The eyes are among the most telling facial features, providing others with a focal point during communication. Often referred to as the window to the soul, a person’s eyes move subconsciously in expression and offer vivid insight as to what someone is feeling or thinking, sometimes without obvious verbal expression. It is, in part, because of this movement that the signs of aging begin to appear around the eyes. Crow’s feet, under-eye bags, and extra skin on the eyelids are present in most individuals with maturing skin. To prolong a youthful appearance and display a more energetic look, Renu Artful Medicine offers patients an array of surgical and non-surgical eye rejuvenation procedures. One of the most transformative surgeries is blepharoplasty, commonly called eyelid lift surgery, performed by Dr. Philip Schoenfeld of the Washington, D.C. suburb, Chevy Chase, MD.
Who is a Good Candidate for Blepharoplasty?
Prospective candidates for blepharoplasty at Renu Artful Medicine may display loose, sagging skin of the upper or lower eyelid, unattractive fullness around the eye area, and lines and wrinkles like crow’s feet that could be corrected through surgery. Dr. Schoenfeld typically accepts blepharoplasty patients who meet the following conditions:
- Non-smokers in good health with no medical conditions that could lead to unnecessary risks
- Accepting of the limitations of the procedure, with realistic aesthetic goals
- In good eye health with no serious conditions
In cases of hereditary fullness beneath the eye, or bags, younger people may opt to undergo a corrective blepharoplasty procedure. The same is true for a hooded eye area, as this feature may be present before other signs of aging occur. Blepharoplasty is not necessarily an age-specific procedure and can benefit both men and women.
The Blepharoplasty Procedure
Cosmetic surgery of the eyelids may be performed to address the upper lids (Upper Lid Blepharoplasty), the lower lids (Lower Lid Blepharoplasty), or both for a total eye makeover. In many cases, patients also request that the crinkles at the outer corners of the eyes be smoothed. Prior to the procedure, the doctor may use a medical marker to draw a blueprint that he can refer to during the surgery. This will ensure that all of the patient’s concerns are addressed, and the doctor can employ the best method for each case on an individual basis.
Under local anesthesia combined with intravenous sedation, the doctor creates skillfully hidden incisions to access extra eye tissue, such as muscle, skin, and fat, to permanently excise them from the eye area. If blepharoplasty is performed along with other plastic surgery procedures, the doctor may opt to use general anesthesia for optimal patient comfort. Patients can expect some postoperative bruising of the areas, but they are able to use cosmetics to conceal any discoloration one week after the surgery. Though termed an “eyelid lift,” this is a misnomer as there is no actual lifting performed during this procedure.
Before & After Blepharoplasty Patients:
Upper Lid Blepharoplasty
During upper lid blepharoplasty, the doctor will create an incision in the crease of the eye, approximately 1 cm above the lash line. Working through this incision, the doctor can remove the extra skin that distorts the natural eyelid contour, displaced fat, and sometimes muscle fullness. These changes can correct the hooded appearance or deep-set look of the eyes, as well as puffy upper eyelids. If there is extreme sagging of the upper eyelid, the surgery can also improve obstructed vision and eye comfort. In many aging individuals, the upper eyelid skin can hinder eyesight, and surgical correction offers undistorted sight and more comfortable blinking.
Lower Lid Blepharoplasty
There are more variations possible through lower lid blepharoplasty than with the upper eyelid version of the surgery. Patients undergo lower lid blepharoplasty because of under eye bags, which can be comprised of fat pads, muscle, and skin laxity. The appearance of tired, unhappy eyes can be caused by genetics, age, or years of unprotected environmental exposure. In some cases, the fat pad below the eyes may be removed, but Dr. Schoenfeld has developed a technique that repositions this tissue to prevent the hollow appearance that can sometimes result from total excision. This ensures a natural-looking lower eyelid-cheek complex.
Blepharoplasty may be one of a series of procedures performed to rejuvenate the face. This surgery can be enhanced with procedures performed on the skin, such as Fraxel laser skin resurfacing or chemical peels, to address minimal amounts of skin laxity and lower eyelid texture. Addressing additional signs of aging with dermal fillers can prevent the contrast created when youth is restored to the eyes. Cosmetic injections can restore or create attractive curvature in the cheeks and lips, and fill lines of the face that contribute to an aging appearance.
The Brow Lift (also called a forehead lift) is another procedure that complements blepharoplasty. During the surgery, Dr. Schoenfeld repositions the eyebrows and lifts the skin of the forehead, removing extra tissues to smooth the look of the brow area. Many people associate the eyes and lips with emotive expression, but the forehead and eyebrows are affected, too, and often display the signs of aging.
Dr. Schoen feld literally changed my life.I had consulted with plastic surgeons before, but Dr. Schoenfeld made me feel comfortable right away. Not only did he listen to me and understand that one size doesn’t fit all. He BELIEVED in me - he knew, and made me believe, that I would still be me just better!
I suffered no pain with the recovery. Sure, it was uncomfortable for a few days, but it was never painful. And within two weeks of the surgery I knew that my life would never be the same.
I think the biggest change is one that other people can't see. Do I look better? YES! But also feel better! I now have new energy and a new, more positive attitude and it is apparent to everyone who knows me and everyone I meet.
