Blepharoplasty, also known as upper or lower eyelid surgery, helps patients who have puffy, droopy eyelids or deep, bulging bags under the eyes by removing the excess fat, skin, and tissue. Eyelid surgery can help patients who appear tired from sagging eyelids or sad from under eye bags, a common problem in adults over 35 years old in America. Plastic surgeon Dr. Robert J. Paresi Jr., MD helps patients regain a youthful, alert appearance with eyelid surgery, sometimes called an eyelid tuck. For some patients, having the excess skin from the upper eyelids can help some patients improve their field of vision in addition to their overall refreshed appearance.
Eyelid surgery has evolved over the last ten years to include augmentation techniques to add volume and improve skin texture in the periorbital area. This is often called "augmentation blepharoplasty". This often involves the use of the patient's own fat cells to add volume to the areas around the eyes. The fat is usually harvested from the area around the belly button and processed into 'microfat' and 'nanofat'. The microfat is harvested using special instrumentation and processing techniques that results in fat particles that are less than 1 mm in size. The fat is then used to add volume to the periorbital area. In the upper eyelids, it is often the brow area that has lost volume through the aging process. This results in skeletonized, hollow upper eyelids that benefit from the additional volume of microfat grafting. This in combination with skin removal from the upper eyelids will result in a more youthful appearance.
Aging of the lower eyelids is a result of a combination of factors. This can result in crepey skin (wrinkles), lower eyelid bags (excess fat pads), or volume loss (dark circles). Treatment of the lower eyelids often involves a combination of techniques that will treat the different causes of the aging. Wrinkling of the lower eyelid skin with excess skin can often be addressed with raising of a skin flap and skin removal. The incision used for the removal is placed in the subciliary location (under the lashes) and is well hidden and inconspicuous. Bulging of the lower eyelids is often a result of redundant fat pads in the periorbital area. A transconjunctival approach (incision inside the eyelid) can be used for removal of the excess fat with no external incision. The bulging of the lower eyelids can also be a result of volume loss of the cheek area resulting in more prominent lower eyelids. In these cases, the patient's own fat (microfat) is used to augment the upper cheeks and lower eyelids to replace the lost volume resulting in less prominent lower eyelid fat pads.
Dark circles of the lower eyelids are often a result of multiple issues including: skin wrinkles at the inner aspect of the of the lower eyelid, skin pigmentation, loss of volume in the inner aspect of the lower eyelid resulting in the 'tear trough deformity', bulging fat pads resulting in a shadow below the bulges, and/or loss of volume of the cheeks resulting in a more prominent tear trough area. A customized treatment plan which addresses the underlying causes of the dark circles can result in excellent improvements. Nanofat, or homogenized microfat, is often used for injection into the dark circles (tear trough deformity) and results in improvement of skin texture and correction of pigmentation of the area. Nanofat contains growth factors that have been shown in studies to increase skin thickness resulting in less visible tear troughs.
