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Eyelid Lift

Koch Facial Plastic Surgery

R. James Koch, M.D.

Facial Plastic Surgeon located in San Mateo, CA

It is a natural part of the aging process to develop loose upper eyelid skin due to the effects of gravity and because it is the thinnest skin of the face.  This sagging tissue can make you look older than your age and, if severe enough, can interfere with your vision.  The upper eyelids can also show protruding fat pockets which look like peas under the skin and are considered unattractive.  Similarly, the lower eyelid can develop loose or crepey skin, and fat pads which are commonly referred to as “lower eyelid bags”.

At Koch Facial Plastic Surgery in San Mateo, California, R. James Koch, MD specializes in in-office eyelid lift procedures without the need for general anesthesia.  An in-office eyelid lift also offers a faster recovery time and less risk than a traditional one and still gives you amazing results.  Call Koch Facial Plastic Surgery to schedule an in-office facelift consultation or book one online today.

Eyelid Lift Q & A

What is an eyelid lift?

A Blepharoplasty (Eyelid Lift), usually performed in the office setting, is a surgical procedure that improves the visible signs of aging around the eyes.  Dr. Koch has extensive experience in performing both upper and lower blepharoplasties to remove loose eyelid skin and protruding fat pads. This experience allows him to perform the vast majority of these procedures safely and comfortably in the office setting without the need for general anesthesia.

Dr. Koch also specializes in Asian blepharoplasty that retains the natural contours of Asian eyes while reducing heaviness in the eyelids as well as the creation of a “Double Eyelid” if desired.  His goal with eyelid surgery is to give you a more youthful, natural appearance, and not to make you look “different”. 

Am I a good candidate for a Blepharoplasty (Eyelid Lift)?

If you have sagging skin causing folds or drooping in the upper or lower eyelid, have puffiness in the upper eyelid due to excess fat deposits, have bags under the eyes or droopiness of the lower eyelids, and don’t have certain eye medical conditions, you may be a good candidate for a blepharoplasty.  It is extremely common to get both the upper and lower eyelids corrected at the same time, or just one or the other depending upon your condition and desires.

What does it mean that the procedure is performed in the “office setting”?

Dr. Koch performs many procedures in his on-site procedure room in Suite A under “twilight” conscious sedation using oral medications and tumescent anesthesia.  These are not “Mini” versions of the procedures, but the Gold Standard ones.  Although patients are fully monitored and pre-screened for this approach, they are performed without an IV or the cost and risks of a general anesthetic.  Dr. Koch finds that most patients enjoy a twilight anesthetic where they are completely comfortable but can still communicate with their surgeon.

Generally, in-office blepharoplasty procedures are less invasive because of the anesthetic techniques used.  Dr. Koch believes that a “breathing tube” and general anesthesia are unnecessary in the vast majority of blepharoplasty candidates.

What happens during a Blepharoplasty?

During an in-office blepharoplasty, you are awake yet comfortable (“twilight”).  You will be given medication by mouth to help you relax.  Usually an IV is not necessary.

For Upper Eyelid Blepharoplasty, after your skin is completely numb, Dr. Koch makes an incision in your existing eyelid crease. He then removes the redundant skin and any protruding fat pockets.  The incision is then closed with sutures which are hidden in the eyelid crease. 

For Lower Eyelid Blepharoplasty, Dr. Koch either makes an incision right under your lower eyelashes (external) or just on the inside of the eyelid (transconjunctival).  He will discuss the best approach for you during your consultation, but generally the external approach is used when loose skin is the main problem and transconjunctival when it is fat bags.  For the external approach, the incision heals in the shadow of the eyelashes, and for the transconjunctival approach there are no visible incisions or sutures used.  Frequently Dr. Koch will recommend adding a “Skin Pinch” or “Laser Skin Resurfacing” to further improve any loose or crepey skin.  Regardless of the approach used, both loose skin and fat pockets can be addressed. 

How long does it take to recover from a Blepharoplasty?

If sutures are used, they are usually removed at 1 week. So we call it a “1 week recovery period”.  Most swelling (about 80%) is gone after 2 weeks, but the remainder may take an additional 4-6 weeks. 

You will need a ride to and from the office on the day of surgery, and someone to stay with you that night.  For an upper blepharoplasty by itself, you will usually be seen 7-8 days after surgery for suture removal.  For a lower blepharoplasty by itself (or upper and lower), you will usually be checked the next day and the following week.  If you had an external incision or skin pinch, those sutures are usually removed at this following week visit. 

You will be allowed to shower 48 hours after surgery.  For most patients, contact lenses can be worn again 10 days after eyelid surgery.  If you had a “transconjunctival blepharoplasty” (where the incisions are made on the inside of the lower eyelid), we usually wait 2 weeks but please check with Dr. Koch prior to reinserting your contact lenses.  You may want to wear sunglasses when out and about during the first week.

Wearing makeup too soon after your eyelid surgery can irritate the area around the incisions. Additionally, the process of applying and removing makeup can interfere with healing, because it involves tugging on the skin.  In most cases, makeup can be applied around the eyes after 10 days if camouflage is needed, but makeup placed directly over incisions should wait for 3 weeks.

As far as activity, keep exertion to a minimum right after surgery. Do not bend over, pull on your lower eyelids, or lift heavy objects more than 25 lbs.  Refrain from sexual activity or exercise for 2 weeks, and do not heavily exercise for 3 weeks.  Most patients are cleared to travel and return to all routine activities at 3 weeks. 

What can a Blepharoplasty not do?

Blepharoplasty will not remove “Crow’s feet” or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows: BOTOX® and laser skin resurfacing may help with Crow’s feet and other wrinkles; dark circles may improve in appearance when the shadowing from eyelid fat is removed, but will not address allergies, sinus problems, or dark blood vessels under the skin; and sagging eyebrows are improved by Browlift surgery.

Upper eyelid blepharoplasty removes loose skin right above your eyelid creases.  A Browlift may be recommended instead of, or in addition to, an upper blepharoplasty if a low brow position is adding to the problem of excess upper eyelid skin. Not performing a browlift when one is indicated can affect the final results, giving a less than ideal result.  Since there are side effects of certain types of browlifts, Dr. Koch will discuss whether this extra procedure is worthwhile considering your anatomic state.

Dr. Koch will discuss the best options for you considering your individual condition and desires.  Please note that we do not accept insurance for blepharoplasty.  To find out if you’re a candidate for a blepharoplasty or another face-enhancing procedure, call Koch Facial Plastic Surgery to discuss your options or book an appointment online today.