Having drooping eyelids can make you appear exhausted and will often age the rest of your face. Although this sagging is a natural part of aging, in severe cases it can affect your vision as the muscles supporting our eyelids weaken. A blepharoplasty removes excess skin, fat, and muscle in the upper or lower, or both, eyelids. Our cosmetic surgery expert Ricky Allen spoke to two surgeons to learn more about this increasingly popular procedure.
A blepharoplasty is possibly the most common surgery performed after breast augmentation globally. To learn more about the procedure I met with Dr. Angelo Tsirbas, a Oculaplastic Surgeon whose clinic is in Sydney and Dr. Naveen Somia ,a Specialist Plastic Surgeon, whose clinic is in Bondi Junction. They both have extremely busy practices performing blepharoplasties and agreed that these procedures require great technical skill and a real aesthetic knowledge. This is why they often have to correct other doctor’s work.
Every two years the Oculaplastics hold an event which is attended by themselves and the Specialist Plastic Surgeons, to offer education on any new techniques which have been performed overseas so that any procedures they perform are cutting edge. They also look at any new findings relating to anatomy and physiology of the eye areas as medical science is still discovering more about this area all the time.
These is more than one way to treat the upper eyelid and this very much depends on the concern. This could anything from loose flesh causing an impaired visual field through to sunken upper eyelids. The procedure is performed as a day only but sometimes if a patient is very anxious, which can increase the risk of a post- operative bleed ,then they are encouraged to stay overnight.
A local anaesthetic is generally the only anaesthetic required and after one week it is safe to remove stitches. The upper and lower eyelid surgeries are not always needed to be performed at the same time but certainly in a slightly older patient, it can give a really much more youthful look to an aging face if both are. This can often be the first surgical step before having a face lift.
Dr. Somia said that previously blepharoplasty was considered a “cookie cutter” procedure and no matter what your aesthetic concern-fat was removed and then the area stitched-leading to some of the worst sunken eyes possible. Now it is a totally bespoke procedure which ultimately restores a more youthful look to the upper and lower eyes. Skin is only ever removed if absolutely necessary.
Dr. Tsirbas will also correct other problems such a ptosis, if a problem, at the same time. He has found that he is getting many more patients of Asian descent, who do not want to look like they have caucasian eyes but want a slight lift and extension at the side of the eye and a more distinct upper eyelid crease. His results are excellent but are still very ethnically appropriate.
For the lower lid procedure Dr. Tsirbas does minute stitches between the lower lid lashes which he finds give a much better long term and more natural looking result than just working within a rolled out lower lid.
Dr. Somia often gets patients coming in with lower lid bags . Previously these would have been removed, but now most of the bagging (which is usually fat) is moved around giving a very youthful lower lid with no hollowing.
Both doctors have patients starting from their twenties and Dr. Somia even had a patient who was eighty and had a blepharoplasty, with a very good result. Generally, both doctors find their average patient is aged from forties upwards for the upper eyelid and for the lower from twenties upwards. Although some younger women said Dr. Tsirbas, come to see him to have their eyes made more “cat like” in appearance, which can be achieved by an upper blepharoplasty. He will only ever perform a procedure which will look totally natural looking and with a result which lasts for many years. Some of these women are good candidates but some others are not.
Lower lid bagging, which is often genetic, is the main problem for younger patients to present to both doctors. Dr. Somia explained that it is sometimes diet modification and checking for any underlying medical problems is necessary for these patients before any surgery is performed, as certainly having a fluid retention problem can cause the bagging.
Patients can return to work after a week following a blepharoplasty. There is always some bruising which presents on the face under the eyes and after a few days travels down the face to the neck. This occurs after an upper or a lower blepharoplasty. Some of the bruising can be alleviated if the patient applies ice to the eye area for the first twenty four hours after surgery and only sleeps sitting up. Patients should also wear sunglasses out in the sun after an upper or lower blepharoplasty for at least one month, to ensure that the sun does not get onto the post operative scar as this could lead to thickening. Generally in a few weeks, it is impossible to even see any of the scarring.
Both Dr. Somia and Dr. Tsirbas agree that the newest blepharoplasties remove only any really excess skin. They reposition and preserve any excess fat in the upper and lower lids rather than removing it. They also position brows properly as well as increase brow volume . They also control the lateral height and length of the eyelid crease as well as restore the tone of the skin in the area. The end result is always, not just a more youthful and anatomically appropriate looking eye, but a much prettier one or in the case of a male, a much more handsome one.
Ageless beauty is an art and Ricky Allen is our curator. Australia’s leading voice in her field, Ricky has a degree in psychology and nursing (specialising in cosmetic enhancement), is a qualified paramedical aesthetician, and will share invaluable insight on the best and safest procedures for our face and body. You can find her at Aesthetic Reconstructions.
Dr. Naveen Somia
Dr. Angelo Tsirbas