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Eyelid Lift

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Upper & Lower Eye Lift

The eye area is one of the first places to show aging. You may notice your eyes look tired, sad, or older than you feel. Blepharoplasty removes fat and drooping skin of the upper eyelid, minimizes bags under the eyes, and tightens the skin of the lower eyelid. It will help “open up” the eye so the upper lid’s natural crease is visible and remove loose skin and wrinkles of both lids.

Do you look tired? (bags under the eyes? darkness?)
Do your eyes get tired when you read for long periods?
When you wake up do you look really tired?
Do you have heavy lines on your forehead?
Do your eyelids hood over your eyes, so tree branches, cars, or cabinets come out of nowhere?
Does botox no longer work on your forehead? Does it make your brow feel too heavy or hooded?

Welcome to your 40s! The most common surgery I do on men and women in their 40s is eyelid surgery, though I see some patients who need eyelid surgery in their late 30s, and some who can push it off until their early 50s. I know those who would benefit from eyelid surgery when I can see people compensating with their forehead, causing those lines to deepen and the “tired” look increases. When bad enough, insurance may even help cover the upper eyelid surgery because the drooping lid causes visual field impairment.

I love the subtle improvement. Patients don’t look like a different person- they just look “well rested.”

Lower eyelid blepharoplasty

OPEN LOWER LID BLEPHAROPLASTY vs. PINCH BLEPHAROPLASTY.

There are two techniques for this area, an open technique and a pinch blepharoplasty technique.
I choose the technique depending on your anatomy, the amount of excess skin, the amount of fat, and your risk of dry eyes.

FAT SPARING.

In the old days, they use to remove all of the fat on the lower lid to get rid of the “puffiness.” That left many people with a flat lower lid, but a hollow aged look. I perform a fat sparing eyelid surgery technique to preserve the fullness and youthfulness of the lower eye.
Some of the hollow of the lower lid is actually an issue of the upper cheek losing volume as you age.
I usually combine the lower lid surgery with facial fat transfer to the eyelid cheek junction to help with under eye shadowing and the “tired” look.
I am a big fan of micro fat transfer, and with the lower eyelid, the cheek usually is a big component of aging and the “tired” look.

DON’T FORGET THE CHEEK.

The lower eyelid hollow, what makes you look “tired” or have “eye bags,” is also partly a cheek issue. This needs to be addressed.

SCAR

Runs along the lower lash line.
If only fat is removed, this can be done from inside the eyelid in a transconjunctival approach. This does not allow any skin tightening.

upper eyelid blepharoplasty

BROW vs. UPPER EYELID ISSUE.

Usually upper eyelid aging is due to a combination of your eyebrow falling and excess skin on the upper eyelid.
If the issue is the brow, then a browlift (endoscopic, temporal, a small stitch through the upper lid, or fat grafting) may be needed.
If the issue is the eyelid itself, then the excess skin is removed.

FAT. TO REMOVE OR NOT?

A youthful eye has fullness; it does not look skeletonized.
For the upper lid, I do conservatively remove some fat during blepharoplasty, but only fat which protrudes with gentle pressure. Again, you do not want to look hollow.

WILL IT CHANGE HOW I LOOK?

This is a common concern for many of my patients who do not want to look like a different person or surprised. Eyelid surgery does not change the way you look. EYEBROW surgery may. It is part of the reason I prefer to start with doing eyelid surgery. It has a hidden scar in the crease of the eyelid which fades well, it can be done under local anesthesia, and it does not change the way you look.

"I chose Dr. Greenberg because of her honesty and her amazing results focused on keeping her patients looking natural." - Patient
*Individual results may vary

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Nonsurgical lower eye "lift"

Soft tissue fillers can provide a nonsurgical lower eye “lift.” It is a simple office procedure injection. You may have some bruising following the procedure. Try to avoid aspirin and nonsteroidal products for 2 weeks prior to injection.

There are two places to inject. If you are injecting just under the eye, the skin is thin. I tend to do a cannula injection (so less bruising) and use a finer HA filler like Refyne. The other way to indirectly improve the eye area, with the addition of improving the cheek, nasolabial fold, marionette lines, and jowls, is to inject more laterally on your cheekbone. The common fillers I use in this area are HA fillers like JUVÉDERM®, Voluma, and Restylane®, or longer term fillers like Sculptra®.

Again for the lower eyelid area, I am a believer in adding volume to the lower eyelid cheek junction to help this area. This does not mean you have to look fake, over plumped, or plastic. There are many examples of poor technique in adding volume on TV and in magazines. When done well, you just look “good for your age.”

If you have done in-office fillers and you like the look, consider a more lasting procedure like micro fat transfer to the cheek and eyelid junction. Not only does the fat last for a long time (I have patients out years with lasting results), many believe the stem cells in the fat help rejuvenate the overlying skin. I am in the camp of plastic surgeons who believe fat helps improve the skin quality. It is slow and subtle, but I think real. This is a surgical procedure, and will have 1-2 weeks of swelling and mild bruising.

To find out if you are a good candidate for cosmetic eyelid surgery, known as blepharoplasty, contact my practice to schedule an consultation.

insurance coverage

Eyelid surgery doesn’t just make you look more awake and rested, there is a real benefit to doing the surgery. Insurance sometimes will help cover the cost of upper eyelid surgery (lower eyelid is always cosmetic) if you have enough visual field impairment.

What is that? Visual field impairment is when your eyelid hangs over your eye, and reduces your field of vision. Essentially, you are like a horse with blinders. If a car or skier “comes out of nowhere,” you hit your head on tree branches or cabinets because you just don’t see them, or you don’t need to use sunglasses anymore, this is likely an issue of overhanging skin.

Blepharoplasty cost

The typical surgery I do when doing eyelid surgery addresses the upper eyelid, lower eyelid, and facial volume loss. To do this surgery in a seamless way, where you look natural, I think it is important to address the skin laxity and volume loss components together. This is typically what most people need. Ballpark cost for this is around $11,000. I LOVE THIS SURGERY. I think it is so subtle, but not subtle. Eyelid surgery and balanced fat grafting rejuvenates how you look in a fabulous way, where you just look “refreshed.”

I do have some patients who just want to address the upper eyelid alone. That surgery is less expensive and could be done under local anesthesia/ twilight.

Healing After eyelid surgery

Eyelid surgery healing takes about 1 – 2 weeks. It varies:

How much swelling or bruising do you get? The more swollen and bruised, the longer it takes to heal and for you to look normal. There are things you can do like sleep with your head elevated to help. Some commonly used techniques (like icing) or herbals (like arnica) are not okay to use when doing fat grafting to the face at the same time, as they may impair fat survival. Don’t strain, lift heavy objects, or bend over- these all increase pressure in your face, which may increase bruising. Two weeks prior to surgery get off medications and herbals which may cause bruising. (see blog on that HERE)
What amount of healing is okay to you for others to see? After the first week, your bruising (if you have any) will be lighter in color. Your sutures are visible, but are removed 6-7 days after surgery. If your threshold for being out is lower, most of what you have can be hidden by wearing glasses (and if you don’t need glasses, buy a pair of cheap readers – they hide all sorts of things) or wearing sunglasses. So a trip to Trader Joes? Easy to do. Giving a presentation at work? They’ll see you are not fully healed.
Are you doing any face procedures with the eyelid surgery? The most common surgery I do with eyelid surgery is fat grafting to the face. Fat grafting is awesome- it is liquid gold, and helps reverse the volume loss in the face. But it will leave you looking a little doughy for 2 weeks. If you are just doing the upper lids, the scar is hidden when your eyes are open, so it is easy to hide. The lower eyelid scar is visible, as the scar runs directly under the lash line, and it may look a little red for the first few weeks, which makes it look like “allergy” eyes.

Eyelid surgery does not hurt much. Expect it to be hard to read or do computer work for the first couple days. This is because of swelling and the eye ointment which can make things blurry. TV or audible books (or just sleep!) are a better choice. You can drive when you can 1. see well and 2. are off your pain medications, which is usually about a week out. Sutures are removed at about a week. No contacts or eye makeup for 2-3 weeks Exercise can restart once your swelling and bruising is gone, usually around 3 weeks out.

Eyelid Lift Blogs

HOW CAN I GET RID OF THE DARK CIRCLES UNDER MY EYES?

WHAT ABOUT THOSE WRINKLES AROUND MY EYES?

FAT INJECTIONS FOR THE FACE AND EYE REGION

Face Blog

Correcting Other Eye Conditions

Other problems with the eyelid can also be improved with blepharoplasty.

In addition to the cosmetic appearance of excess skin, the lateral part of the eyelid can start to “hood” and block lateral vision. If this is severe enough, as documented through visual field deficit testing, insurance may help pay for the procedure.
Another condition, ptosis (where the muscle that lifts the eyelid is stretched), can be repaired at the same time. Extra caution needs to be taken in patients with Graves’ disease, laxity of the lower eyelids, glaucoma, and dry eyes.