Blepharoplasty | Eyelid Surgery

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

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.

Lower Eyelid Surgery

Lower Eyelid Surgery xroplasty 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. 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. Lower Eyelid Surgery may include a cheek lift, fat grafting, repositioning of fat or the addition of injectables or fillers to the midface.

The Upper Blepharoplasty Eyelid Surgery Procedure

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. 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. Men have a different aesthetic preference so less upper eyelid skin is removed. Patients with pre-existing dry eye will also 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-op care includes keeping your head elevated, resting, using ice packs, and lubricant drops.

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.

Blepharoplasty / Ptosis Surgery

Ptosis is when your upper eyelid droops and begins to cover part or all of your pupil (dark part of the eye) limiting your vision. The levator muscle in your upper eyelid opens the upper eyelid failure of the levator muscle to keep the upper eyelid open is called ptosis. Ptosis can be congenital in children who develop eyelid droop at a young age, 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 most commonly associated with aging occur from the levator stretching and/or separating from the eyelid margin making it difficult keeping your eyelid open and limiting vision. 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 to keep your eyelids open to see. 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. The degree of ptosis can be determined by a visual field test and in severe ptosis, insurance may cover the procedure. Eyelid surgery for ptosis may be performed under local with IV sedation or general anesthesia. The most common ptosis repair is a tarsolevator repair that reattaches the levator to the eyelid margin or shortens the levator aponeuroses allowing for improved muscle function. The ptosis repair can be done in conjunction with Blepharoplasty 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.


Kind words from our patients

I was very pleased with the outcome of the procedure. Office is very inviting and both doctor and staff very pleasant.

Read More

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 making it prone to irritation. The most common causes of lower eyelid malposition include scarring from trauma, previous surgery or a lower eyelid tumor causing the lower eyelid to shorten and expose the eye causing dry eye and irritation. The orbicularis muscle functions to close the eyelid and scar tissue in the lower eyelid including the muscle can result in lower eyelid muscle dysfunction with difficulty closing the eyelid. Blinking or repeatedly closing your eyelid is normal and helps your eyelids to evenly distribute tears across the surface of your eye keeping it moist.

Symptoms of eyelid malposition include watery eyes, dry eyes, irritation, and sensitivity to light. Watery eyes can be a sign of lower eyelid malposition with your eyes producing excess tears and instead of normally draining the tears with blinking the tears pool and drain over the side of the eyelid. Dry eyes cause a dry, gritty or sandy feeling over the eye. Burning and redness of your eyes caused by irritation from dry eyes or excessive tears may occur. Finally, you may be sensitive to light with your dry or irritated eyes. Artificial tears or lubricating ointments may provide temporary relief from these symptoms.

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 to hold the lower eyelid in a normal position and possibly a spacer graft to release any scar tissue in the lower eyelid. Blepharoplasty may include to cheek lift to recruit additional tissue in cases of severe scarring.

Blepharoplasty can be performed as an outpatient under local anesthesia with IV sedation or general anesthesia. Revisional Blepharoplasty will take longer to heal then 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.


What causes droopy upper eyelids?

What are typical symptoms?

How can droopy upper eyelids be corrected?

How long does the procedure take?