Eyelid surgery is performed by a cosmetic surgeon in a specialized and approved clinic. The practitioner must have a great experience of this type of surgery because it is very delicate, especially in regards to surgery of the lower eyelids.
What is a blepharoplasty?
A blepharoplasty or cosmetic surgery of the upper eyelids treats eyelid defects, most often linked to aging of the face. It is an operation that rejuvenates the face and a person’s looks. This meticulous and specialized surgery must be carried out by an aesthetic or oculoplastic surgeon who is the holder of a DESC diploma in plastic, reconstructive and aesthetic surgery.
A distinction is made between the upper eyelid, which is mobile and most often has excess skin (dermatochalasis) with ptosis of the eyelid downwards, discomfort with make-up, erasure and disappearance of the natural groove of the eyelid and often association with a fatty pocket at the inner corner of the eyelid.
The lower eyelid most often has greasy hernias (bags under the eyes) giving a tired look and a puffy appearance to the face associated with excess, wrinkled skin. An overall loosening of the lower eyelid may exist (round eye or ectropion). The valley of tears is sometimes very marked with an underlying dark circle and a relaxation of the cheekbone, which is drawn downwards.
There is often, in addition to the excess of skin on the upper eyelids and bags under the eyes, a ptosis of the eyebrows (sagging skin) aggravating the symptomatology which is the indication of a temporal lifting of the eyebrows (mannequin lift) in addition to a blepharoplasty.
The different techniques and possible eyelid procedures available
- Upper eyelid or upper blepharoplasty: the objective is to remove any excess skin and a possible internal greasy hernia.
- Lower eyelid or lower blepharoplasty: the objective is to remove the bags under the eyes, tighten the wrinkled skin, and possibly correct the valley of tears and any dark circles.
- Blepharoplasty of the 4 eyelids (upper and lower eyelids)
- Canthopexy: the principle is to replace the external canthus of the eyelid towards the outside and the top (doe or almond look)
- association with a temporal or mannequin lift which aims to raise the falling eyebrows
- association with a concentric centrofacial or malar lift that goes up the cheekbone
- combination with lipofilling (fat transfer), which fills the valley of tears, improves cutaneous trophicity of the dark circles and can increase the volume of the cheekbones.
- association with a mini facelift which treats the oval of the face and the neck
- combination with an injection of botox or hyaluronic acid for the lion’s wrinkle
This surgery is the simplest. The first step is of course to consult your surgeon. Usually this is an operation performed from the age of 40 when there is sagging skin on the upper eyelid and the eyelid groove is no longer visible with the skin beginning to reach the eyelashes or even hide them. However, it can happen that surgery is performed before the age of 40 as some people have very early sagging of the eyelids or even have an enlargement, often of genetic origin, of the underlying fatty organs.
This is a procedure for both men and women. A great fear of many patients is not to recognize themselves after the operation, or to have had their eyes changed. There is however no reason for someone’s looks to have changed by removing excess skin from their upper eyelids.
Preparation for the operation is simple, you just need to take a few arnica pills before the operation to avoid bruising, stop smoking (which is bad for scarring) and not take any medication that could facilitate bleeding such as aspirin or any anti-inflammatory drugs. The operation takes place at the clinic where Dr. Masson operates, not his medical office. Local anesthesia is sufficient in almost all cases. A skin spindle is removed which can easily reach 2 cm in height. Sometimes, depending on the indications, I may have to remove an excess of underlying muscle or a pocket (often internal) of fat. Either a cold scalpel, an electric scalpel or a laser is used depending on the case. A suture called an intradermal suture is put in place to close and then cold is immediately applied.
Once the operation on the upper eyelids has been performed, the post-operative recovery process is straightforward but requires 10 days off work because an edema will be present. The abnormalities treated by this surgery are: excess skin (dermatochalasis) and sometimes the internal fatty pockets. There are two pitfalls to point out for the upper eyelids: performing a blepharoplasty at all when in fact the problem does not come from the upper eyelid but from the forehead which is relaxed and draws the eyebrows down. In this case it is rather a forehead or temporal brow lift (or even botox injections) that must be performed. A blepharoplasty procedure will only make the problem worse by pulling the eyebrows down even further. The second pitfall is to remove the tissue too deeply and to damage the levator muscle of the upper eyelid, which will cause ptosis (the eyelid droops downwards). A complication that is usually spontaneously reversible in a few months and, fortunately, rare. The scar left by the blepharoplasty will be a little red at first and then form a white line which is almost invisible because it is hidden in the groove of the palpebral or even a little on the side in a fold of the crow’s feet if a significant lateral excess was present.
Please note that this is a more delicate operation than upper eyelid surgery. The organization is the same as for upper blepharoplasty (and it is of course possible to associate both the upper and lower eyelids during the same procedure). With the difference being, however, that in the majority of cases it will be necessary to use general anesthesia. When operating the upper eyelids, the eyes are closed during the procedure so there is no concern but for the lower eyelid the eyes need to be opened. It is actually very difficult for a patient to keep their eyes open during the operation, the fact of seeing the instruments necessarily leads to a backwards reflexive movement, and the operating light itself is very strong and dazzling. The whole problem with the lower eyelid is the skin and the cartilage support. The biggest fear of surgeons is to end up with a round or ectropion eye. The lower eyelid will be drawn downward in a U which is extremely unsightly. A clinical examination during a consultation is essential and the general rule of thumb is to never remove too much skin from the lower eyelid.
