Upper Eyelid Surgery (Upper Blepharoplasty)
Upper blepharoplasty, upper lid lift, or upper eyelid surgery, is a common operation in which excess skin of the upper eyelids is removed to give a refreshed, and more youthful look. This procedure is commonly performed in both men and women and is a high bang for the buck operation with minimal downtime. This procedure can be done without anesthesia in the office for appropriate patients, making it easier to schedule and less expensive than other cosmetic surgeries. Your safety and comfort are our first priorities. For patients apprehensive about surgery, Dr. Poppler offers in office sedation, or surgery in an OR under anesthesia as well.
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There are many changes that occur around your eyes in addition to lose, sagging skin that can make you look older. Upper blepharoplasty with skin removal is not appropriate for everyone. Other procedures such as facelift, mid-face lift, lower eyelid lift (lower blepharoplasty), browlift, fat transfer around the eye, or laser skin tightening or resurfacing may be needed instead of, or in addition to simple skin removal to give you a natural appearance. Although many surgeons around Boise, Meridian, Eagle, Nampa, Caldwell, Canyon County, and throughout the Treasure Valley offer upper blepharoplasty, it is important that you choose a surgeon certified by the American Board of Plastic Surgery, like Dr. Poppler with extensive training and experience in facial aesthetic surgery. This ensures your surgeon has all the skills and experience necessary to perform all these procedures and can help you choose the best procedure for you, rather than a more limited set of procedures with which they are experienced and comfortable.
Where Are the Scars for Upper Eyelid Blepharoplasty?
The scar of an upper eyelid blepharoplasty is hidden in the natural crease of your upper eyelid. Excess skin, muscle, and sometimes fat is removed from the upper lid with an elliptical incision carefully planned so that the scar will land at your upper lid crease. The scar is typically invisible when your eyes are open and only very faintly noticeable with the eyes closed.
How do I know if I need upper blepharoplasty or another procedure?
Upper blepharoplasty is appropriate for patients who have loose, redundant skin of the upper lids that hangs and makes your upper eyelids look heavy. Women often first notice this because their mascara gets on their upper eyelid skin. Others may ask you if you’re tired or tell you that you look tired.
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Some patients have excess fat in the upper lid near the corner of their eye by the nose. These patients may need a very small amount of fat removed in that area as part of their upper blepharoplasty. However, many more patients lose fat around their eyes and that is one of the primary drivers of looking older. Additionally, the bones around the eye tend to shrink as we get older, making our eye sockets look bigger and hollower. This loss of volume is likely one of the primary drivers of drooping brows and lids. A surgeon certified by the American Board of Plastic Surgery, like Dr. Poppler will help you compare your current face with photos of your younger self and decide, which of these components are contributing most to your eyes looking older. The two of you will then make a plan to address those changes that matches your goals, budget, and willingness to go through surgery and post-operative recovery. In general, most patients do not need a brow lift but rather need excess skin of their upper lid removed (upper blepharoplasty), lifting of their cheeks with a lower lid lift, facelift, fat transfer, or fillers, and fat transfer to their upper lids, temples, and brows to achieve a more natural, youthful look. These can be done one at a time, or in combination.
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In the past, upper blepharoplasty was the go-to surgery for managing aging around the eyes. It was often paired with a browlift with good, but not necessarily naturally youthful results. Fat was also often removed from around the eye. However, improved understanding of the aesthetics of the eye has led to a more modern approach. Young patients DO NOT have high eyebrows or hollow upper lids. Yet, older patients tend to look better with higher eyebrows and their excess lid skin removed? Why? The answer comes from a concept called the “orbital oval theory.”
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Orbital oval theory suggests that the eye looks best when it sits at the center of an oval formed by your upper cheek and eyebrow. As we age, the cheeks sag as we lose fat in our lower lid and our cheekbones shrink. The bones and fat around our upper eye also shrink, causing the skin of the upper lid, and brow to sag. Surgeons figured out decades ago that the older eye looks better when the brow is lifted and excess skin is removed to match the older, lower cheek. For this reason, the traditional answer to fix aging of the upper eye was always a brow lift and upper lid blepharoplasty. However, better does not mean natural or young looking, just better. Look at the photo below of Jane Fonda when she was in her 20s and in her 70s. She looks good in both, but you will notice that young Jane Fonda’s brow is lower and her upper eyelids are fuller. Also, the bones around her eyes are less obvious because she has more fat in her face.
