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BLEPHAROPLASTY 101

Intro - 4

In a Nutshell:
The 30 Basic Questions
course philosophy Introduction blepharoplasty questions

blepharoplasty in a nutshell

"There's a certain cruelty to being on a big screen as your eyelids start to sag."
-- George Clooney


The contours of the eyelid skin and fat pockets account for a large part of the expressiveness of the face. If the lids begin to sag, droop, or bulge over time, the face can project a look of fatigue and lack of vigor despite adequate rest and good health.

Blepharoplasty is an operation that can reinvigorate an aging face. When the eyes appear bright and alert, the effect of a sagging jaw line or neck becomes less apparent.

On the other hand, classic "textbook" eye lift procedures can sometimes yield the opposite result. If the eyes are left hollowed or tight, the whole face will appear older and unnatural. Today's less destructive techniques restore youthful characteristics by relying less on subtraction and more on restoration.


If you're in a hurry or just casually browsing
, continue reading the questions/answers below for a highly abbreviated but quick overview of blepharoplasty essentials.

If you're more serious about the topic, your time will be better spent inside the course.

Sun damage, smoking, stretching from swelling or obesity, and the wear and tear from blinking and rubbing all contribute to a gradual deterioration in the eyelid's tissues and their support.

By far, however, the most important variable is one's heredity expressed over time.

Since eyelid skin is thinner than that on the rest of the face, the eyes are usually the first facial component to demonstrate a noticeable age-related loss of attractiveness.

A person who is physically and psychologically healthy is ready to consider blepharoplasty whenever the effects of Mother Nature or Father Time bother him or her enough that an improvement is desired.

You won't be able to understand blepharoplasty options without learning at least a little about the eyelid's structure. We provide plenty on that in the full course.

Since blepharoplasty is not a stock procedure, operating times will vary with the extent of changes and scope of the operation.

As a general guideline, performing upper or lower blepharoplasty alone takes about 45-60 minutes, while having them both performed together takes about 90 minutes.

Adding related procedures such as canthopexy or chemical peel will require more time.

Blepharoplasty is routinely performed under local anesthesia with oral sedation. Most patients report little or no memory of the procedure.

Compared to general anesthesia, local anesthesia is associated with less bleeding, increased safety, enhanced precision, and faster recovery.

Compared to a stainless steel scalpel, use of the laser in blepharoplasty has been associated with increased collateral tissue damage, delayed healing, increased scarring, less precision, and higher cost.

Advertised claims of less bruising and a more rapid recovery have not been validated in unbiased studies.

No. The eyelid's internal tissues are too delicate and require direct visualization during blepharoplasty.

Since the anatomy and health of the eyelids and surrounding face varies person to person, every operation must be custom tailored to fit the needs of the individual. That's what the course is all about.

The majority of patients report mild aching or burning, which is usually well controlled with Tylenol and cold compresses.

Most patients experience moderate discoloration that is gone within about ten days.

Swelling peaks on the morning after surgery. While it mostly resolves over the next two weeks, a small amount may persist for several months or more.

Not compared to most other facial operations.

While most normal tasks can be resumed within two days, too much activity during the first week will increase swelling.

Most people prefer to lay low for several weeks. Strenuous activities should be avoided for two weeks or more.

In upper eyelid surgery, the incision is hidden in the crease.

In lower eyelid surgery, the incision is placed along the back surface of the eyelid and/or just below the lashes.

Puffy eyelids look just as bad on a man as they do on a woman.

In today's competitive and youth-oriented world of business, both men and women have come to appreciate that while they may be well-qualified, they also post their resumes on their faces.

Surgery to create or enhance an eyelid crease is so different in intent and execution from standard blepharoplasty that it is best considered a unique operation and not grouped with "blepharoplasty.".

There are several common anatomic features that often require more consideration when planning surgery. Typical patient concerns relate to scar visibility and the possibility of forming keloids.

No. Most semicircular rims of depression are the result of a relative deficiency of bone along the upper cheek with secondary sagging of the cheek's fat pockets and muscles.

Since the indentation (often called a "tear trough") is not caused by an eyelid or orbital deficit, blepharoplasty is not corrective. Injection with a commercial filler is the most common treatment.

Eyelid hollowness is not the same thing as cheek hollowness, a tear trough, or dark circles, all of which are much more common conditions (see the previous question).

If the lids themselves have become hollowed due to insufficient fat volume following overdone blepharoplasty or aging changes, they can sometimes be reinflated by grafting fat into the socket around the eye.

No, although there are several timing considerations.

Yes, but not drastically. Conservatism is key. Some procedures are better than others.

No. The two operations are not interchangeable.

For that, you'll need to access the full course.

A nice outcome requires thoughtful analysis, informed planning, and skilled execution.

A realistic expectation is that most patients will achieve about a 75-90% improvement after upper lid surgery and a 60-80% improvement after lower lid surgery. Some slight asymmetry is the rule rather than the exception.

Requested crease shapes and heights can be approximated but not guaranteed.

Compared to procedures designed primarily to fight the effects of gravity (face lift, brow lift, etc.), blepharoplasty lasts a very long time.

In the majority of patients, cosmetic eyelid surgery is performed only once.

Trying to predict your outcome by viewing photos is of limited value unless you happen to look exactly like the people shown.

Our before-and-after blepharoplasty photo section features many patients of very different ages and with a wide range of starting points.

Such techniques are more a matter of maintenance than restoration, and their potential to offer real improvement is limited.

No. Cosmetic surgery is no different than any other profession in which the training, interests, aptitude, and dedication of its practitioners will vary widely. Consider, for example, just one of many such variables: the wide range in levels of experience.

According to the American Society of Plastic Surgeons 2010 statistics, there were more than 23,000 physicians likely to perform cosmetic plastic and reconstructive surgery procedures. In 2010, there were just over 240,000 blepharoplasty operations performed.

Thus, the average general cosmetic surgeon performed less than one such surgery a month, a far cry from the number typically performed by a specialist whose practice is devoted fully to the eyelids.

No. There are just over 500 physicians in the United States who are fellowship trained in the advanced subspecialty of ophthalmic plastic and reconstructive surgery (also known as oculoplastic surgery). Essentially all are Board-Certified ophthalmologists.

To learn more about the differences between plastic and oculoplastic surgeons, refer to the full course.

If you are shopping price, be aware that some offices quote only the surgeon's fee by telephone, excluding such extras as operating room, anesthesia charges, etc.

While cost is obviously important, the quality of your care and outcome are most crucial. Pricing is discussed in detail in the course.

Surgery undertaken with the primary intention of improving the cosmetic appearance of the eyelids is not covered by medical insurance.

On the other hand, surgery undertaken with the primary intention of improving on the function of the eyelids and/or relieving significant vision interference is covered by most medical insurance policies even though there is almost always a secondary improvement in appearance that comes along for the ride.

Distinguishing "cosmetic" from "functional" blepharoplasty can be tricky.

Next: Today's Best Blepharoplasty


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