Eyelid Procedure Reviews
"Top-notch! - I had a lower blepharoplasty and fat transfer in February 2021. I could not be happier with the results and with my decision in choosing Dr. Paresi. From calling to schedule the consultation, to the follow up appointments, everything has been top notch. Dr. Paresi and his staff take the time to explain every detail about the procedure, recovery time, what to expect and even the cost. There..."- P. / RealSelf / Apr 06, 2021
"Top-notch! - I had a lower blepharoplasty and fat transfer in February 2021. I could not be happier with the results and with my decision in choosing Dr. Paresi. From calling to schedule the consultation, to the follow up appointments, everything has been top notch. Dr. Paresi and his staff take the time to explain every detail about the procedure, recovery time, what to expect and even the cost. There were no “hidden” fees, or surprises. During the procedure, I was under local anesthesia. Dr. Paresi and his staff demonstrated superb bedside manner. He explained the procedure throughly as he was working and kept any anxiety I might have had at a zero. My results reflect a skilled doctor. I could not be more pleased."- P. / RealSelf / Apr 21, 2021
"The past few years I felt older than I wanted to. Stress, gravity/aging and pandemic, so I decided to research upper eyelid surgery. I felt quite anxious about getting work done on my eyes. Kim, Regina, Susan, Dr Paresi and other surgery staff are a great team. Communication is thorough and each step well organized. I felt welcomed and that I was in caring, knowledgeable hands. Dr Paresi is ‘down to earth’ and very skilled - an artist at his work. My eyes look great 5 weeks after the procedure, more even in size, brighter and I feel 10 years younger. I did not need much medication except some Tylenol for a couple of days. I also appreciate that Dr. Paresi and staff contribute to others in need."- N.D. / Google / Mar 18, 2022
"My experience at Inside Look has been extremely positive. Starting from the office staff are very professional and welcoming. I was impressed by the initial consultation. My sister and I wanted to get the information on upper and lower eyelid surgery. Dr. Paresi was clear on what to expect. The day of the surgery, the nurse and Dr. Paresi made me feel at ease and during the recovery I was comfortable with the follow-up provided.It has been a month since the surgery and the results are what were expected. I am happy that I went through with the surgery and selected Dr. Paresi."- S.P. / Google / Mar 19, 2019
"Dr Paresi was highly recommended to me by a friend. He worked on my upper and lower eyes and I am delighted with the results. Dr. Paresi never pushed me and made me feel comfortable at all times. Everything about my experience exceeded my expectations. The office staff are friendly and scheduling was easy. "- S. / Healthgrades / Dec 15, 2022
Upper Eyelid Surgery
During upper eyelid surgery, an incision is made within the natural fold of the lid and extended outward. The incision will go out as wide as possible so that additional skin folds on the outside of the upper eye can also be addressed. Once the incision is made, excess skin, tissue and, in some cases, a small portion of the orbicularis occuli muscle are removed. The incision is closed with absorbable sutures and the scar remains almost completely hidden because of where it resides in the natural crease.
Lower Eyelid Surgery
During lower eyelid surgery, an incision is made along the bottom of the lash line. This allows the surgeon to remove excess fat and tissue. In patients who have puffy lower eyelids but good skin tone, an approach known as a transconjunctival blepharoplasty can be performed. This technique puts the incision inside the lower eyelid rather than outside. Patients who have dark circles under their eyes will sometimes have a deficiency of fat in these areas. Injectables can be used to help fill these soft-tissue deficiencies and can improve the appearance of these circles.
Eyelid surgery is performed under general anesthesia as an outpatient procedure in an accredited surgical facility. It generally takes up to 2 hours for both the upper and lower eyelids to be addressed. Following surgery, the area around the eyes will be bruised and swollen. Patients should apply ice packs, keep their heads elevated, and apply medicated eye ointment for a few days. Patients comment on the fact that friends and family tell them they look great, but often can’t put a finger on what is different. These subtle, yet dramatic results restore a softer, more youthful appearance.
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Eyelid Surgery FAQs
After surgery, scarring will not be visible because of where the incisions are placed. In the upper eyelid, the incision follows the natural crease of the eye. The lower eyelid incision will run just under the eyelashes or inside the eyelid. Scarring will be inconspicuous.
Eyelid surgery will reduce puffy bags and excess skin and may help contribute to some minimization of crow’s feet. However, to truly treat crow’s feet, one will need a different approach. BOTOX® injections and procedures such as a browlift, are better options to help eliminate crow’s feet.
Irritation After Surgery?
Some patients will experience dryness and minimal irritation following surgery. If these occur, we can recommend ointments and eye drops to assist during the healing phase. Patients should protect their eyes against wind and sun irritation for the first several months by wearing dark sunglasses.
If anything, eyelid surgery actually helps improve the vision for many patients. Not only does it restore a fresh, younger look from a cosmetic standpoint, it eliminates the excess skin that may have been impairing vision. It is important to select a skilled surgeon who has expertise with eyelid surgery. We take great care during this surgery so that the eyes themselves are left untouched and unharmed.