Eyelid Surgery (Blepharoplasty)

MiddleagedOften, the eyes are the first facial feature noticed when meeting a new person. The eyes provide us with a powerful means of expression, allowing us to communicate a wealth of emotion and feeling. The ageing eyelids can convey a tired, sad, or stressed appearance. Eyelid surgery, otherwise known as blepharoplasty, can rejuvenate the areas around the eyes, reverse common signs of the natural aging process, and provide a rested, more youthful look. In addition to improving aesthetics, blepharoplasties can also address certain functional problems of the eyelids.

Dr. Neil Zemmel and Dr. Kasandra Dassoulas have the experience and skills to revitalize your appearance while customizing each eyelid surgery procedure in order to achieve your individual aesthetic goals. In addition to the cosmetic benefits, our patients at Richmond Aesthetic Surgery often report feeling an increased sense of self-esteem after their blepharoplasty procedure. Patients often combine eyelid surgery with one of our other facial procedures for a more complete rejuvenation.

How Do the Eyelids Change with Age?

Changes in eyelid appearance are one of the earliest signs of facial aging that typically begin in the late thirties and then progress over time. Some of these changes include:

  • Fine wrinkling of upper and lower eyelid skin
  • Bulging of eyelid fat pads
  • Development of deepening grooves of the lower lids adjacent to the nose (tear troughs)
  • Development of loosening of eyelid skin.
  • Loss of eyelid tone or “snap”, resulting in drooping of the lower eyelid and increased show of the soft tissues that are normally hidden by the eyelid. The net result of these changes is a sad or tired appearance of the eyelids. The on-going bulging of lower eyelid fat and skin can contribute to chronic swelling, that often worsens as the day progresses.

What Is Blepharoplasty?

Blepharoplasties are surgical procedures that correct age-related aesthetic and functional abnormalities of the eyelids. The goals of the procedures are a more youthful, yet natural appearance to the eyelids. Because the of role that the eyes play in our personal interactions, surgical rejuvenation of the eyelids can convey an overall more youthful appearance to the entire face. However, blepharoplasties are frequently combined with other facial rejuvenation procedures, such as the brow lift or facelift, to provide a more holistic treatment of facial aging.

What Does the Blepharoplasty Consultation Entail?

Ideal candidates for eyelid surgery include healthy men and women who have heavy, drooping eyelids, excessive wrinkling, or bags and swollen areas around the eyes. During your initial consultation, you will have the opportunity to convey your eyelid concerns and the outcomes you hope to achieve. You will undergo a comprehensive review of your medical history, including any underlying ophthalmologic conditions, such as dry eyes or glaucoma. Patients who suffer from these conditions may not be eligible for eyelid surgery or may require the need for additional precautions to minimize issues postoperatively. After a thorough examination of your eyelids, their supporting structures, and brows, your surgeon will provide a customized surgical plan to address your eyelid concerns. A successful blepharoplasty treatment relies on each patient maintaining realistic surgical expectations as well as clear doctor-patient communication with our plastic surgeons. Smoking can compromise blepharoplasty results, so Dr. Zemmel and Dr. Dassoulas recommend that all patients are non-smokers or cease smoking well before surgery.

If your surgeon determines you to be a good candidate for blepharoplasty after the initial consultation, they will provide detailed pre-operative instructions in preparation for your surgery.

In some cases, the weight of excess upper eyelid skin and fat causes changes in an individual’s visual fields. In these cases, upper eyelid blepharoplasties may be covered by certain insurance plans. To determine whether you may qualify for insurance coverage, you may be referred to an eye care professional who performs the specific tests necessary to determine the extent to which your eyelids affect your vision.

What Are the Different Types of Eyelid Surgery?

There are three main types of eyelid surgery: upper eyelid, lower eyelid, or double eyelid. Some patients may also choose to combine upper and lower eyelid surgery. The type of surgery selected for your personalized blepharoplasty treatment plan will be based upon your physical exam, your medical history, your cosmetic goals, and any vision impairment you may experience due to sagging eyelids. This decision will be made during your preliminary consultation with Dr. Zemmel or Dr. Dassoulas.

Upper Eyelid Surgery

upperblephUpper eyelid blepharoplasties remove excess loose skin of the upper eyelid. As a result, the overall eyelid tone tightens and wrinkles and fine lines diminish in appearance. During this procedure, an incision is designed that is hidden in one of the eyelid creases. The amount of skin to be excised is measured so that enough excess tissue is removed to achieve a more youthful appearance. Once extra skin and some of the muscle immediately deep to the eyelid skin is removed, some of the pockets of bulging eyelid fat can be thinned or removed. The fat is removed progressively to avoid hollowing out the eyelid area, resulting in an overdone look. The incision is then closed with sutures that are typically removed approximately one week after surgery.

