Meronk Blepharoplasty
Los Angeles, Ventura, Southern California

• Two-thirds of adults consider their eyes to be their defining facial feature. Judge for yourself:

• 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. More

• 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. More

(Please note that Dr. Meronk limits his practice to healthy adults between the ages of 18 and 60.)

• You won't be able to understand blepharoplasty options without learning at least a little about the eyelid's structure. Review the essentials in this video narrated by Dr. Meronk.

1. Be sure your computer's sound in turned on.
2. Click the II button in the bottom left corner of the movie controller bar.
3. Once the > arrow appears, click it to begin.

More videos are available here.

• 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.

Learn more about anesthesia for eyelid surgery.

• No. 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. More

• 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. For an overview of general principles, see

	Upper Blepharoplasty Technique
	Lower Blepharoplasty Technique
	Operations Photographed Step-by-Step

• 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.

Two Days After Upper Blepharoplasty

Five Days After

One Week After

Three Weeks After

Three Months After

• Not compared to most other facial operations.

To review sample instructions after surgery, see Blepharoplasty Care.

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

Strenuous activities should be avoided for two weeks or more.

Most people prefer to lay low for several weeks.

• In upper blepharoplasty, the incision is hidden in the crease.

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

While full thinning and fading of any scar on the body can take a long time, keloids on the eyelids are rare.

	One month
	Two months
	Six months
	One year

• 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.

See Cosmetic Eye Surgery for Men.

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

See African American Eyelid Surgery.

• 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. More (To view an example of true lower eyelid hollowness, see the next question.)

• 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.

To learn more about orbital fat grafting for upper or lower eyelid hollowness and how it differs from injection of fat or commercial fillers, see The Hollowed Eyelid.

• No, although there are several timing considerations.

See LASIK and Cosmetic Eye Surgery.

• Yes, but not drastically. Conservatism is key.

See Dry Eyes and Eyelid Surgery.

• For an overview of blepharoplasty risks and complications, see The Good, The Bad, The Ugly.

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

To learn more, see Achieving Natural Results with Blepharoplasty (a collection of video discussions).

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

With Asian double eyelid surgery, requested crease shapes and heights can be approximated but not guaranteed.

More

• 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.

More

• 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.

See Minimally Invasive Techniques for Eyelid Rejuvenation.

• 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 2007 statistics, there were more than 23,000 physicians likely to perform cosmetic plastic and reconstructive surgery procedures. In 2007, 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. Dr. Meronk is one of the less than 500 Board-Certified ophthalmologists in the United States who are fellowship trained in the advanced subspecialty of ophthalmic plastic and reconstructive surgery (also known as oculoplastic surgery).

To learn more about the differences between general and oculoplastic surgeons, see A True Eyelid Specialist.

• 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.

To learn more about blepharoplasty costs, see Fees.