Addressing Drooping and Puffiness

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 eye bag issues, you are also more likely to.

How the Eyes Age

The skin around the eyes changes over time as the dermal structure loses elasticity and takes 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 makes eyelid skin more prone to stretching and sagging. The natural movement of the eyelids can also lead to some fine lines around the eyes, accentuating 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 also become more prominent over time. The excess eyelid fat also retains water, so bags often appear puffier in the morning or when your sleep patterns are inconsistent.

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What is Eyelid Surgery?

Cosmetic eyelid surgery, also known as blepharoplasty or an eyelid lift, involves the removal of fat and excess skin to reduce the appearance of bags, pouches, and wrinkles. Doing so can produce a more open and awake appearance, a primary benefit of eyelid surgery. In addition, if the 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 the upper and lower eyelids to remove excess skin, dispositioned muscle, or fatty tissue to create a smoother, more youthful frame for the eyes.

Both procedures utilize incisions 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. An eyelid lift is a successful procedure that dramatically refreshes the entire face even when performed alone. Dr. Maas also combines upper and lower blepharoplasty with a brow lift or a facelift to further enhance the results of those procedures. At your initial consultation, Dr. Maas will discuss all your aging concerns and aesthetic goals to develop a treatment plan for you.

Upper Eyelid Surgery Before & After

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Eyelid Surgery Options

There are three different ways Dr. Maas can perform eyelid surgery at The Maas Clinic™ in San Francisco:

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 simultaneously to restore the natural eyelid crease and make it easier for patients to apply makeup to the lid.

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, typically a combination of skin laxity, small fat deposits, and water retention. Lower blepharoplasty eliminates 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 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 your procedure's safety and success. 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 and lower blepharoplasties have you performed as the surgeon in charge or the primary surgeon in the past year?
  • 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 rare in blepharoplasty, any surgeon who has done enough facial procedures to be considered an expert will 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 who 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 procedures with your consultation surgeon as their primary surgeon.)

As you review your questions with the surgeon at your consultation, consider how your inquiries are answered. Does the doctor spend sufficient time explaining so you feel comfortable with the responses? Working with a surgeon you can talk to easily is essential, which will put you at ease throughout the surgical process.

Lower Eyelid Surgery Before & After

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Eyelid Surgery Overview

Blepharoplasty can be performed on an outpatient basis, using either local anesthesia with sedation or general anesthesia. Local anesthesia tends to reduce risks during and after surgery and makes for a quicker recovery process. However, suppose you are combining your eyelid surgery with other procedures like a facelift. In that case, Dr. Maas will likely recommend general anesthesia to ensure you are comfortably asleep throughout your operation. 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 who has performed blepharoplasty for many years, he has perfected his techniques to create a positive aesthetic outcome 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 to require an external incision when performing this operation. Dr. Maas selectively removes small fat pockets in the lid during the procedure to create a smoother line beneath the eye. He rarely excises skin from the lower lid. If tightening is necessary, he can often achieve optimal results using a skin resurfacing procedure rather than surgical excision to create a smoother appearance without additional incisions.

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.

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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 the "dryness curve" to ensure your comfort after your procedure. His experience has shown that patients who 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 common dryness 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 can usually return to normal activities within a week or less after eyelid surgery if they carefully follow all their post-operative instructions. By then, swelling and bruising should be minimal and easily concealed under makeup. Protecting your eyes from sunlight during the recovery period is essential to prevent irritation or damage to the delicate skin around the eyes as they heal.

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Refreshing Your Appearance in San Francisco

Eyelid surgery is a relatively quick, comfortable process that offers dramatic results in refreshing your appearance. Corey S. Maas, MD, and the staff at The Maas Clinic™ in San Francisco look forward to answering any questions you might have about blepharoplasty surgery. To schedule an appointment with us today, contact us today.

Corey S. Maas, MD, reviewed the information about blepharoplasty. If you have any questions, please don't hesitate to contact us using our contact form below.

Eyelid Surgery FAQ

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

Can I Shower and Wash My Hair the Day After Eyelid Surgery?

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

Does This Procedure Take Care of Dark Circles Under the Eyes?

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

Yes, there are, and each has its 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, using neuromodulators like Botox, and using 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 could be better 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. Using a filler underneath the eyebrow can create some volume and lift in the right kind of patient, which translates into less redundancy of the skin of the upper eyelid.

Can I Shower and Wash My Hair the Day After Eyelid Surgery?

We recommend that our patients take a sponge bath and not shower on the same day after their surgery, but the day after, returning to your regular routine would be all right. It is most important to wash the face gently with a good antibacterial 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?

Patients must have their surgeon evaluate their brow position and eyelid skin redundancy before deciding on the proper procedure. Generally, 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. At the same time, a brow lift performed with Dr. Maas's endoscopic technique also takes around an hour but involves 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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