The Expert Guide to Blepharoplasty Techniques

The eyes are the windows to the soul, and most of us want those windows to be wide open. But as we age, the muscles around our eyelids gradually weaken, and we tend to accumulate excess skin and fat around the upper and lower lids. This can cause the eyes to look smaller, the browline to sag, and the development of under-eye “bags” that make us look perpetually tired. The aging process of the eyelids presents not only cosmetic problems, but functional ones as well. Peripheral vision can become impaired if the upper eyelid becomes too heavy and drooping, making it harder to drive safely and perform other daily activities. Fortunately, blepharoplasty can restore the eyelids to a more lifted and youthful position, while helping to correct any sight limitations.

What is blepharoplasty?

Blepharoplasty is a surgical procedure that removes or reforms excess fat and aging skin from around the eyelids to widen the resting gaze and generally give the whole face a younger, more alert appearance. Especially popular in Asia, the aesthetic goal of many blepharoplasties is to give the upper eyelid a “double-lidded” appearance by defining the crease between the skin covering the actual eye and the skin underneath the eyebrow. 

Blepharoplasty can be done on the upper eyelid, the lower eyelid, or both. It is an outpatient procedure that can often be performed with local anesthetic and IV sedation, and is well-tolerated by most patients. If blepharoplasty is done to help correct a documented vision problem, a portion of the procedure may be covered by insurance, with the remainder to be paid out-of-pocket for additional cosmetic alterations made at the same time. Blepharoplasty is commonly done in conjunction with other rejuvenating cosmetic procedures, such as a face or brow lift. If this is the case, general anesthesia will be used for the duration of the procedure. Blepharoplasty is one of the most common anti-aging plastic surgeries, and has become more and more sought-after in recent years due to its relative affordability, functional advantages, and beautiful results. 

What are common blepharoplasty techniques?

There are many different blepharoplasty techniques, and it is vital to find a surgeon familiar with all of them so that your individual needs can be met using a customized approach. This is a very delicate area of the face that should only be worked on by an expert, and results should look natural and tailored to the client’s ethnicity and gender identity. 

Pinch Blepharoplasty Technique

Pinch technique blepharoplasty can be a great solution for relatively young patients without much excess upper eyelid volume, or patients who have already had a blepharoplasty, but need a bit of a refresher for under-eye sagging that has developed since. In a pinch blepharoplasty, the surgeon makes an incision just below the lower lash line, at the outer corner of the eye, so that any scarring will be concealed in the natural crease that forms in that area. The surgeon then pinches the skin underneath the lower eyelid, removing any excess tissue that is causing sagging or bags to form under the eyes.

Suture Blepharoplasty Technique

In our practice, we do a lot of suture blepharoplasty revisions, because in the early years of blepharoplasty, inexperienced surgeons were too aggressive with upper lid fat resectioning, which often had the effect of causing brow tissue to migrate downward in order to compensate — sometimes leaving the patient looking older than they did to begin with. Initial attempts to correct this problem by lifting the brow line often resulted in dry eye symptoms, but the latest innovations in upper-lid suturing techniques are much more targeted, conservative, and lasting. We cannot stress enough the importance of finding a surgeon who has been trained in the most current techniques if you are considering a suture or “classic” blepharoplasty focused only on the upper lid, or a revision of a former procedure..

Anchor Blepharoplasty Technique

Anchor blepharoplasty is a popular type of blepharoplasty that is often used to fix a previous suture procedure where upper eyelid drooping has once again become apparent, or caused the eyes to appear uneven. In an anchor blepharoplasty, an incision is made above the eye, and is “anchored” to the cartilage just below the lower eyelid, rather than to the levator muscle above it. By anchoring the sutures to unmoving cartilage, as opposed to a dynamic eyelid muscle, results tend to be more symmetrical and stable.

5 Point Blepharoplasty Technique

5 point blepharoplasty is an excellent option for patients with a tear trough deformity — meaning a concave under-eye area that casts a fatigued-looking shadow over the face. In the early days of blepharoplasty, there were lots of complications after lower-lid surgeries. But nowadays, a 5 point blepharoplasty offers a safer and more effective alternative that often requires no invasive incisions or fat removal at all.  In a 5 point blepharoplasty, fat injections are first done underneath the eye, and certain muscles and ligaments around the eye are then manipulated before sutures are installed to lift the upper eye. The procedure thus has the effect of tightening and lifting the entire periorbital area. 

Loeb’s Blepharoplasty Technique

Like 5 point blepharoplasty, Loeb’s blepharoplasty technique addresses under-eye depressions that come with aging, but is a bit more invasive. Instead of injecting fat under the eye, an incision is made in the corner nearest the bridge of the nose, and the natural fat pads underneath are grafted or lifted higher up before being stitched back together, plumping up any sunken areas beneath the lower lid. 

What are common upper lid eye lift techniques?

Common upper lid eye lift techniques are suture blepharoplasty and anchor blepharoplasty, though 5 point blepharoplasty also addresses the upper eyelid area. 

What are common lower lid eye lift techniques?

Common lower lid eye lift techniques are pinch blepharoplasty, Loeb’s blepharoplasty, and 5 point blepharoplasty. 

