed or redistributed to eliminate under eye bags or bulges, puffiness or to improve dark circles or hollows beneath the eye. Since one option for the incision is located along your lash line, any resultant scar blends in with your lower lashes making it virtually invisible. Scars that are med in the conjunctiva are not able to be seen.
Transconjunctival Approach & Lower Eyelid Surgery
While under eye bags and puffiness may result from age, they can often be genetic. This means that patients as young as their early 20’s may suffer from this unattractive and very aging puffiness. Oftentimes, with this particular condition, Dr. Doherty will decide that the best approach for removing the fat from the lower eyelid is with a transconjunctival blepharoplasty. In this procedure, an incision is placed inside the lower eyelid, through the conjunctiva. The advantage here is that the incision gives him complete access to the fat beneath your lid without the need for external stitches. However, this technique cannot be used to remove excess skin, so it only works for those patients who suffer from excess lower lid fat only.
For patients who are bothered by just loose skin below their lower eyelids, Dr. Doherty may need to perform a more extensive removal of the excess skin although some patients can get away with what’s called a skin pinch procedure. Here, a small area underneath the lash line is removed. This also can result in some tightening of the lower lids.
Recovery from Eyelid Surgery
Eyelid surgery may be performed under local anesthesia in the office or surgery center or under general anesthesia in the hospital or at an accredited surgical facility. While every patient heals at his or her own rate, you can expect to be bruised and swollen for the first 7-10 days. Your eyes will feel irritated at first and will need to be treated regularly with eye drops and a lubricating ointment. Dr. Doherty often recommends alternating hot compresses and ice to help with the swelling.
In general, an upper blepharoplasty heals faster than a lower blepharoplasty particularly one that entails manipulation of the fat pad. The stitches are usually removed after 7 days. Recovery from upper eyelid surgery is not particularly painful or long lasting. Most patients are back to normal activities within a day or two and can return to full exercise after two weeks.
If your eyes are making you feel more like a Shar Pei than a supermodel, perhaps it’s time to schedule a consultation to discuss eyelid surgery. In under an hour, you can take a decade off your face. Now that’s what we call rejuvenating.
To find out more about eyelid surgery with Dr. Sean Doherty at his Boston or Brookline office, contact us today or call (617) 935-0801 to schedule a consultation.
Will eyelid surgery change the shape of my eyes?
We’ve all seen pictures of celebrities who no longer look like themselves and nine times out of ten, it’s due to their eyes. So, yes, eyelid surgery can change the shape of your eyes, but it doesn’t have to do that. My goal is for your eyes to look like they have always looked — only more open, with less droop and drag. I will often ask my patients to bring in old photos so that together, we can look at how, exactly, your eyes have aged. When I’m done, friends and family won’t know what’s different unless you decide to tell them.
I’ve been reading a lot about fillers under the eyes. Would they work for treating my dark circles?
For some patients, fillers can be a good option for filling in the hollow by the inner corner of the eye that often accentuates dark circles. This is called the tear trough. Filler her may help the shadowing, but there are other anatomical things that contribute to dark circles. These include: thin skin, swelling and genetics. So, yes, filler MAY work for your dark circles. But they can’t address loose skin or a fat pad that has migrated out of position. I will often combine fillers with my lower eyelid surgery for truly exemplary results. The right option for you is really going to depend on your anatomy and needs.
Will an upper blepharoplasty raise my eyebrow back into position?
No. Upper eyelid surgery will address loose skin and muscle only. And while this can go a long way towards making you look younger; it will not place your brow back where it was in your 20’s. To do this, you will need a brow lift or a facelift. A non-surgical option is to have Botox injections. When done on the outside of the eye, Botox can provide a nice browlift. This may be all that you need. I tell all of my upper blepharoplasty patients consider Botox as a complement to their surgical result.
If I only address my eyes, will it make the rest of my face look funny?
It depends. My goal is to create a face that is in harmony. Assuming that your skin tone, texture and elasticity is good then eyelid surgery alone should be fine. However, if you have severely drooping skin in the rest of your face and you only correct your eyes then yes, you may look out of synch. In that case, it might be best to consider combining a facelift with your eyelid surgery. All of these issues and scenarios should be discussed before surgery.
As a man, I am worried about the downtime associated with lower eyelid surgery, but the bags under my eyes are really bothering me. What should I do?
I hear you. Men tend to suffer from more severe under eye bags than women. And they can be extremely aging. So, it is really going to depend on how much they bother you. There is really no non-surgical solution for under eye bags. Lower eyelid surgery is a very effective surgery with a pretty limited recovery period. However, if you don’t want anyone to know that you had anything done, you are going to need two weeks off. Maybe the best thing to do is just think of it as a “staycation”. You’ll certainly return looking revitalized and rested! In addition, men tend to also have a subtle refreshed look when their upper eye lids are treated and the recovery from this is typically shorter and easier.