For the first time in my life I introduce myself to people,smile and talk, without hose old anxieties of what THEY were noticing about me.The surgery has removed a barrier that didn't allow me to be myself. I meet someone new almost every time I go out now, as opposed to hanging with the same old crowd all night long. And I'am dating!
Thanks again for everything Doc! You're the best. I look forward to seeing you on the 15th.
How long does bruising last after blepharoplasty and is there any way to speed recovery?
Dr. Schoenfeld knows his patients are eager to return to their regular schedules after surgery, and he can recommend different things to promote faster healing. The doctor recommends that prior to surgery patients temporarily discontinue the use of vitamins and natural remedies as they can lead to increased bleeding and bruising of the face following blepharoplasty. Before the doctor begins the procedure, he administers epinephrine to prevent blood flow during surgical injections of the eyelid and face, which decreases intraoperative bleeding. Directly following blepharoplasty, Dr. Schoenfeld applies Arnica gel topically to reduce pain and inflammation, and he encourages patients to ice the affected area immediately. Even with these precautions, bruising will likely occur. Photorejuvenation (light laser) treatment can expedite the resolution of bruising postoperatively. Additionally, patients can use makeup to cover the bruising one week after blepharoplasty. Click here to learn more details about recovery and side effects of Eyelid Lift surgery.
Does eyelid surgery treat under eye hollows? If so, does it incorporate fat injection?
Lower eyelid surgery can treat hollowness in the lower eyelids through various methods. The doctor can administer in-office injections of fillers such as Restylane or Juvederm to restore volume to the lower eyelids. Lower blepharoplasty with fat removal and repositioning is another way to treat this aesthetic concern. Lower eyelid surgery results last longer than filler injections to the lower lids, and the results are often more aesthetically pleasing. While fat injections to the lower eyelids can be performed, this method may lead to an uneven texture and irregularities of the area as the under eye skin is very thin.
How do you correct upper eyelids that are not visible?
Excess skin or eyebrow ptosis (lowered brows) may result in the hidden appearance of the upper eyelids. Blepharoplasty can treat extra eyelid skin, while brow lift can adjust the position of the forehead and lift the eyebrows. A thorough physical examination of the eyelids will allow the doctor to determine which surgery is most appropriate for a patient. During the surgical consult, each option can be explored in depth.
Do Blepharoplasty patients experience difficulty closing their eyes following surgery?
The purpose of eyelid surgery is to rejuvenate the eyes so a person may appear more alert and refreshed. The doctor does not alter the shape and overall appearance of the eyes through blepharoplasty, so closing the eyes should not be difficult as the anatomy essentially remains the same and only extra biological materials are snipped away. One potential complication of upper eyelid surgery is the removal of too much skin, which can lead to difficulty closing the eyes. Dr. Schoenfeld is an experienced blepharoplasty surgeon, and he takes time to create proper measurements of the amount of excess upper eyelid skin prior to removal to avoid this potential complication.
What is Transconjunctival Blepharoplasty? Is it superior to regular eyelid surgery?
Transconjunctival eyelid surgery is commonly performed to address bulky tissues of the lower eyelids and some mildly loose skin. During transconjunctival lower lid blepharoplasty, the incision is created on the inside of the lower eyelid. The incision penetrates the conjunctiva (mucus membrane that lines the inner eyelids) and allows the doctor to enter directly into the fat compartments under the skin, avoiding visible incisions. The transconjunctival lower eyelid surgical approach has a much lower incidence of post-operative eyelid malposition than a traditional eyelid surgery.
What is the typical post-op period like after eyelid surgery?
Blepharoplasty patients will feel physically well in less than a week postoperatively, but it could be two weeks before they may be presentable at work. The lower eyelids tend to swell and bruise more so than the upper eyelids, depending on the surgical fixes. If patients feel self-conscious of the visible bruising and swelling of the eye area, they can request two weeks away from their regular schedule to ensure adequate recovery time.
How does a facial plastic surgeon determine whether a patient needs blepharoplasty or a brow lift?
A thorough physical examination by an experienced surgeon can help patients determine which plastic surgery would most benefit their looks. The doctor can explain how upper or lower blepharoplasty would alter the eyes and surrounding skin, and he may use imaging during this process. When a patient lifts his or her brow and still finds a visible amount of excess upper eyelid skin in place, he or she may opt for an upper eyelid lift and brow lift. When performing the same motion, if excess skin of the eyelids disappears and the patient is pleased with the appearance of the face in that position, a brow lift may be the sole requested plastic surgery. Lower blepharoplasty candidates will notice very visible under eye bags that often do not disappear, regardless of how they move their face.
Philip S. Schoenfeld, M.D., F.A.C.S.
Dr. Schoenfeld, the founder and Medical Director of Renu facial plastics of Chevy Chase, MD, is double board certified in Otolaryngology/Head and Neck Surgery and Facial Plastic and Reconstructive Surgery. The doctor has been practicing facial plastic and reconstructive surgery for nearly two decades. An Army veteran, Dr. Schoenfeld completed his residency training at the internationally known Walter Reed Army Medical Center.
Aside from his duties as a cosmetic surgeon, the doctor works with trauma patients, has involvement in philanthropic work, and teaches upcoming practitioners about the art of facial plastics. Schedule a personalized visit with him today by calling 301-652-RENU (7368), or filling out his Patient Contact Form.