What are the newest blepharoplasty techniques?

The most current trends in blepharoplasty tend to emphasize minimally-invasive techniques involving fat transfer or supplementation rather than simply making incisions to remove existing tissue. Whenever possible, we want to reposition or volumize the patient’s natural facial anatomy rather than making reductions to it, but it is all very case-dependent. A surgeon trained in the latest techniques is in a better position to combine any number of them if necessary for the most favorable results. 

What blepharoplasty techniques should I avoid?

There is no particular “wrong” way to do a blepharoplasty, and any mixture of techniques may be utilized to give the patient the results they are seeking. Every plastic surgeon has their own specialized set of skills and methodological preferences, so the choice of your practitioner is much more important than your choice of a specific technique. In your initial consultation with your surgeon, you should always feel free to ask about their methods and their rate of complications, and be sure to look at their before-and-after photos from previous blepharoplasties so you can decide if you like the outcome on comparable patients. 

What is periorbital rejuvenation?

Periorbital rejuvenation refers to any cosmetic surgery or application addressing the area of the face between the upper cheekbone and the brow. This is an especially important area for clients seeking to give the face a much younger and livelier appearance. Eighty percent of all person-to-person interactions involve direct eye contact, and the condition and position of the periorbital area can make a real difference in terms of the way we are perceived by others. Subconsciously, we look at a person’s eyes and draw conclusions about their age, energy level, and interest and engagement in what we are saying. The upper third of the face, and the periorbital area more specifically, tends to show signs of aging more rapidly and readily, and a blepharoplasty can help open up the eyes and make them look more expressive and youthful. 

Is swelling normal after blepharoplasty?

Yes. You should expect some swelling and bruising after blepharoplasty, and possibly some itching around the affected site as well. You may also feel that your eyelids are “tight,” or stretched, but all of these symptoms should resolve fairly quickly. Swelling generally subsides in one to two weeks, and using cold compresses and keeping the head elevated can help to reduce it. You may need to apply topical medications to aid in the recovery process, and should keep your face out of direct sunlight while the thin skin around the eye heals, or wear dark sunglasses if you need to go outside. Avoid smoking, non-steroidal anti inflammatory medications, and blood thinners before and after surgery. As always, follow your doctor’s orders for aftercare closely and carefully, and if you are experiencing severe pain or swelling that seems beyond the scope of what is normal, never hesitate to call your surgeon’s office. 

What are the healing stages after blepharoplasty?

The healing timeline after blepharoplasty depends on which type of surgery you have done. Although this is a minimally-invasive procedure that is well-tolerated by most patients, you should still expect to take some time off work, or from your regularly-scheduled activities. Initial healing after an upper eyelid blepharoplasty takes about 7-10 days, while lower lid procedures usually take about 10-14 days. 

You may experience some itching around your eyes, but try not to rub them, and use ice packs if needed to dull the sensation instead. Any non-dissolvable stitches will need to be removed about a week after the procedure. For the first month after surgery, avoid strenuous exercise or weight-bearing activities. And while prescribed ointments may temporarily blur your vision, blepharoplasty itself should not have any negative impact on your ability to see clearly, so you may feel free to work from home on a computer as soon as you feel up to it. Be sure to keep all follow-up appointments with your surgeon to ensure proper healing.

When should I contact my doctor after blepharoplasty?

Contact your doctor after blepharoplasty if you experience chest pain, shortness of breath, or an irregular heart rate following the procedure, as these may be signs of an adverse reaction to anesthesia or sedation medications. Also contact your surgeon if you are experiencing severe pain, bleeding, or changes in vision. Soreness after the surgery is to be expected for the first couple of days, but severe pain should always be reported to your doctor. 

Why would I need blepharoplasty revision surgery?

Blepharoplasty revision surgery is not at all uncommon — we do many of them here at our practice in Beverly Hills and Sacramento. Sometimes we do them because the results of the first surgery were suboptimal or unsatisfactory, but we also do many revisions on this particular surgery simply because the skin around the eyes continues to age, and patients find that after a while, they need to have the procedure repeated in order to maintain their desired look. 

Do I need a blepharoplasty plastic surgeon near me?

Patients should expect to travel to an expert blepharoplasty plastic surgeon. Because there are only a handful of expert plastic surgeons in the country, patients should expect to travel to a location like Beverly Hills for their procedure.

Have questions?
Email Dr. Sykes at hello@sykesplasticsurgery.com

About Dr. Jonathan Sykes

Dr. Jonathan Sykes is a world-famous expert plastic surgeon who performs all cosmetic and functional plastic surgery procedures on the face and neck. He is a past president of The American Academy of Facial Plastic and Reconstructive Surgery, and served on their Board of Directors for over 10 years. He is also a Professor Emeritus in Facial Plastic Surgery from UC Davis Medical Center, and the former Director of Facial Plastic Surgery at that institution. He is known as the expert’s expert, and is often called to consult and advise other plastic surgeons in both Northern California and Beverly Hills. He has a special interest in eyelid and browlift surgery, facial rejuvenation surgery, including facelifts and rhinoplasty.