Surgery to rejuvenate the eyelids is known as a blepharoplasty and may be applied to the upper eyelids (upper blepharoplasty), the lower eyelids (lower blepharoplasty) or both upper and lower eyelids. This is, by far, the most common form of facial rejuvenation surgery and is also the form most likely to be performed on male patients.
My Preferred Technique: Upper Blepharoplasty
Of the various surgical procedures for facial rejuvenation, upper blepharoplasty (eyelid tightening) seems to be the easiest for patients to comprehend. People are usually very aware of the excess upper eyelid skin that contributes to their aging appearance, making "eye shadow" application problematic, and frequently interfering with upward peripheral vision. Disappointment, however, may occur if the possible detrimental effect of very low eyebrow position (eyebrow ptosis) is not considered prior to upper blepharoplasty.
The surgical procedure to tighten upper eyelid skin is performed by removing just the correct amount of excess skin, along with any excessive underlying fat (orbital fat), in such a manner that the final sutured incision falls within the crease line of the upper lid:
This effectively produces a refreshed and less "tired" appearance, once healing is complete. Upper blepharoplasty is usually performed under local anesthesia and is not associated with significant post-operative pain.
View video animation of upper eyelid procedure
My Preferred Technique: Lower Blepharoplasty
The lower eyelids, like the upper ones, acquire an aged appearance when the lower eyelid skin begins to sag and, to an extent even greater than with the upper eyelids, when lower eyelid fat (orbital fat) begins to protrude forward, producing the well known "bags" of the lower eyelids. Correction of this aging appearance of the lower eyelids requires elimination of this fat protrusion, as well as some degree of skin tightening.
As was customary for this procedure when I first performed it decades ago, the operation was carried out by working through a single incision just beneath the lower eyelashes. Through this approach, the supporting muscle of the lower eyelid (orbicularis oculi) was also cut and lifted to enable removal of protruding fat, followed by removal of excess skin and suturing the surgical incision closed.
I was frequently disappointed during those initial years by the subsequent slight but permanent downward shift of the lower eyelid level, producing what I viewed as an obvious telltale sign of prior eyelid surgery.
In 1993, several plastic surgeons introduced a new method to remove protruding lower eyelid fat, without the requirement of cutting or injuring the supporting muscle of the lower eyelid (orbicularis). Soon thereafter, I began to use this approach (transconjunctival) for the removal of protruding fat, drastically reducing the occurrence of altered lower eyelid position among my patients.
It is for this reason that my preferred lower eyelid tightening technique today, is to remove the excess fat through an incision on the back surface of the lower lid (transconjunctival), while still removing excess skin, if necessary, on the front surface of the lid, just beneath the eyelashes, but avoiding damage to the supportive orbicularis muscle:
