The eyes reflect our emotions and can make us look happy, sad or angry. However, when you begin to appear tired, sad or worried even when you are not, you may have to blame the aging process rather than your emotions. Changes to the delicate skin around the eye area lead to significant drooping above the eye, even as early as our 30s. You might also see changes beneath the eye, as loose skin in this area can lead to puffiness that exacerbates your weary appearance. The lower lids are subject to numerous factors besides aging, including heredity. So, if your parents had issues with eye bags, you are more likely to as well.

How the Eyes Age

The skin around the eyes changes over time as the dermal structure begins to lose elasticity and take on a loose and sagging appearance. Eyelid skin is thinner than any other skin on the body, with relatively little subcutaneous fat underneath. While the limited fat allows for free movement of the lid in closing and blinking the eye, it also leads to eyelid skin that is more prone to stretching and sagging. The natural movement of the eyelids can also lead to some fine lines around the eyes, which serves to accentuate the aging process.

The natural passage of time is not the only factor that can affect the delicate tissue around the eyes. Other contributing forces include:

  • Genetics
  • Insufficient sleep
  • Sun exposure
  • Habitual squinting
  • Allergies
  • Other medical conditions like thyroid and renal disorders

All these influences can lead to the weakening of the muscles around the eyes, which then leads to loss of elasticity and loose skin. Tiny fat pockets above and below the eyes become more prominent over time as well. The excess eyelid fat also retains water, which is why bags often appear puffier in the morning or when your sleep patterns are inconsistent.

What is Eyelid Surgery?

Cosmetic surgery of the eyelids, also known as blepharoplasty, involves the removal of fat and excess skin to reduce the appearance of bags, pouches and wrinkles. In doing so, we can produce a more open and awake appearance, which is a primary benefit of eyelid surgery. In addition, if hooding of the upper lid is obstructing vision, the lid can be lifted to restore the line of sight. Cosmetic blepharoplasty can be performed on both the upper and lower eyelids to remove excess skin, dispositioned muscle or fatty tissue to create a smoother, more youthful frame to the eyes.

Both procedures utilize incisions that are made in the natural skin folds of the eyelids, making them virtually unnoticeable after healing. Dr. Maas minimizes healing time with his careful surgical techniques, which he performs right in his office as an outpatient procedure. 

Eyelid surgery is a successful procedure that offers dramatic refreshment of the entire face when performed alone. Dr. Maas also combines upper and lower blepharoplasty with a brow lift or a facelift to enhance the results of those procedures further. At your initial consultation, Dr. Maas will discuss all your aging concerns and your aesthetic goals to develop a treatment plan for you.

Options in Eyelid Surgery

There are three different ways Dr. Maas can perform eyelid surgery:

Upper Blepharoplasty

When the skin of the upper eyelids hangs over the eyes, producing a hooded appearance, your entire appearance can look less youthful, and your vision range can even be limited. During an upper blepharoplasty, excess skin is removed from the top lid to create a smoother contour over the eye. Hooding is eliminated at the same time to restore the natural eyelid crease and make it easier for patients to apply makeup to the lid if they choose.

Lower Blepharoplasty

When the skin becomes loose underneath the eye, sagging can also occur. In some individuals, the sagging can be severe enough to reveal the white of the eye underneath the iris. Another problem with the lower lid can be puffiness, which is typically a combination of skin laxity, small fat deposits and water retention. Lower blepharoplasty eliminates both sagging and puffiness by removing excess skin and creating a firmer lower lid contour.

Combination Blepharoplasty

Many patients will benefit from upper and lower blepharoplasty at the same time. Treating both lids does not add significant time, risk or recovery to the procedure overall and patients achieve all their aesthetic goals with just one time under anesthesia and one recovery process. Dr. Maas will advise you as to whether a combination blepharoplasty is the right approach for you.

Choosing a Surgeon for Your Eyelid Surgery

Your choice of plastic surgeon for your blepharoplasty will make a difference in both the safety and success of your procedure. Dr. Maas recommends asking the following questions during your consultation with any surgeon:

  • How many blepharoplasty surgeries have you performed in the past month as the surgeon in charge or the primary surgeon?
  • How many upper blepharoplasties and lower blepharoplasties have you performed in the past year as the surgeon in charge or the primary surgeon?
  • Do you have board-certification from the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery? (Both these organizations are reputable in the plastic surgery industry due to their intense requirements for certification.)
  • Have you ever experienced complications with a patient after blepharoplasty surgery? (If the surgeon responds no, you should question that answer. While significant complications are quite rare in blepharoplasty, any surgeon having done enough facial procedures to be considered an expert with have experienced at least a few difficulties and these should be discussed openly at your consultation.)
  • What is the worst complication you have experienced during or after blepharoplasty and how did you manage this complication?
  • Can I speak with some of your former blepharoplasty patients that have had the procedure in the last month or two? (These individuals can provide a firsthand account of their experience and let you know whether their expectations for the operation were adequately met.)
  • Can I see before and after photos of some of your patients? (Make sure the pictures are of patients who underwent their procedures with your consultation surgeon as their primary surgeon.)
  • As you go through your questions with the surgeon at your consultation, pay attention to how your inquiries are answered. Does the doctor spend sufficient time explaining, so you feel comfortable with the responses? It is also essential to work with a surgeon that you can talk to easily and that will put you at ease throughout the surgical process.

