How Long Does the Improvement
from Blepharoplasty Last

Everyone has heard about the unlucky patient who undergoes a face lift and experiences a wonderful result only to sag all the way back to his or her starting point within a couple of years. It is only natural, then, to wonder how long the improvement from another sort of lift -- an "eyelid lift" -- should be expected to last.

In contrast to a face lift (in which surgery is directed primarily against the gravitational effects of aging by reinforcing and lifting sagging tissues), not much is truly "lifted" in a so-called "eyelid lift". The term is unintentionally misleading and used only to draw an analogy between the well-known cosmetic operation used on an aging face and the primary cosmetic procedure used on the eyelids. "Blepharoplasty" is the better term.

Blepharoplasty differs from face and body lifts in several important ways:

- Blepharoplasty is directed more against the influence of heredity on the eyelids than against the effects of gravity. The main determinant of eyelid "sagging" and "bulging" is not so much g-forces as it is a loss of tissue elasticity that comes hard-wired into your genes and then expresses itself during the late thirties and early forties. The surgery to restore an eyelid to its normal contour is, therefore, not so much of a losing battle against the immutable laws of Newtonian physics.

- Tissues placed under tension will invariably stretch, a trait that makes many reconstructive operations possible. While a face lift does indeed place tissues under some tension, a well-done blepharoplasty should not. One of the main determinants of "recurrence" is thus avoided.

- Once hereditary deficiencies have been reversed, they show much less of a tendency to re-express themselves than do changes that are determined primarily by gravity (which disappears only in outer space) .

- Eyelid fat does not "grow back," even with weight gain. While it is possible for additional socket fat to eventually work its way forward into the eyelid, it will almost never reaccumulate to the degree that predated the blepharoplasty. Many people, in fact, experience the opposite effect with age-- that is, a gradual loss of fat.

What all of this means is that blepharoplasty yields a longer lasting result than most other cosmetic operations.

The vast majority of patients will undergo blepharoplasty only once. While many articles on cosmetic eyelid surgery quote durations like "ten years" to describe longevity, we know of no data to support such statements.

There is an old saying about plastic surgery: it can turn back the clock, but it can't stop it. So, some of the luster of the original blepharoplasty should be expected to be lost with time. Rarely, however, does the full-blown operation ever need to repeated (unless, of course, the first surgery was undertaken at a very early age). Any sort of later "touch-up" is usually quite conservative.

As the years pass, progressive gravitational-driven deterioration in the facial structures surrounding the eyelids may adversely affect the appearance of the eyelids and mimic a need for another blepharoplasty.

Such changes are more common past the age of sixty.

If the forehead drops significantly, the upper eyelids may once again appear baggy. The proper treatment is generally a forehead lift (in reality, an upper face lift) and not another upper blepharoplasty.

Once the cheek begins to head south, a slight hollowness may appear below the lower eyelids, a change that seems to outline the lower edge of the lid and mimic the return of fat bulging.

The proper restorative operation is not additional fat removal but rather a partial or full lift of the midface (again, another sort of face lift), or a tightening of the eyelid tendons, and/or a repositioning of the eyelid fat.

The lesson, if there is one?

Have your blepharoplasty once the mirror says you're ready and then enjoy it for many years to come.

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