In this second, zoomed in photo of Jane Fonda’s eyes, you see an oval drawn around her eye. Jane Fonda is a privileged actor and activist who has had very good plastic surgery and her eyes are nicely proportioned in both photos, but you can see that the oval is larger in the older photo because her eyelid has moved up and her cheek has moved down. Although raising her brow has helped to balance the look of her eye, a more youthful look would have been achieved by raising her cheek back up with a mid-face lift or facelift to its original position and restoring its youthful fullness with fat transfer. Those procedures would have also returned her eye to the center of the oval without the need to raise the brow. You can also see that her upper lid is a lot more hollow in her older photo.
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Here is another example of hollow upper lids:
It is easy to see that Cher has a lot of upper lid hollowness compared with her younger photo. This is in a woman known for having lots of excellent plastic surgery. Unfortunately, Cher had her eyes done before the popularization of fat grafting/fat transfer when it was still common to remove fat from the upper lids. Even with modern fat transfer techniques, it is difficult to replace fat in the deep compartments of the eye with fat grafting.
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Here is another example:
Although she looks amazing, Cyndi Crawford’s older eyes have much more hollowness in the upper lids. All three of these women have probably had upper blepharoplasty. Jane Fonda appears to have had a brow lift. All three look great and much younger than their age. Despite this, each of these women would probably look more youthful by adding fat around they eye.
What is fat transfer or fat grafting?
Fat transfer, or fat grafting is a procedure that involves removing fat from an area of the body where you don’t want it with liposuction, processing that fat to remove injured fat cells that won’t live and non-fat tissues, then injecting that fat in areas where you want more fullness. This is a very common and safe operation, especially for patients undergoing breast reconstruction. Dr. Poppler has extensive experience performing this operation for breast reconstruction and also does it commonly in the face. In general, about 70-80% of the fat transferred to the face will survive and will permanently add volume. This is a very good option for men and women who have fat they would like to get rid of on their abdomen and flanks and who want a more youthful look to their face. This is not a good operation for very thin patients who do not have fat that can be removed. However, new “alloplastic” fat options (fat donated by human organ donors) are available at Treasure Valley Plastic Surgery and Medical Spa for thin patients interested in fat transfer. Fat transfer to the face can be done in the office with mild sedation, or can be done in the OR on its own in combination with other procedures.
Are there non-surgical ways to address heavy upper lids?
For patients with mild excess skin of the upper lid, carbon dioxide or other fractionated ablative lasers can be used to mildly tighten the skin without decreasing upper lid volume. This is a popular option for young patients who don’t yet feel ready for surgery. However, ablative lasers can be more uncomfortable than surgery during recovery and may take longer to fully heal. Dr. Poppler, and our providers at Treasure Valley Medical Spa can talk you through this procedure and help you decide the best procedure for you.
Are the recommendations different for men and women?
The same processes contribute to looking older in men and women. However, men tend to have a stronger bony brow than women, and therefore tend to have less upper lid hollowness created by bone loss. Men also have less distance between their lash line and the upper lid crease.
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Society is much more tolerant of women having a non-natural appearance created by old school cosmetic surgery than men. For this reason, it is extra important to not to distort men’s natural anatomy, but rather to restore it. When done incorrectly, upper lid blepharoplasty can hollow out the upper lid and lengthen the distance from the lash line to the upper lid crease. Dr. Poppler has extensive experience treating aging around the eyes in men and women and spends a good deal of time looking at your younger photos with you so that you and he can make a plan together to restore your natural appearance and not raise eyebrows. Dr. Poppler also has extensive experience working with adult transgendered patients seeking to masculinize or feminize their face so he is very attuned to the subtle differences between genders and will not inadvertently feminize a mans face.
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Below are two examples of poorly done upper lid surgery in men:
You can clearly see that Kenny Rodgers (first set of photos) and Bradley cooper (second set of photos) have low brows and full upper lids in their young images. Both have an elongated distance from their lash line to their upper lid crease, that looks more feminine after upper lid surgery. Additionally, Kenny Rogers has inappropriately had a significant amount of fat removed from his upper lids, giving him a very unnatural appearance. Choosing an American Board of Plastic Surgery certified plastic surgeon with extensive experience doing eyelid surgery on men like Dr. Poppler is the best way to avoid results like these.