    The specific overview of your surgery will depend on the type of procedure you choose:

    Upper Blepharoplasty

    During an upper blepharoplasty, Dr. Maas will make incisions along the natural creases of the upper lid, using a combination of a micro cautery dissector and scalpel. While some plastic surgeons are now offering eyelid surgery via laser, Dr. Maas believes that the scalpel approach does not increase bleeding during your operation and gives him the precision necessary to produce the best possible result for you. As a surgeon that has performed blepharoplasty for many years, he has perfected his techniques to create a positive aesthetic result with minimal downtime and almost no visible scarring afterward.

    Through the incisions, Dr. Maas removes the excess skin to expose the underlying muscle. A small strip of the exposed muscle is also removed to create a deeper eyelid crease. When the muscle has been eliminated, the fat pads are revealed so he can also carefully remove excess fat deposits. Once corrections have been made, the incisions are closed with fine sutures that are either absorbable or will be removed in his office within three to five days.

    Lower Blepharoplasty

    Dr. Maas primarily uses the transconjunctival technique for his lower blepharoplasty procedures, which involves the creation of an incision inside the lid, so there is no visible scarring afterward. With advances in this method, Dr. Maas finds little reason ever to require an external incision when performing this operation. During the procedure, Dr. Maas will selectively remove small fat pockets in the lid to create a smoother line beneath the eye. He almost never excises skin from the lower lid – if tightening is needed, he can often achieve optimal results using a skin resurfacing procedure rather than surgical excision to create a smoother appearance without additional incisions required.

    Blepharoplasty procedures can usually be completed in about one hour. After surgery, you will be monitored by our staff for a couple of hours before you are released to recover in the comfort of your own home.

    What Happens After Eyelid Surgery?
    Some swelling and bruising will occur immediately after surgery with minimal discomfort. Dr. Maas will focus on helping you stay ahead of what he calls the “dryness curve” to ensure your comfort after your procedure. His experience has shown that patients that maintain moisture in the eyes during the healing process tend to have a quicker and more comfortable recovery. He provides both ointments and drops to be used as directed, encouraging patients to use the products as often as possible to combat the dryness that is common after surgery. In addition, he advised patients to restrict their time staring at a computer screen or television during the early days of recovery, since these activities can also contribute to excess dryness. Icing and elevation during the first few days are also recommended to manage swelling and increase your comfort level.

    Patients are usually able to return to normal activities within a week or less after eyelid surgery if they follow all their post-operative instructions carefully. By that time, swelling and bruising should be minimal and easily concealed under makeup. It is essential to protect your eyes from sunlight during the recovery period as well, to prevent irritation or damage to the delicate skin around the eyes as they heal.

    Refreshing the Appearance

    Eyelid surgery is a relatively quick, comfortable process that offers dramatic results in terms of refreshing your appearance. Corey S. Maas MDTM and the staff at The Maas ClinicTM look forward to answering any potential questions you might have about blepharoplasty surgery in San Francisco. To schedule an appointment with us today, give our office a call at (415) 567-7000 or contact us by email.

    The information about rhinoplasty was reviewed by Corey S. Maas MDTM. If you have any questions, please don’t hesitate to contact us using our contact form below.


    Are There Non-Surgical Alternatives To Eyelid Surgery or Blepharoplasty for Saggy or Droopy Upper Eyelids?

    Yes there are, and each has its own unique benefits and downsides. The most important thing would be to come in for a consultation so Dr. Maas can help you identify the option that will work best for you, and help you understand what each can realistically achieve.

    For upper eyelids, the three main options are skin resurfacing, the use of neuromodulators like Botox, and the use of fillers.

    Skin resurfacing is used to selectively injure the skin to stimulate the creation of new collagen, remodeling existing collagen, and forming new skin cells or regrowth over the skin surface. Some tightening can be achieved with skin resurfacing, but it is far from perfect if there’s a lot of excess skin to be addressed.

    Botox, Dysport and Xeomin can be injected around the orbicularis oculi muscle that pulls the eyebrow down, creating some hooding in the eyelid. By relaxing this muscle, a degree of brow elevation can be achieved that can pull the eyelids up somewhat.

    The use of a filler just underneath the eyebrow can create some volume and lift as well in the right kind of patient, which translates into a little less redundancy of the skin of the upper eyelid.


    Can I take a shower and wash my hair the day after eyelid surgery?

    We strongly recommend that our patients take a sponge bath and not shower on the same day after their surgery, but the day after it would be alright to return to your normal routine. It is mostly important to very gently wash the face with a good anti-bacterial soap the day after surgery, not get shampoo or conditioner in your eyes, and not spend too long under the water.

    Blepharoplasty (Eyelid Surgery) or a Brow Lift - Which is Best for Sagging Eyelids?

    Every patient needs to have their surgeon evaluate their brow position and their eyelid skin redundancy before deciding on the right procedure for their needs. In general terms, most people concerned about saggy eyelids would benefit from blepharoplasty, and patients in their 40s, 50s and beyond would benefit most from a combination of the procedures.

    Eyelid surgery is a relatively simple outpatient procedure with very little recovery time, while a brow lift performed with Dr. Maas’ endoscopic technique also takes around an hour, but involves a little more bruising and swelling and a week of recovery.

    Does this procedure take care of dark circles under the eyes?

    No. Dark circles are mainly caused by chronic edema, which this procedure does not address. Some patients confuse dark circles with the shadows created by deep eye bags, which will see some improvements after blepharoplasty.

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