Your eyes are the first thing that people notice when they look at your face. Because they also are one of the first areas to age, eyelid surgery is often a very rewarding part of your facial rejuvenation process. An eyelid lift can restore a youthful look, making you look rested, refreshed and awake. Dr. Mandal invites you for a facial consultation to discuss the many ways that blepharoplasty can benefit you.
Best Candidates for Blepharoplasty
- Loose or excess eyelid skin
- Protruding fat bags around the eyes
- Low pre-operative risk factors
- Realistic expectations
- In good health
Aging of the Eyelids
Eyelid fullness can be noted as early as one’s 20’s and 30’s. When present at a young age, it is often due to genetics and consists of bulging fat. As you age into the 40’s and 50’s, the eyelid skin loses it elasticity and becomes lax, crepey and wrinkled. The fibrous tissue that supports the fat compartments inside the orbit(eye socket) also loosens, causing the orbital fat to protrude and appear as bulges or bags around the eyes. “Eye bags” are common in the inner corner of the upper eyelids, the outer corner of the lower eyelids as well as all along the upper and lower eyelids. These changes can give a tired, sad or angry look to the face. The eyes can even appear smaller, slit-like or droopy. Since everyone ages differently, heaviness of the upper eyelid area can sometimes be the result of sagging eyebrows rather than aging of the upper eyelid itself. During your personalized consultation, facial plastic surgeon Dr. Mandal can determine the proper cause of your eyelid fullness and tailor treatment to your specific needs.
Palm Beach Blepharoplasty
Palm Beach eyelid surgery, also known as blepharoplasty, is a surgical procedure in which loose skin, protruding fat and/or muscle is removed from the upper and/or lower eyelids. There are several surgical approaches to eyelid surgery, depending on each person’s unique aging process as well as the amount of fat and/or skin to be removed.
The aesthetic goals of upper eyelid surgery are to reduce lid fullness, make the lid more visible and add depth and definition to the natural upper eyelid sulcus. The incision is well hidden in your natural upper eyelid crease. Excess skin and bulging fat are then removed. The incision is closed with a very fine suture using subcuticular stitches which are taken out in 3 – 5 days. The final result reveals a more youthful, refreshed and rested appearance.
The aesthetic goals of lower eyelid surgery are to smooth out wrinkles, remove excess skin and flatten bulges without hollowing the lower eyelid area. Surgery is performed using various methods, the choice of which depends on the degree of skin and/or fat removed. Unlike an upper eyelid lift, the site of the incision in lower eyelid surgery varies with the patient and, in large part, depends on whether skin is to be removed.
This lower eyelid procedure can reduce excess, lax or wrinkled eyelid skin. It is important to note that pinch blepharoplasty is not intended to completely flatten or tighten the lower lid. It involves excising an ellipse of eyelid skin without entering the deeper muscle layers. Pinch blepharoplasty is a conservative lower eyelid lift in which some, not all, of the laxity and wrinkles of the lid are improved to give modest eyelid tightening. There is less overall disruption to the eyelid tissues, thus reducing the risks of lower eyelid surgery. The results reveal a more modest, natural improvement. Like all cosmetic procedures, patients must have realistic expectations when considering pinch blepharoplasty.
Standard Lower Lid Blepharoplasty
This lower eyelid lift is designed for patients with significantly more loose skin and/or bulging fat of the lower eyelids. Compared to Pinch Blepharoplasty, a standard blepharoplasty incision is longer yet still well hidden just under the lower eyelash line. Skin and underlying muscle are lifted to access bulging fat which is removed. Excess skin and muscle are also excised. The incision is closed with very fine sutures. The stitches are then removed within 3 to 5 days.
This lower eyelid lift is used when there is no loose or excess skin and mainly bulging fat is present. Unlike the skin incisions of pinch and standard blepharoplasty above, the transconjunctival incision is placed inside the eyelid, well hidden within the conjunctiva. Because the incisions are internally placed, there are no sutures to remove and no visible scars. The eyelid muscle’s integrity and overall lid support are also better preserved. Transconjunctival blepharoplasty is not only very safe but allows for fat removal without entering the skin, muscle and fibrous support of the lower eyelid. This procedure can effectively reduce the eyelid “bags” with less tissue disruption, lower risk and faster recovery.
Combined Transconjunctival and Pinch Blepharoplasty
Sometimes, transconjunctival blepharoplasty is combined with a pinch blepharoplasty when excess skin and fatty bags are both present. One must be realistic and expect a mild to modest improvement.
