The types of blepharoplasty
Eyelid surgery covers several distinct operations. This sets out what each one does, the incisions involved and which anatomy each suits.
Blepharoplasty is a family of operations rather than a single one. They share a region and very little else, and which applies to you is determined by anatomy.
Upper blepharoplasty
Removes excess skin and, where required, fat from the upper lid. The incision follows the natural crease, so the scar sits within the fold and is not visible with the eye open.
It restores the visible lid, improves symmetry between the two sides, and where the fold had encroached on the visual field it improves that too.
Lower blepharoplasty
Addresses the bulge below the eye by removing or repositioning the herniated fat pads, and tightening skin where there is redundancy. There are two routes to it.
Transcutaneous The incision runs below the lash line. It allows both skin and fat to be addressed, which is what is needed where there is genuine skin excess. It demands precision, because the lower lid is unforgiving of over- resection and the consequence is a change in lid position.
Transconjunctival The incision is inside the lid, so there is no external scar. It allows fat to be removed or repositioned but not skin to be excised, which makes it the approach for younger patients with prominent fat pads and little skin excess.
Double eyelid surgery
Creates a defined upper lid crease where there is not one, making the lid margin more visible and the eye appear more open.
Two techniques: incisional, which removes skin and fat and produces a permanent crease; and suture or non-incisional, which creates a fold without excision and is less permanent.
Blepharoplasty in Asian eyelid anatomy
A specific application of crease surgery in which the aim is a crease consistent with the patient’s own anatomy rather than the imposition of a different one. The technical point is that the anatomy of the upper lid differs, and the operation is planned around that.
Revision blepharoplasty
Corrects the outcome of previous eyelid surgery — asymmetry, over-resection of skin, or under-correction. It is technically harder than a primary operation because the tissue planes have been altered and, where skin has been removed, there may be little to work with.
Laser blepharoplasty
Uses a laser rather than a blade to make the incisions, which reduces bleeding during surgery and may reduce swelling afterwards. It is a difference in instrument rather than in operation, and it does not change what can be achieved.
Non-surgical treatment
Plasma treatment, radiofrequency tightening and fillers improve mild laxity and restore volume. The effects are temporary and they do not remove skin. Where the problem is a redundant fold, these are not alternatives to surgery.
Choosing
The decision follows from age and skin elasticity, from what specifically is producing the appearance you want changed, and from whether there is a functional element. The consultation should cover what you want, your medical history, and any previous procedure to the same area.
Recovery in general
Swelling, bruising and mild discomfort, managed with cold compresses, elevation and prescribed medication. Most patients resume normal activity within one to two weeks. Non-surgical treatments have little or no downtime.
The procedure this relates to
Surgery to the upper eyelid, the lower eyelid or both, removing or repositioning skin, fat and muscle. It is done to soften the changes that come with age, and where drooping upper lids obstruct the field of vision.
Before you act on this
Everything here is general. What applies to you depends on your anatomy, your history and what you are trying to achieve, and none of that can be assessed from a page. If a question here is yours, bring it to a consultation.