Eyelid surgery, or blepharoplasty, is a common procedure used to improve the appearance and function of both the upper and lower eyelids. Excess skin, muscle and fat can either be removed or reshaped to achieve a more energetic, less tired and more youthful look. Functional problems, such as visual impairment from drooping upper eyelids, may also be addressed.

The Best Candidates for Eyelid Surgery

The best candidates for eyelid surgery are patients who have a clear impression of their desired goal. The goal of a good blepharoplasty should be refinement and improvement while seeking to avoid an “overdone” or “over-corrected” look. Dr. Granzow uses a precise and conservative approach to both the upper and lower eyelids to maximize the chances of an excellent result and minimize the chances for an overdone appearance.

What to Look For in a Good Blepharoplasty

A good blepharoplasty seeks to improve the appearance of energy and vitality in a patient’s eyes and spirit. The removal of some wrinkles is important, but the ablation, or complete removal of every last wrinkle and shadow, can well be counterproductive, as the character of the eyes and expression may no longer be in harmony or fit with the rest of the face or the body’s appearance. Especially important is seeking to avoid an oversculpted or “hollowed out” look, which are telltale signs of eyelid surgery.

Telltale signs of eyelid surgery include:

  • No wrinkles or creases in upper and/or lower eyelids in an individual who has multiple wrinkles or creases in the face or hands otherwise.
  • A hollowed or “scooped out” appearance of the upper and lower eyelids, making the entire orbit or region around the eye appear hollow and actually more aged.
  • An over-tightened or over-pulled lower or even upper eyelid, which may result in a “cat’s eye” appearance.
  • Excess removal of skin or fat. This can result in inability to close the eye or excess showing of the sclera (whites of the eye).
  • Many so-called “minimally invasive” facelifting techniques may unnaturally alter the shape and appearance of the eyes.

The human eye and brain is naturally programmed to recognize even the slightest changes in the eyelids. Therefore, eyelid surgery can be very tricky because even small changes in eyelid position or appearance are easily spotted by even a causal observer.

So What About a Brow Lift?

Sometimes the excess and baggy skin in the upper eyelids is due to hanging or low-set eyebrows rather than problems with the upper eyelids themselves. The effects of age, gravity and sun damage may cause the skin and musculature of the forehead and eyebrows to sag. This excess tissue then results in sagging or creased upper eyelid skin and musculature, which can cause a tired and wrinkled look and may even impair vision.

During your consultation, Dr. Granzow will carefully evaluate both the position of the eyebrows and the eyelids to specifically review your situation. The eyebrows may commonly be addressed at the same time as the eyelids to achieve an optimal result.

Just as with the eyelids, caution must be exercised with the eyebrows to avoid an over-repositioning or “surprised” look, which may often be seen in women who have had one or more procedures by overzealous surgeons seeking to achieve just too much.

The Surgery

Upper eyelids:
Upper eyelid surgery often may be performed safely even in an office setting, but this will depend on the comfort of the patient and the amount of work that is required. Removal of skin or skin and muscle and small amounts of fat can also be accomplished under simple local anesthesia safely and comfortably. Larger procedures or procedures that involve a brow lift will require IV sedation or general anesthesia performed in a surgery center or hospital setting.

Before your surgery, Dr. Granzow will carefully mark out the limits of the skin, muscle and fat in the upper eyelids. He will then use these marks during the procedure to carefully sculpt and shape the result. An incision is made precisely through the skin and fine electrocautery is used to ensure minimal bleeding and swelling. Careful attention is paid to addressing each layer, including skin, muscle and fat, and to carefully shaping and sculpting each layer. Fine absorbable sutures may be placed, usually underneath the skin surface, and an additional fine sliding suture can be threaded under the skin which is easily slid out approximately 5-7 days after the procedure in the office.

Fine dressings, called Steri-Strips, may also be used to protect the skin edges for the first several days after the procedure.

Lower eyelids:
Procedures for lower eyelids may also be performed under local anesthesia in the office, but more commonly require intravenous sedation or general anesthesia in a surgery center or hospital setting. Removal of external creases can be accomplished through fine incisions which can be hidden in specific eyelid creases and folds. In this way, external rejuvenation of the droopy skin and even muscle may be accomplished.

However, more in-depth procedures may also be performed. In patients with excellent skin tone but who have excess fat or baggy lower eyelids, for example, incisions may be performed through the inside of the eyelid. This allows the scar to be hidden inside the eyelid to produce “scarless surgery” with no outside visible scars.

Most internal sutures are self-dissolving with time, although tightening of the lower eyelid may require very fine permanent sutures to improve the position and laxity of a lower eyelid in specific cases.

The Recovery

Recovery from eyelid surgery is usually relatively painless. Recovery from upper and lower eyelid surgery may be as little as several days, and most swelling and bruising should be gone by one to two weeks. Fair-skinned patients may have bruising present for longer periods of time although this is uncommon. Patients may return to normal activity such as a desk job or other non-strenuous activities in as little as several days but may need to wait one or more weeks to resume heavy physical activity or working out to keep the swelling down.

Risks of the Procedure

Blepharoplasty is a commonly performed procedure and is typically quite safe. However, common risks do exist and are similar for all physicians and centers which perform the procedure. These include bleeding, infection, pain, damaged nerves and vessels, dry eye, difficulty with the eye opening or closure, scarring and unhappiness with the final appearance or outcome. Change or loss of vision have been reported in the medical literature but these problems are even more remote.

Your Consultation

During your consultation, Dr. Granzow will review the specifics and details about your individual case. Be sure to bring a list of medications you are taking and other medical treatments you have received. Also be sure to tell the doctor about any contact lenses or corrective glasses you may require and any problems or complaints of eye allergies, irritations, infections, especially dryness. Dr. Granzow encourages questions, so please write them down ahead of time so that they are not forgotten during the interview.