Combined Upper and Lower Lid Blepharoplasty
People often age simultaneously in both their upper and lower eyelids. In such cases, both and upper and lower lid blepharoplasty are performed at the same time.
Sometimes, upper eyelid fullness is mainly due to sagging eyebrows rather than excess skin and fat of the actual eyelid itself. In such cases, a browlift would be the treatment of choice as opposed to an upper eyelid lift.
While blepharoplasty is a very safe procedure, there are pre-operative conditions that may increase the risks of blepharoplasty:
- Frequent or regular dry, irritated or watery eyes
- A loose lower eyelid (not eyelid skin) that does not snap back after being pulled away from the eyeball
- Scleral show (the white area of the eyeball between the lower lid and the pupil edge is more visible than average when looking straight ahead)
- Bulging or protruding eyeballs (proptosis or exopthalmos)
- Unhealthy medical history
While none of these risk factors are absolute contraindications to having blepharoplasty, they should be taken in consideration. A personalized consultation with Dr. Mandal can provide you with a thorough understanding of whether you are a candidate for blepharoplasty and what it can do for you. Dr. Mandal tailors the choice of eyelid and brow procedure to your lifestyle and individual needs. During your facial consultation, she will address your concerns, review your options and discuss realistic expectations. You will also have the opportunity to see before and after photos.
Dr. Mandal believes that technical expertise is one aspect of achieving good results. She gives special attention to aesthetic details to enable a youthful, natural result:
- Placement of incisions in very specific locations to allow them to become unnoticeable once healed from surgery
- Preoperatively marking out of the eyelid incisions with the patient in sitting position to assure removal of only precise amounts of skin reduces chances of a “surprised” look and eyelid closure problems
- Use of very fine sutures with a special suture technique to enable more rapid healing of incisions
- Use of local anesthesia, whenever possible, to reduce recovery and overall risk
- Attention to lateral hooding of the upper eyelid to improve sad or droopy outer eyelids
- Careful removal of only the necessary amount of fat to prevent a hollowed appearance to the eyelid
- Recognizing when a browlift is needed instead of an eyelid lift
- Advising additional procedures for a balanced appearance
Downtime & Recovery
Eyelid surgery is an outpatient procedure. After surgery, patients are discharged to the comfort of their own home. No postsurgical dressings are used. Because the eyelid skin is thin, bruising and swelling are to be expected but are typically minimal at one week, being easily concealed with makeup.
Patients can assist with their healing process by:
- Taking high dose Arnica (Arnica Forte is available through Dr. Mandal’s office)
- Keeping the head elevated
- Applying ice
- Manual lymphatic drainage treatments
- Aggressive use of prescribed saline eye drops and eye ointment
Fortunately, bruising does not correlate with pain as most patients experience minimal discomfort after eyelid surgery. While prescription pain medication is given, most patients switch to either plain Tylenol or stop all pain medications within 1-2 days after the procedure. All sutures are removed between 3 and 5 days postoperatively. Typically, patients feel comfortable being seen in public at one week. Most can also return to nonexertional activities at this time. Straining, lifting and strenuous activity should be avoided for several weeks. Once healed, you can reveal a refreshed, more youthful eyelid contour which can take up to 5-15 years off your face.
Dr. Mandal most commonly performs upper and lower eyelid surgery using local anesthesia. With advances in local anesthetic techniques, the patient is awake during the procedure, but feels no pain. While blepharoplasty can also be performed using general anesthesia or intravenous sedation also known as “twilight sleep”, more aggressive anesthesia is reserved for special situations.
Types of Anesthesia
- Local anesthesia – lowest risk, quickest recovery, shortest operating room time
- Twilight sleep or IV sedation
- General anesthesia
Additional procedures to compliment or enhance the results of blepharoplasty are commonly performed.
- Botox® Cosmetic or Dysport for frown lines between the brows, laugh lines or crows feet around the eyes, wrinkle bunching under the eyes and forehead lines.
- Laser resurfacing or chemical peels for fine lines around the eyes.
- Injectable fillers such as Restylane to fill tear trough hollows under the eyes and improve dark circles.
- Sculptra to fill in the temple depressions to make your eyes appear more awake.
- Brow or forehead lift to improve upper eyelid fullness that is due to sagging eyebrows rather than excess eyelid skin
During your consultation, Dr. Mandal can evaluate your needs and customize the choice of procedures that will best rejuvenate your eyelid area.