Blepharoplasty is the medical term to describe eyelid surgery. Upper blepharoplasty is a procedure that removes hanging skin from the upper eyelid. The procedure calls for small incisions along the natural lines of your eyelids to minimize scarring. However, the removal of too much skin can actually make the face look older by hollowing out the eyeball socket.

Trends in blepharoplasty surgery include conservative skin resection and the addition of volume (fat) to the upper eyelid sulcus. Fat grafting alone can sometimes rejuvenate this area as well. For men in particular, upper lid blepharoplasty MUST be performed by someone who understands the aesthetic ideals of a masculine face. Too often, skin resection in men imparts a feminine look. If you see male celebrities on TV with botched plastic surgery, you can bet they had their upper lids done. This is a big danger zone for men and must be done very conservatively to yield the best results.

Many men and women complain that they have been told they look tired or have bags underneath their eyes. The eyes do often play a role in expressing our physical state. Bags or puffiness under the eyes are often managed with lower lid blepharoplasty. These small deposits of fat can be removed with an incision behind the lower lid, making the incision totally hidden.

This fat is then removed or repositioned over the rim of the eye. As with the upper lid, the lower lid blepharoplasty procedure can hollow out the lower lid, making the face look older. Thus, fat is also transferred to the oribital rim to smooth out this region, or the orbital fat is repositioned to produce a natural look. When sagging skin is the predominant issue, lower lid blepharoplasty can address this problem with a conservative skin excision, with or without the addition of fat grafting.

A browlift (forehead lift or forehead reduction) may be required to open the eyes if the brow is sagging. Please see the brow lift section for more information pertaining to this technique.

Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift or brow lift.

Blepharoplasty eyelid surgery may be performed under local or general anesthesia. Upper blepharoplasty can be done quite easily in the office setting. Lower lid blepharoplasty often requires sedation or general anesthesia. Most patients are back to their normal routine within a few days, although complete recovery including the disappearance of swelling or bruising may take longer..

In some cases, blepharoplasty surgery can be replaced with Juvederm or fat grafting alone. Fat, Restylane, or Juvederm added to the hollowed out area below the eye will add necessary volume, eliminating puffiness and dark circles.

The Consultation


Your evaluation of the eyelids will be guided by your particular complaint. People that have upper eyelids that look heavy require a different conversation than those who believe they simply look old. The treatments may differ. Skin resection or the addition of volume may be considered. A combination of skin resection and volume addition may also provide the most effective changes to the orbital region.

Simulation of skin resection can easily be achieved in the office during the consultation. Images or examples of fuller eyes due to volume addition may also be shown to allow you to understand the true issue and potential solutions.

Lower lid aging may manifest with hollowing out, bags, extra skin, or all of the above. Your conversation with Dr. Neavin will focus on the true agents of aging and potential solutions ranging from least invasive to more invasive procedures, depending on your needs.

On examination, if bags are the culprit, you will be asked to look up and down. This motion will be filmed and shown to you to reveal the dynamic nature of your bags. Discussion will range from cases where bags can be camouflaged with fillers, to conditions where the bags must be surgically removed or repositioned for the best possible outcome.

A proper evaluation and DIAGNOSIS is the key to good lid surgery.

A medical history will be obtained. Important information will include any history of hypertension or medications that can cause bleeding with surgery. Optimal blood pressure is critical for lower lid blepharoplasty to reduce the dreaded complications associated with a hematoma. If blood pressure is not controlled well, surgery must be postponed until control is established.

The Surgery


Upper eyelid surgery, unless combined with other procedures, is performed under local anesthesia in the office. It involves the addition of volume to the upper eye sulcus, the removal of skin and fat on the upper lid, or a combination of above.

The proposed skin excision is marked pre-operatively. The eyelid is anesthetized with local anesthesia. If fat is to be harvested, the donor site (usually the flank) is marked as well and anesthetized with local anesthesia. Fat is harvested with a small liposuction cannula, processed, and prepared for injection. Skin excision is performed and incisions are closed with absorbable stitches. Fat is injected with a small cannula into the hollow under the eyebrow.

Lower eyelid surgery is more commonly performed with either general anesthesia or local with sedation. The transconjunctival approach is most commonly performed for either bag removal or repositioning. If skin excision is required, an external approach is made to access the bags and allow skin resection. Three separate bags exist in the lower eyelid: the nasal, central, and lateral (temporal). The nasal and central bags are separated by a small muscle that controls eye movement, the inferior oblique. Fat is carefully removed from these compartments by incising the lower eyelid on the inside and removing or repositioning fat and tissue over the rim to blend into the tear trough.

Fat may be harvested from the flank in the same method as for upper lid blepharoplasty. Fat is injected into the tear trough area and surrounding mid-face to blend the lid-cheek junction.

With the transconjunctival approach, no stitches are necessary. With an external approach, stitches are placed and will need to be removed in our office a few days after your surgery. In addition, taping of the lower lid may be necessary for a brief period of time to ensure proper healing.

CO2 resurfacing may be combined with the lower lid surgery to aid in skin tightening and create a smoother result.

Recovery & Results


With both upper and lower lid surgery, pain is generally well-controlled with oral narcotics. A hospital stay is unnecessary. Patients will ice their eyes for two days and sleep with their head elevated to reduce swelling and promote healing to the area. Blood pressure control is critical for lower lid surgery.

Swelling and bruising may occur, particularly with lower lid surgery, and exist for up to 10 days. Eye drops for lubrication and swelling will be prescribed. Final results may not be evident for up to six weeks or more, as swelling can linger and skin may need to tighten.

Eyelid surgery could have risks and complications that may occur due to the complexity of the operation. Risks of such surgery will be discussed during your consultation with Dr. Neavin. If you would like to find out if you are a candidate for eyelid surgery, contact Artisan of Beauty Plastic Surgery today at 310‑858‑8811 or text 323‑975‑1287.

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