Eyelid Surgery (Blepharoplasty)

What is Blepharoplasty?

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No feature makes your face look older than aging of the eyes. Very popular for patients in Toronto, Blepharoplasty is a procedure that can reverse the signs of aging in the upper and/or the lower lids. Upper lid Blepharoplasty is fairly straightforward, while lower lid Blepharoplasty is a more technically demanding procedure. For that reason, you should choose an eyelid surgeon who is experienced in—and very comfortable with—all aspects of Blepharoplasty. Lawrence Tong, MD will guide you through the process of making your decision about eyelid surgery.

Signs of Aging in the Upper Lids

Upper Lids: The Aesthetic Ideal

The upper lids should have a clean, crisp, and uniform crease height. There should be no hanging skin touching the lashes and the skin itself should ideally be smooth and wrinkle-free.

Upper Lids: Typical Signs of Aging

• Excess lid skin that hangs down, making the patient look older
• A patient describes themselves as having ‘droopy eyelids’
• The eyes looking sad, tired, or appearing angry
• Patients typically lose the appearance of a well-defined lid crease, and the lid skin may be wrinkled
• Patients find it difficult to apply eye makeup due to the excess skin
• In some cases, the excess skin causes upper visual field obstruction
• The appearance of bulging fat in the upper lid is common
• As patients continue to age, the upper areas of the eye tend to lose fat, resulting in a gaunt, aged appearance

Upper lid Blepharoplasty is a procedure that can reverse many signs of aging in the upper lids.

Signs of Aging in the Lower Lids

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The lower lids should have a smooth appearance. The lid should blend seamlessly with the cheek, free of bulges or fat bags. The skin is ideally tight, and the lid margin should sit at, or be slightly above, the lower edge of the iris.

Lower Lids: Typical Signs of Aging

• The main culprits of lower lid aging are the ‘eye bags,’ which are composed of protruding fat and create a tired, worn-out appearance
• Crepe-like lower lid skin and fine wrinkles on the lower lid, which stem from loss of elasticity as a result of aging and sun exposure
• Dark circles are very common with lower lid aging. Dark circles are caused by shadows cast by the bulging fat or deeper pigmentation in the lower lid region

Lower lid Blepharoplasty is a procedure that can reverse many signs of aging in the lower lids.

What Does Blepharoplasty Accomplish?

Blepharoplasty helps reverse the signs of aging in the upper and lower eyelids. Specifically, Blepharoplasty can:

• Get rid of fat pockets in upper and lower lids
• Remove excess eyelid skin
• Smooth out wrinkles
• Improve dark circles in the lower lids
• Repair eyelid drooping (upper and/or lower lids) caused by aging

Who is a Candidate for Blepharoplasty?

Dr. Tong will make sure that you are a suitable candidate for surgery at the time of your consultation. Anyone with signs of aging in the upper and/or lower lids may benefit from Blepharoplasty. Patients should be generally healthy and relatively fit. Smokers should quit smoking at least 2 weeks prior to surgery and not resume for at least 6 weeks. You should let Dr. Tong know if you have issues with dry eyes or thyroid problems, as these medical issues may affect your procedure.

Blepharoplasty Considerations

Upper Lid Blepharoplasty vs. Lower Lid Blepharoplasty

Upper and lower lid Blepharoplasty are distinct operations with different approaches and risks. The difference stems from the unique way in which each lid changes with aging. In general, the main concern for the upper lid is excess skin, while the main concern for the lower lid is fat bags. Lower lid Blepharoplasty tends to be much more technically demanding than upper lid Blepharoplasty.¹

Excess Skin Removal in Blepharoplasty

In the upper lid, skin removal will help restore a clean, consistent crease and help eliminate wrinkling due to crepe-like skin.

In contrast, skin removal in the lower lids must be done cautiously; too much removal of lower lid skin can lead to functional and aesthetic problems. A patient may complain about dry eyes, a sad appearance, or the inability to fully close their eyes if too much lower lid skin is removed.

Excess Fat Removal in Blepharoplasty

In the lower lids, fat removal is acceptable and desirable when eye bags are present. However, over-removal can cause a hollow, unattractive appearance. Excess lower lid fat is frequently repositioned (instead of removed outright) to help contour the lower lid/cheek junction.

For the upper lids, fat needs to be removed judiciously and in the right areas; too much removal can lead to a ‘skeletonized’ look. In the upper lids, an important sign of aging is loss of fat; therefore the upper Blepharoplasty technique should not exacerbate the appearance of fat loss by removing too much of it.

Dr. Tong is very comfortable and experienced with all facets of upper and lower lid Blepharoplasty.

How is the Blepharoplasty Procedure Performed?

Dr. Tong performs Blepharoplasty in the private CPSO-accredited operating suites in Yorkville, Toronto. In select patients, Blepharoplasty of the upper lids may be done with local anesthetic only. Otherwise, IV sedation or general anesthesia is preferred for upper and lower lid Blepharoplasty.

Upper Eyelid Blepharoplasty

Dr. Tong carefully designs skin markings on the upper lids prior to surgery, indicating the nature of surgical work to be done. After anesthesia is administered, Dr. Tong makes an incision in the upper lid crease and removes excess skin. When appropriate, he removes fat in the upper lid and does so in a conservative manner. If the upper lid is drooping due to the effects of age, Dr. Tong corrects the drooping with specially placed stitches in the eyelid muscles. Finally, the incision is meticulously sewn together to obtain a fine scar.