Is there a best procedure to start with?
In general, addressing the primary driver of your eye looking older is the best place to start. If you do not have much fat loss and have excess skin of the upper lid, removing that with an upper eyelid blepharoplasty first makes sense. If you have a lot of fat loss around your eyes, starting with fat transfer to the face makes the most sense. If your cheeks are sagging and your lower lids are the problem, starting with a lower eyelid lift (lower blepharoplasty) or a facelift may make the most sense. Dr. Poppler will guide you through these options, give you his observations on what is the primary driver of aging around your eyes, and help you decide. Many of these procedures can be done together at the same time.
Why Patients Choose Upper Eyelid Blepharoplasty
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The primary driver of their aging eye is redundant skin of the upper eyelid
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The procedure takes less than 2 hours and can be done in the office without general anesthesia
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Recovery generally takes only a few weeks before patients feel confident being out in public
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Upper eyelid blepharoplasty makes an immediate difference with less cost than many other cosmetic procedures
Why Patients Choose Fat Transfer around the eye
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Fat transfer restores a natural appearance to the eyes in patients with a lot of atrophy (shrinkage) of the bones and fat around the eye.
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Fat transfer can be done in the office without general anesthesia or in the OR based on your preferences.
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Fat transfer can address the upper and lower eyelids, the cheek, the brow, and the temples at the same time. It can also be used to address other areas of the face if needed.
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Recovery is generally longer for fat transfer than upper eyelid blepharoplasty because there tends to be more swelling and it persists longer.
Possible Complications
Like all surgeries, upper eyelid blepharoplasty has risks. The risks are small but are higher in people with certain medical conditions such as smoking, poor nutrition, auto-immune diseases, or diseases that require the use of blood thinning medications. Dr. Poppler will carefully review your risk factors with you at your consultation and help you modify these where possible to make your surgery as safe as possible. At Treasure Valley Plastic Surgery, your safety is our number one priority.
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Possible complications of upper eyelid blepharoplasty include (listed from most to least common):
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Temporary worsening of dry eyes - common
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The brows may lower mildly as you relax your forehead because you no longer need to hold them up to see - common
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Worsened upper lid hollowness – rare when done correctly
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Over resection of skin and difficulty closing the eyes – rare when done correctly
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Scars that may be thick or uneven – rare
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Poor wound healing – very rare
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Bleeding or hematoma (a blood collection around the eye that if left untreated could cause blindness) – very rare
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Infection – extremely rare
Possible complications of fat transfer around the eye are all rare but include (listed from most to least common):
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Uneven contour where that fat is removed
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Uneven fullness around the eye
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Need for additional fat transfer to achieve your goals
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Persistent swelling
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Firm lumps called fat necrosis or oil cysts
Should I lose weight before surgery?
If you are significantly overweight, you may not be a good candidate for an elective surgery and Dr. Poppler may recommend you lose weight prior to surgery so that he can give you a better result and decrease your risks with surgery. Best results are achieved when you are at the weight you intend to stay at. Losing weight before surgery is not helpful if you think you will gain it right back. Similarly, doing surgery before losing weight produces a sub-optimal result because your skin will loosen again and the tissues around your eye may change. For this reason, it is best to lose weight eyelid surgery if you intend to lose weight or if you are significantly overweight, but otherwise you should have surgery when you are at a stable weight you are happy with.
How long is recovery after eyelid blepharoplasty?
Recovery from upper eyelid blepharoplasty usually takes about 1-2 weeks before you feel comfortable being out in public and 6-8 weeks for swelling to completely resolve. Most patients return to light activities within 1-2 days, and work in 1 week. Return to most exercise is possible about 1 week after surgery. You will need to sleep with your head elevated for 1-2 weeks. Swelling is typically mostly gone in 3-6 weeks but will come and go for about 3 months. If you have liposuction and fat transfer, swelling will be more severe and persistent than if you have an upper eyelid blepharoplasty by itself.
Is upper eyelid blepharoplasty safe?
Upper eyelid blepharoplasty surgery is generally very safe when performed on appropriate patients by a board-certified plastic surgeon. Like all surgeries, there are risks such as asymmetry, poor scarring, upper eyelid hollowness, unnatural appearance, lumps, or pain. Choosing an experienced surgeon like Dr. Poppler, following his advice to modify any risk factors before surgery, and following aftercare instructions lowers these risks and improves results.