Surgical and Nonsurgical Eyelid Options

 Some say the eyes are the windows to the soul. Extra care should be taken to preserve the full function and maybe help dress up the windows with eyelid surgery. In this day of numerous technological advances, there are several options to “dress up” the eyelids. 

Traditionally upper eyelid surgery usually entails removing skin and sometimes some fat medially. Traditionally lower eyelid (eye bags) surgery entails removing fat and sometimes some skin. These remain the best options in the right candidates.

There are now other options to treat upper and lower eyelids problems cosmetically to yield good results depending upon the physical findings and desires of the patient. Some surgeons feel that removing excess skin for upper eyelids (hooding effect) is treating the result of aging and not the underlying cause. One option may involve re-inflating the loss of volume in the face resulting in raising the eyebrows and pulling up the excess upper eyelid skin. Another option may involve using energy devices to tighten upper eyelid skin resulting in a lifting effect. It may be combined with an eyebrow lift or energy devices to contract the forehead skin to help correct drooping eyebrows.

There are also other options for lower eyelid surgery besides the traditional surgical removal of fat which sometimes results in a “hollowed” appearance due to loss of fat and giving a more bony orbital look. Other options may involve chemical peels, energy devices to contract the skin of the lower eyelid resulting in tightening of the skin and improvement in the “eye bags”. Placing fat around the eyes may be another option for periorbital rejuvenation.

These procedures aim to improve droopy upper eyelids and puffy bags below the eyes, features that may make you look older and more tired than you feel. Sometimes to obtain the best result may require a combination of different approaches. Rejuvenating your eyes will help rejuvenate your overall facial appearance. Almost all eyelid surgeries can be done as an outpatient.

Who is a Candidate for eyelid surgery?

  • Patients who are in reasonably good health
  • Patients that have reasonable and realistic expectations
  • Patients that have excess saggy skin (droopy eyelids), loose saggy skin with excess fat (eye bags) 
  • Patients that have wrinkled sun-damaged eyelid skin
  • Patients who have excess upper eyelid skin that interferes with vision

Who is not a Good Candidate for an eyelid lift?

  • Patients who are not in reasonably good health with serious or poorly controlled health problems
  • Patients who do not have reasonable and realistic expectations
  • Patients who want absolute perfection 
  • Patients who smoke
  • Patients who have serious eye problems

General Description of eyelid surgery:

  • Eyelid and periorbital surgery are almost always done as an outpatient.
  • Anesthesia is usually done with local anesthesia alone or conscious sedation. Initial discomfort is usually mild and controlled with oral medication.
  • Either a scalpel or scalpel-like device is used for skin incisions or energy-based devices with no incisions are available.
  • The traditional eyelid incisions are made in the natural upper lid skin crease (upper eyelids) or in either inside the lower eyelid or just below the lower eyelash line (lower eyelids). 
  • Excess skin or fat (or both if necessary) are removed.
  • Excessive “laxity” of the lower eyelid may require a tightening procedure (canthopexy) which can be done at the same time.

How much does eyelid surgery cost?

  • The fee for eyelid surgery depends on the type of procedure performed, type of anesthesia if performed in an outpatient surgery center or in the surgeon’s office. The nonsurgical procedures may start as low as a few hundred dollars, upper eyelid surgery as low as 1200 dollars, or traditional outpatient surgical facility procedure to around $2500. For an accurate estimate, it is necessary to have a consultation with the surgeon.

What Alternatives are there Traditional Eyelid Surgery?

  • Nonsurgical energy-based devices such as radiofrequency (RF) or CO2 laser devices
  • Chemical peels
  • Neuromodulators and/or fillers
  • Forehead lift
  • Fat transfer
  • Eyelid surgery is never necessary except when interfering with vision

What is the recovery like?

  • PAIN: Discomfort is usually controlled with oral analgesics.
  • HOME CARE: You will be discharged home to the care of a responsible adult in most cases.
  • ACTIVITIES: Plan to rest in bed immediately after treatment. Later in the day, short walks such as to the bathroom are good. Resume light daily activities usually within a day or two. Most traditional surgical eyelid surgeries may require you to miss work only a day or two, but usually no more than a week. Nonsurgical eyelid procedures usually require minimal to no downtime. Resume exercise gradually as recommended by your surgeon.
  • WOUND CARE AND DRAINAGE: Some blood-tinged drainage may be expected for usually less than 24 hours if a surgical procedure. Wound care depends upon the type of treatment but usually only requires topical skincare. Bruising and possibly sensitivity to light usually subside within a week or two.
  • FOLLOW-UP APPOINTMENT: Usually within a few days after your procedure. 

Notes

As with all surgical procedures, there are inherent risks. The specific risks and suitability of this procedure for a given individual can only be fully determined at the time of consultation with your cosmetic surgeon. All surgical procedures have some degree of complications. Most are minor and temporary and rarely affect the overall cosmetic results, occur occasionally such as swelling, bruising, minor lumps and bumps, and skin numbness. Major complications are uncommon but include significant cosmetic irregularities such as extensive lumps and bumps, poor contouring, indentations, scarring, skin necrosis, discoloration of the skin, infections, bleeding, or hematomas. Some major complications can take months to resolve or improve, or maybe permanent and should be discussed with your surgeon prior to the proposed procedure.