Reconstructive Surgery of the Eyelids

Your eyes are often the first things people notice about you, and are an important aspect of your overall appearance. Young eyelid skin is smooth, but over time, the eyelid skin stretches, the fat bulges, and the muscles weaken. The eyebrows may also droop and sag (a condition called brow ptosis). Age, heredity and sun exposure all contribute to this process. Loose or baggy eyelids detract from your overall appearance and make you look tired or older. When the brow droops, it crowds more skin down over the upper lids and exaggerates the hooding and crow’s feet at the outer corner of the eyes, making you look sad, tired, or angry. When severe enough, the upper eyelid skin may hang over the lashes and obstruct your vision.


Surgery to improve the appearance of the eyelids is called blepharoplasty. The goal of blepharoplasty is to give the eyes a more youthful look by removing excess skin, bulging fat, and lax muscle from the upper and lowers lids. If the sagging skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand the visual field. Excess skin and fat are removed from the upper lid through an incision hidden in the natural eyelid crease. If the upper lid is droopy, the muscle that raises the lid can be tightened.

Before Blepharoplasty
Before Blepharoplasty
After Blepharoplasty
After Blepharoplasty

Fat in the lower lid can be removed or repositioned through an incision hidden on the inner surface of the lid. Laser resurfacing or chemical peel can be performed at the same time if desired, to smooth and tighten the lower lid. If there is excess skin in the lower lid, the incision is made just below the lashes. Fat can be removed or repositioned through this incision, and the excess skin is removed. The incision is then closed with fine sutures.

Brow Lift

Blepharoplasty will not elevate a drooping brow or remove wrinkles in the crow’s feet area. A procedure to elevate the brows may be appropriate, instead of, or in addition to upper lid blepharoplasty. Correction of mild to moderate brow ptosis can be accomplished through incisions directly above the brows, in the forehead creases, or at the hairline. These techniques are most effective if the brow ptosis involves predominately the central area of the forehead.

For more significant amounts of brow ptosis, or to address deep frown lines or lateral hooding of the upper lids, it may be necessary to raise the brows and forehead through incisions behind the hairline. The endoscopic brow lift is performed through small incisions hidden behind the hairline, using an endoscope and special instruments. The muscles that pull the brow down and crease the forehead skin are relaxed, allowing the brow to be raised into a more youthful position. A coronal brow lift can achieve the same results through a larger incision well behind the hairline.

After Surgery

Cold compresses are applied to reduce swelling and bruising. Antibiotic ointment or drops may be prescribed. Strenuous activity should be minimized for several days. Warm compresses may be recommended after several days to increase blood flow to the area and promote healing. Discomfort is generally mild. Non-aspirin pain relievers are usually all that is necessary post-operatively. Aspirin products, non-steroidal anti-inflammatory medications like ibuprofen, and other blood thinners should be avoided before and after surgery as they may increase the risk of bruising and bleeding. Most patients are able to return to regular activities within several days.

Eyelid Reconstruction Specialist

Gary T. Raflo, M.D., FACS
Gary T. Raflo, M.D., FACS

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