Blepharoplasty, or eyelid surgery, addresses eyelid heaviness and puffiness that contribute to the common complaint “I look tired, but don’t feel that way”. I assure patients at my Boston practice that if the eyes are the windows to the soul, then the shades shouldn’t be distracting.
Blepharoplasty can be performed on the upper eyelids, lower eyelids, or both. However, when considering periorbital rejuvenation with patients I often find it important to address more than one component so that the entire area maintains balance. The 3 most common ancillary procedures I’ll perform are:
- Brow Lift
- Upper Blepharoplasty with Lower Blepharoplasty, or vice versa
- Corrugator Resection
When examining “heavy upper lids”, it is extremely important to gauge whether it is the lids alone that are sagging or if there is also a degree of brow sagging. The upper eyelids and brow act like a see-saw in this setting, and those lines we all get running across our forehead can be an indication of our forehead muscles trying to keep everything elevated. Removing eyelid skin only results in the forehead relaxing, and the forehead lines disappear, but the brow then drops even further and the entire area appears even “heavier”. So in patients that have both brow and upper eyelid descent, I’ll recommend first performing a brow lift to place the brow back in its normal position, and then performing the upper blepharoplasty removing only the amount of excess upper eyelid that is appropriate. I’ll perform these procedures at the same time and it’s a complex surgery that requires expertise.
Doing only one set of eyelids (either the uppers or lowers) can sometimes lead to disharmony as the premature aging of the other set may become more apparent in recovery. This is perhaps more often the case when considering lower eyelid surgery alone.
Lastly, although more of a convenience than a necessity, if a patient is interested in upper eyelid surgery and has also been receiving BOTOX® Cosmetic treatments for glabellar lines (the “11s” between the eyebrows), the corrugator muscles can be addressed. Through the same incision used for the upper eyelid procedure the corrugator muscles between the brows can be isolated and partially weakened. This can reduce, if not eliminate, the need for future Botox treatments of the “11s”.
Like all plastic surgery, in eyelid procedures, proper planning and attention to detail can translate small changes into dramatic and long-lasting results.