Drooping upper eyelids and sagging lower eyelid skin with puffy under eye bags can give the appearance of looking tired, sad or even angry. Upper and lower eyelid surgery is used to remove and reposition the excess skin and fat that contributes to this appearance to create a more refreshed and youthful look.
Case Study 001
40-year-old woman who complains of redundant upper lid skin and heavy feeling to eyes.
Premarked just before surgery: Lids were marked holding brows in normal position as is typical for patients with upper lid skin to try and raise brows to get skin off lids.
Marking of skin to be removed:
Immediate post op photo:
Three weeks after surgery: Not lifting brows, very happy with appearance. Had no bruising at all:
Typical skin incision, slightly red and raised, will over next three months as body remodels scar to become flat, thin white invisible scar. Can wear makeup at this stage:
Case Study 003
43-year-old woman with mild dermatochalasis wanting cosmetic upper lid blepharoplasty. Note that patient also had mild upper lid retraction, 0D> OS and has mild hooding-mostly concerned about “crepe-like looking upper skin. Wanted very consenlative blepharoplasty as she did not want her children to notice too much of a difference.
Immediate postop photos with stitches in place:
Postoperative photos at two weeks. Still has some swelling. Patient has upper lid retraction so that right eye upper lid is higher and thus hard to see lid platform or crease.
Post operative photos after blepharoplasty at 16 months . Right eyelid still higher than left so that lid crease not seen but crepe- like skin is gone and patient can wear makeup and feels much happier with appearance.
Scar at 18 months on upper lids:
Case Study 004
45-year-old Hispanic man complaining of lower lid fat bags that he feels are deforming to his appearance. Also has upper lid fullness and patient elected to have upper lids done as well but did not want an excess of skin taken so a very conservation upper lid blepharo- plasty was done.
Post operative appearance at one month out. Still has mild swelling that is normal for two months after surgery. Sleeps on right side so right side more swollen.
Two months out, has mild pink eye which was reason for visit, lids healing well. Note bulge right under lower lid lashes is normal as that is the normal muscle, the orbiticularis that surrounds the eye allowing forceful lid closure and is normal. However swelling has continued to go down and patient is happy with conservative upper lid blepharoplasty.
Case Study 005
44-year-old white woman who complains of heavy lids, feels she looks older than age and her eyes look smaller than normal. Cannot wear makeup as before and works occasionally on TV so appearance is very important. Three weeks post op, patient doing very well. No bruising with some mild upper lid swelling. Good lid crease and platform. Can wear makeup at this stage.
Three weeks post op, patient doing very well. No bruising with some mild upper lid swelling. Good lid crease and platform. Can wear makeup at this stage.
Case Study 006
47-year-old Hispanic woman needing upper lid removal of redundant skin plus removal of fat from lower lids.
Two months after surgery still has some upper lid swelling but is very happy with results.
Important note: In patients that are heavy – and this patient just recently had a lap band procedure as she is about 80 pounds overweight – it is important not to resect too much fat as patients can look hollowed around the eyes when the weight is lost. This is especially true with resecting upper eyelid fat rather than lower lids. This patient lost about 20 pounds when the second photo was taken and she is now developing loose skin around the eyes. Our plan though is to wait until she loses all her weight before doing any more resection of skin. Her brows are also heavy due to fat there. Sometimes a little resection of brow fat in women tends to help make a more attractive brow shape, but again because of her need for weight loss I only did a little resection there. Patient is very happy with results.
Case Study 007
53-year-old man with lower lid bags and redundant upper lid skin. Unhappy with appearance, feels he looks much older than his age.
Has very prominent lower lid fat bags and fatty upper lids as well. Patient is normal weight. Appearance of eyes he stated runs in his family.
One month post op after subconjunctival blepharoplasty lower lids and upper lid blepharoplasty. Notice patient is so pleased with appearance he has had his eye- brows professionally done.
Case Study 008
53-year-old woman with Dermatochalasis both upper and lower lids with prominent lateral hooding of upper lids . Has no fat in lower lids but is unhappy with crin- kling of skin under lids. She has some fat in her upper lids as well with fullness centrally and some mild fullness medially too.
Six weeks after upper blepharoplasty with lower lid skin removal as well for wrinkling of lower lids.
Case Study 009
59-year-old white woman with lower lid fat protrusion. Not interested in having upper lids done yet. Very concerned about lower lid appearance. Having the patient look up rolls the fat pads forward and allows for better identification of fat pads. She has prominent medial, central and lateral fat pads
Immediate post-op appearance after surgery with betadaine still on face and mild oozing from eye as incision is within the lower lid through the cul-de-sac of the lower lid. This is a typical sub-conjunctival blepharoplasty incision and surgery which leaves no skin scar as all the sutures are inside the lid and are dissolvable so there is not suture remomal needed. Swelling of lower lids is mostly due to the injection of li- docaine to numb the area and dissipates within a few hours.
Post operative photo six weeks out. Very happy with outcome. This patient would have been a good candidate for a lower lid pinch to remove redundant skin but she was only interested in removing the fat pads.
Case Study 010
68-year-old white woman with concerns of heavy and drooping upper lids. Lateral fullness due to prolapsed lacrimal gland.Note she lifts her eyebrows up to help get skin off her lashes to both see better and feel less weight on lid. Postoperative photos below at 4 weeks. Notice how laterally already brows have relaxed and the forehead has less lines.
Case Study 011
41-year-old white woman bothered by medial fat bags bilaterally
Medial and middle fat bag protruberance. Complains of dark circles in tear trough area. Looking up shows the distribution of lower lid fat more clearly.
One month post op after subconjunctival blepharoplasty
Case Study 012
Initial exam. Note medial mass in left upper lid. Unsure at time what this was since she said she had it since birth but turned out to be fatty tumor with no malignancy. Crepe-like redundant upper lid skin. 54-year-old Isreali woman with upper lid redundant skin and fatty tumor from in- fancy left medial upper lid. Lower lids also have fatty bags and are loose. First surgery was on upper lids. Followed by lower lid surgery a month later. Lower lid surgery was done by subconjunctival blepharoplasty.
One month post op after upper lid surgery. Very happy with results. Ready for lower lid surgery.
One week after lower lid surgery to remove fat bags. White of eye is a little red inferiorly and she is using antibiotic ointment which gives glistening appearance to eyes. Sleeps on right side so that side more swollen. Mild bruising because patient was on aspirin.
One month post-op after lower lid subconjunctival blepharoplasty. Very happy with results. Note how swelling upper lids now gone completely along with any bruising. Residual swelling right lower lid but she sleeps on that side so it takes longer for swelling to go down completely.
Case Study 013
68-year-old white woman who was a professional model earlier in life and although she does not like her upper lid appearance her primary complaint is that her lids feel very heavy especially as she works mostly on her computer. In fact she states she has to lift her eyelids with a finger at end of day to see well. Note how skin rests especially laterally on her eyelids. This affects both her superior vision but also how much light gets into the eye as once the lid is so hooded it is like having a big sunhat on.
However we looked extensively at photos of her when younger to make sure that she has the same slightly laterally hooded appearance of her youth even though the majority of her redundant skin is lateral. She also has a lower brow but is not ready for a brow lift. So because of that I was very conservative removing skin because if she has a brow lift in the future that will also raise the upper lid skin as well. I show this in a photo where she is raising her brows.
Right before surgery.