The anomalies treated by lower eyelid surgery are excess skin, dark circles and fatty pockets. In the most favorable cases there are just fatty pockets and the skin is of very good quality. We will then place the scar inside the eyelid (conjunctival route) and it will be completely invisible. We then open to see the yellow pockets of fat appear and remove them with the electrosurgical unit or a laser. The risk of ectropion is almost zero. In difficult cases there are marked dark circles. To try to attenuate them, we inject fat (lipofilling) at the valley of tears and carry out a small peeling or treatment with pulsed light or laser to reduce the visible vessels under the skin. But the problem is that the injected fat can either develop balls when healing or that too much or not enough will be absorbed causing an over or under correction. Or, alternatively, sink down to create an inflammatory malar pocket which is difficult to get rid of afterwards (use of local anti-inflammatory drugs, hyaluronidase, hifu, direct suture removal, etc.).
Finally, in another form of case that is also difficult to treat, there is an excess of skin (flag effect) on the lower eyelid. In this case it will be necessary to carry out an incision under the eyelashes (subciliary approach) and to remove an excess of skin and even underlying muscle. The risk is then under the effect of scarring to see the skin retract down and form ectropion. The principle is to never remove too much skin. The surgeon should not recommend lower eyelid surgery if the result appears too uncertain.
Price and fees for eyelid surgery (blepharoplasty)
The price depends on the chosen procedure. Fees start from 2500 euros for the upper eyelids, 3500 for the lower eyelids, and 4200 euros for all 4 eyelids.
Frequently asked questions about eyelid surgery
From what age can a blepharoplasty be considered?
Generally requests come from patients, both women and men over 40 years of age, but it is not uncommon to perform the procedure in younger patients (who have very marked pockets, dark circles, etc.) before their thirties sometimes.
What are the correct indications for a blepharoplasty?
- A tired look.
- Pockets under the eyes.
- Folds on the lower eyelids.
- Dark circles.
- Excess skin on the upper eyelids.
What is the duration of the blepharoplasty procedure?
30 minutes to 2 hours
What anesthesia is given for a blepharoplasty?
Upper eyelids: local anesthesia
Lower eyelids: general or local anesthesia with sedation
All 4 eyelids: general or local anesthesia with sedation
What is the duration of hospitalization for a blepharoplasty?
Most often ambulatory or day surgery (entering and leaving the same day), sometimes overnight hospitalization in the case of general anesthesia.
What is pain like after the procedure?
A blepharoplasty is a very painless procedure. A simple feeling of tightness is felt in the eyelids.
Where are the blepharoplasty scars located?
They are almost invisible in all cases. For the upper eyelid, the scar is located in the eyelid groove (the natural fold of the eyelid), for the lower eyelid it is located under the eyelashes (subciliary route) in the case of skin straightening and inside the eyelid (endoconjunctival or conjunctival route) to remove only the pockets (therefore a blepharoplasty without a visible scar).
How long does a blepharoplasty last?
It varies, depending on external life factors (sun, smoking etc.) and age, but at least 10 years.
What happens before the operation?
Two consultations with Doctor Masson are necessary and a possible consultation with the clinical anesthetist in the event that sedation or general anesthesia is required.
A possible blood test and ophthalmological consultation depending on the case.
Cessation of smoking at least 3 weeks before the operation and all drugs that can cause bleeding, such as aspirin, at least 10 days before.
What is the post-operative recovery like?
For the first two nights you will have to sleep with your head raised to avoid swelling.
Homeopathic pills (arnica) to avoid bruising.
Possible bruising for 7 to 10 days.
Eye drops and ointment to be applied several times a day, prescribed by Dr. Masson.
Ice to be administered to the eyes as often as possible for the first few days.
Sutures to be removed between the 3rd and 7th day after the procedure.
Plan to take a week to 10 days off work + use sunglasses.
After one week, make-up can be used to hide the scars.
What are the possible complications of a blepharoplasty?
Any cosmetic surgery can lead to complications. They are rare, but it’s important that you know what they are. Additionally, surgery of the lower eyelids is more complex and more responsible for complications than that of the upper eyelids. We can therefore cite the following possible complications:
- round eye (ectropion) by retraction of the lower eyelid, avoided by the conjunctival technique
- ptosis, that is to say a drooping eyelid with asymmetry (often preexisting before the operation but discovered during it)
- ocular complications (keratitis, chemosis, blindness)
- dry eye syndrome (dry eyes, often preexisting but unmasked and aggravated by the intervention)
- scar cysts
- asymmetry and residual pockets
What procedures can be associated with blepharoplasty?
Cosmetic eye surgery can be combined with other different procedures: