Upper eyelid surgery.

How I read an upper eyelid

When someone tells me their eyes look heavy, the first thing I want to understand is why. A hooded upper lid can come from surplus skin settling over the natural fold, from fat pushing forward, or from a lid that itself sits too low. Those are different problems. Excess skin and fat are what an upper blepharoplasty addresses; a drooping lid is a separate question, and I would rather sort that out at the consultation than discover it in the operating room.

For some people the concern is purely how they look: tired in photographs, the crease lost, makeup with nowhere to sit. For others the skin has come down far enough to crowd the upper edge of their vision. Both are reasonable reasons to talk. I look at the lid, the brow above it, and the face as a whole, because an eye is never assessed in isolation.

What the operation actually is

An upper blepharoplasty is a short, precise operation. I place the incision in the natural crease of the upper lid, where it will fold out of sight once healed. Through it I remove the redundant skin, a conservative strip of the orbicularis muscle, and the fat that has bulged forward. On the upper lid alone, that usually takes forty-five minutes to an hour, done under local anesthesia with sedation.

The word I keep returning to is conservative. The most common way to spoil an eyelid is to take too much. A lid that has been over-resected looks surgical, and it is difficult to give tissue back. My aim is an eye that looks rested, with its own shape intact, so that people notice you look well without being able to say why.

The lower lids are a different operation with different trade-offs. When bags or puffiness below the eye are part of the picture, a lower blepharoplasty can be done at the same sitting, sometimes through an incision on the inside of the lid. I mention it only because patients often ask; for many people the upper lid is the whole story. The full range of upper eyelid surgery in Newport Beach at Allure MD, lower lids included, is laid out there.

Before and after the day itself

Preparation is straightforward but it matters. I ask patients to stop smoking and to stop aspirin and anti-inflammatory medicines for two weeks beforehand, and I may start eye drops or ointment before surgery. Good candidates are in good general health and come with realistic expectations; I will say so plainly if I think the goal is not one surgery can meet.

The first two or three days are when swelling and bruising are at their most visible. Cold compresses and resting with the head raised help. Sutures come out in the office around day five to seven, and many people are comfortable going out in sunglasses at that point. Most return to work and ordinary routines around the second week, when makeup can be worn again. The majority of the swelling settles by four to six weeks, and the scar keeps maturing for several months after that, becoming very difficult to find in the crease.

Like every operation, this one carries risk. The ones I discuss with every patient include dry eyes, which are usually temporary, asymmetry, bleeding under the skin, and, rarely, infection. Changes in vision are very rare. I would rather you hear all of this from me than read it somewhere afterwards.

How long it lasts

The skin and fat I remove do not grow back. You go on aging, at your own pace, from a fresher starting point, and results commonly hold for ten to fifteen years or longer. Some patients pair the upper lids with a brow lift, a facelift, or skin resurfacing; many do not need anything else.

Every consultation is with me. I will examine you, tell you what I would and would not do, and explain why.

Upper blepharoplasty  ·  Local anesthesia with sedation  ·  In consultation, never by menu