Blepharoplasty | Eyelid Surgery

DiFrancesco Plastic Surgery performs upper and lower blepharoplasty procedures for patients who wish to give their eyelids a more youthful appearance.

Dr. DiFrancesco will perform a comprehensive exam and discuss your treatment options during your consultation. Blepharoplasty can be performed under local anesthesia with light sedation or general anesthesia as outpatient surgery.

What is Eyelid Surgery?

Blepharoplasty, or eyelid surgery, is performed on the upper and or lower eyelids to refresh and rejuvenate, creating a more youthful you! Eyelid surgery improves the appearance of the eyelid by removing or repositioning fat, excess skin, or muscle. This will refine and rejuvenate your upper and lower eyelids. Dr. DiFrancesco is a board-certified Plastic Surgeon and fellowship trained in oculoplastic surgery. Dr. DiFrancesco has published several papers on eyelid surgery including her latest chapter on fat grafting and complication of the periorbital region. Dr. DiFrancesco specializes in both primary blepharoplasty and secondary or revisional blepharoplasty procedures.

Upper Eyelid Surgery

Upper eyelid surgery will correct droopy eyelids caused by the skin from your brow or upper eyelid hanging over your eyelashes, or by a condition known as ptosis. Early signs of ptosis include difficulty with peripheral vision, especially at night. Blepharoplasty with the removal of excess skin and fat or fat grafting alone or combined with a browlift can dramatically improve your vision and give you a refreshed and youthful appearance.

The Upper Blepharoplasty Eyelid Surgery Procedure

The upper eyelid incision is placed in the natural upper eyelid crease to avoid a visible scar. Dr. DiFrancesco will determine how much excess skin and fat to remove to give you a youthful and natural look. Patients with pre-existing dry eye will have less skin resection to prevent the dry eye from becoming worse. A browlift procedure such as a direct browlift, medial brow lift, temporal browlift, coronal browlift or endoscopic browlift may be performed at the same time as your blepharoplasty. A ptosis procedure is would be completed as this point to repair the levator aponeurosis. Finally, sutures are used to close the skin followed by antibiotic ointment dressing. Post-operative care includes keeping your head elevated, resting, using ice packs, and lubricant drops.

Lower Eyelid Surgery

Lower eyelid surgery is performed to improve the contour of your lower eyelid. Primary blepharoplasty most commonly addresses common signs of periorbital aging. The lower eyelid is part of the midface complex which includes the cheeks, and the nasolabial fold. Lower eyelid surgery may include a cheek lift, fat grafting, repositioning of fat or the addition of injectables or fillers to the midface.

If you are experiencing one or more of the following you could be a candidate for lower eyelid blepharoplasty: tired, puffy eyes, dark circles, wrinkled skin, drooping tissues, tear trough, and loss of volume or midface descent creating worsening nasolabial folds. 

The Lower Blepharoplasty Eyelid Surgery Procedure

There are several options available for your lower eyelid blepharoplasty depending on the underlying bony structure, tissue descent, muscle thickness, and soft tissue atrophy.

A transconjunctival blepharoplasty makes an incision on the inside of the eyelid to avoid a visible scar. Transconjunctival eyelid surgery is most commonly used in patients with puffy eyes to remove fat in the power eyelid with no skin excess and no mild mid face aging.

A transcutaneous blepharoplasty uses an incision just under the eyelashes and along the smile lines. A transcutaneous approach to lower eyelid surgery can be used to perform a cheek lift, place a fat graft in the tear trough or remove extra skin. Dr. DiFrancesco will use this approach for lateral canthal anchoring such as a canthopexy or canthoplasty needed to correct lower eyelid laxity seen with advanced aging.  Transcutaneous eyelid surgery is also used when secondary or revisional blepharoplasty is needed to correct asymmetry or a complication from trauma or previous eyelid surgery.

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Ptosis Surgery

Ptosis is when your upper eyelid droops and begins to cover part or all of your pupil (dark part of the eye), thus limiting your vision. Ptosis can be congenital in children, neurogenic from nerve damage, myogenic from muscle damage such as myasthenia gravis, or mechanical. Mechanical ptosis occurs with age, after an eye injury, as a side effect of surgery such as LASIK or cataract surgery or rarely associated with a tumor.

Ptosis, when associated with aging, most commonly occurs from the levator muscle stretching and/or separating from the eyelid margin. Patients will often recruit the frontalis muscle in your forehead to help keep the upper eyelids open. This can cause unwanted horizontal wrinkles in your forehead from prolonged contraction of your frontalis muscle. Use of Botox to correct the horizontal forehead wrinkles may make your droopy eyelid worse. Most people experience worsening symptoms after remaining awake for long periods, allowing your muscles to get tired and upper eyelid to droop.

Ptosis surgery often includes a blepharoplasty, depending on the degree of ptosis, which can be determined by a visual field test. In severe ptosis, insurance may cover the procedure. Eyelid surgery for ptosis may be performed under local with IV sedation or general anesthesia. The ptosis repair can be done in conjunction with blepharoplasty by removing the extra skin and fat present in the upper eyelid. There is minimal pain and downtime after surgery with some bruising and swelling of the eyelids. Each person heals differently so allow 4 to 6 weeks for full recovery. Most patients experience improvement in their vision immediately upon resolution of the swelling.

Ectropion or Lower Eyelid Malposition

Lower eyelid malposition occurs when the eyelid is pulled down away from the eye or the eyelid is turned outward, exposing the inner surface of the eyelid and making it prone to irritation. The most common causes of lower eyelid malposition include scarring from trauma, previous surgery, or a lower eyelid tumor. 

Symptoms of eyelid malposition include watery eyes, dry eyes, irritation, and sensitivity to light. 

The first step in determining treatment for your eyelid malposition is diagnosis the problem. Treatment depends on the cause of your eyelid malposition. Typically, treatment involves revisional blepharoplasty or lower eyelid surgery with canthal anchoring for lower eyelid support. This may include to cheek lift to recruit additional tissue in cases of severe scarring.

This procedure can be performed as an outpatient under local anesthesia with IV sedation or general anesthesia. Revisional blepharoplasty will take longer to heal than primary blepharoplasty with prolonged swelling. In total, expect 4 to 6 weeks of downtime and 6 months before you see your final results in revisional blepharoplasty.

Schedule a Consultation

To rejuvenate your appearance, contact Dr. DiFrancesco today for a consultation. To make an appointment, call our Atlanta office or fill out an online form. 

Frequently Asked Questions

What causes droopy upper eyelids?

The medical term for the condition is eyelid ptosis, and it is most often the result of normal aging. However, it can also be caused by a congenital abnormality or due to nerve injury. Upper eyelids droop because of weakness or stretching of the muscle responsible for opening the eyelid, excess upper eyelid skin, or nerve damage to the eyelid muscles.

What are typical symptoms?

Symptoms associated with ptosis that occurs with aging are often seen in both eyes and result in drooping of the eyelid and excessive tearing. In some people, the drooping causes vision impairment by interfering with peripheral vision, especially impacting night vision.

How long does the procedure take?

It’s usually done as an outpatient and involves one to two hours of surgery. There is some swelling and bruising of the eyelids afterwards but usually only a week or so of downtime. In some cases, if the drooping eyelids have interfered with vision, the surgery may be covered by insurance.