Upper eyelid surgery may be performed to address cosmetic concerns or to elevate eyelids that may sag or droop into the patient’s field of vision. For patients who choose upper eyelid surgery to restore eyesight, the eyelid is lifted to improve functionality and prevent any obstruction. This functional repair will also frequently result in cosmetic benefits and a more youthful overall appearance.

Lower Eyelid Surgery

lowerblephLower eyelid blepharoplasties are intricate procedures that correct a number of age-related deformities of the lower lids. In most cases, an incision is made immediately below the margin of the eyelashes. A flap of skin and muscle is elevated to expose the structure that holds the fat pockets of the lower orbit in place. Frequently, this structure is released to expose the fat pockets. These fat pockets can be used to fill in areas of the cheek that have lost youthful volume, in particular the tear trough areas. Excess fat that is not used is then removed. The skin and muscle flap can be used as a sling that is suspended at the outer corner of the eyelid to correct laxity in the structural support of the eyelid. Occasionally, tightening of the tendon that supports the eyelid is necessary to correct structural laxity.

The sling of skin and muscle not only provides improvement of lower eyelid appearance and tone but conveys a mini cheek lift for an overall more youthful appearance. Any excess skin and muscle is then removed, and the incisions are closed with sutures that fall out by themselves over time.

Double Eyelid Surgery

Double eyelid surgery, sometimes referred to as “Asian blepharoplasty,” is a customized version of upper blepharoplasty designed to create a defined crease or “double eyelid” more commonly seen in women and men of other ethnicities. This procedure can give patients a more alert look with eyes that appear to be opened wider. Excess fat or puffiness can also be addressed with double eyelid surgery. As an added benefit, many patients find that applying eye makeup is easier after this procedure.

What Can I Expect the Day of My Eyelid Procedure?

All eyelid surgeries are performed at either Bon Secours St. Francis Hospital’s Ambulatory Surgical Center or at Henrico Doctor’s Hospital Forest Campus by one of Richmond Aesthetic Surgery’s  experienced plastic surgeons. Blepharoplasty is considered an outpatient procedure, and patients are typically put under deep sedation or general anesthesia. It is not uncommon for blepharoplasties to be performed with other facial rejuvenation procedures. The surgery can take approximately 2 ½ hours to perform upper and lower lid blepharoplasties depending on the procedural goals you discuss during your consultation.

What Will My Recovery from Eyelid Surgery Entail?

Patients should expect some moderate swelling after eyelid surgery, and our plastic surgeons often recommend eye drops to lubricate the eye during this time. To expedite the healing process, you should keep your head elevated as often as possible. A cool compress can also be used to further reduce any swelling. Any post-operative pain can be easily managed with oral medication. Within 2-3 days, most blepharoplasty patients return to their normal daily activities, though some patients prefer to wait about a week before returning to work while their bodies continue to heal. Sutures are typically removed 5-7 days after surgery. After 6-12 weeks, depending on the speed of your body’s natural healing process, you can begin to fully enjoy your new youthful and revitalized appearance. In most cases, after approximately 3 months the incisions are largely imperceptible.

How Much Does Eyelid Surgery Cost?

Since Dr. Zemmel and Dr. Dassoulas customize each eyelid surgery, there is no fixed cost for the procedure. However, the average price of a cosmetic eyelid surgery in the U.S. is $3,026, as noted in the American Society of Plastic Surgeons’ 2017 statistics. Factors that may influence the total price of blepharoplasty include:

  • Type of eyelid surgery
  • Surgical facility fee
  • Anesthesiologist fee
  • Experience of the plastic surgeon
  • Geographic location of the practice
  • Overall complexity of the procedure

At the end of your preliminary consultation, your surgeon can tell you the cost of your custom-tailored eyelid surgery, including any associated fees. Patients who are undergoing upper eyelid surgery to elevate eyelids that are obstructing their vision may have the cost covered by their health insurance provider. In these cases, a referral from a primary care doctor may be needed as well as documentation that the procedure is a medical necessity. These patients may still be responsible for a copay or the amount of their deductible. Regardless of which type of eyelid surgery you need, we offer a number of flexible facial surgery financing options for all patients, which can facilitate low monthly installment plans with little to no interest.

To learn more about blepharoplasty, or to schedule a consultation, please contact us today.

Turn back the hands of time and renew your youthful appearance.

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