Lower Eyelid Blepharoplasty (External Incision method)

Dr. Tong makes the incision just beneath the eyelashes, allowing the fat in the lower lid to be exposed. He performs fat removal and fat sculpting to eliminate ‘bags,’ and achieve a smooth contour. The fat may be shifted to improve areas of hollowness such as in the ‘tear trough’ region. Dr. Tong removes a small amount of excess skin if required to smooth out wrinkles and tighten the skin. Care must be taken to avoid excessive skin removal, which can cause aesthetic and functional complications. The incision is then sewn together for a beautiful closure.

Transconjunctival Blepharoplasty

In cases wherein no skin removal is anticipated or desired, lower eyelid Blepharoplasty can be performed through an incision on the inside of the lower lid. No external incisions are made. This technique is called a ‘transconjunctival lower lid Blepharoplasty.’ After Dr. Tong makes the internal incision, he carefully removes excess bulging fat in the lower lid. The procedure is complete when the bags are eliminated and a smooth contour is established. Stitches are generally not required with this technique.

Double Eyelid Surgery

For some Asian patients, a low-hanging, invisible, or non-existent eyelid crease can make the eyes appear smaller and make a patient look inscrutable or unexpressive. Double Eyelid Surgery is a variation of upper lid Blepharoplasty specifically tailored to Asian patients with the goal of creating a visible crease in the eyelids. The surgery eliminates the look of a ‘mono-lid’ and provides a more expressive, alert, and attractive appearance. The surgery is performed on young and old patients alike, and is the most widely performed cosmetic surgery in Asia. In fact, this procedure is also one of the most sought-after procedures in Dr. Tong’s practice as well. The procedure tends to skew to a much younger patient population since absence of the lid crease typically manifests from infancy. Most patients will undergo surgery beginning in the late teens to early twenties. In older patients who undergo this procedure, the main goals of traditional Blepharoplasty, which aim to decrease aging of the eyes, are often performed in conjunction with the double fold creation.² For more information about Double Fold/Double Eyelid Surgery click here.

How to Choose the Best Plastic Surgeon For You

What is Recovery From Blepharoplasty Like?

Blepharoplasty Recovery Immediately After Surgery

After your Blepharoplasty, the staff transfers you to the anesthesia recovery area. As you gently awake from anesthesia, our nursing staff monitors your progress. Once the anesthetic effects wear off, Dr. Tong allows you to go home accompanied by friends/family.

Blepharoplasty Recovery At Home

At home, you should try to rest and relax as much as possible. You may do non-strenuous activities, but should avoid watching television, reading, or otherwise straining your eyes over the first several days. To help decrease swelling and bruising around the eyes, sleep in a reclining chair, or use multiple pillows to keep your head elevated. Pain is typically mild, but your eyes may be sensitive to bright light over the first few days. Dr. Tong prescribes pain medication, which you can use during this time. You will have some bruising that lasts 1-2 weeks.

Follow-Up Appointments After Blepharoplasty

Your first appointment with Dr. Tong will occur approximately one week after surgery. The majority of patients return to work (non-strenuous) at 7-10 days. Dr. Tong will likely allow you to start light exercise (e.g. walking) at 1-2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery. After the initial post-operative visit, you will follow up with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

Like any procedure, Blepharoplasty has risks and complications associated with it. The risks are low, but do exist. At your consultation, Dr. Tong will go over the pertinent potential risks and complications associated with Blepharoplasty.

How Long Does Blepharoplasty Last?

It is important to remember that the surgery is intended to reverse major signs of aging, but your face still continues to age afterward. The outcome of Blepharoplasty can last ten or more years depending on your individual rate of aging. The skin of the upper eyelids will continue to be affected by the forces of age, smoking, sun exposure, and—most importantly—genetics, but the ‘hooded’ appearance caused by sagging skin usually does not recur to the same extent, even many years afterward. In the lower eyelids, the removed fatty deposits do not ‘regrow’ and most patients experience an enduring outcome after surgery. Both upper and lower Blepharoplasty offer long-lasting results that very generally do not require retreatment. To further preserve the aesthetic achieved with eyelid surgery, Dr. Tong recommends that patients:

• Avoid smoking as nicotine and a multitude of harmful chemicals in cigarette smoke breaks down elastin, deprives the skin of nutrients, and causes sagging of the skin
• Wear sun and eye protection regularly, including facial sunscreen and sunglasses to minimize the aging effects of UV radiation
• Incorporate high-quality eye creams and skin care products into their regimen to slow down the aging process

It is also important to note that the forehead is not specifically treated during Blepharoplasty.  Some patients may notice that the skin of the brow may have sagged downward over time. Patients considering Blepharoplasty will also be evaluated by Dr. Tong for changes in the forehead due to aging. The usual signs of this include: a low eyebrow position, forehead lines and wrinkles from muscle compensation (to lift the sagging brow), and drooping of the upper lid beyond the lateral corner of the eye (termed ‘lateral hooding’). To achieve comprehensive rejuvenation of the entire upper face, Dr. Tong can perform a brow lift in combination with your eyelid surgery.

Will I Have Scars After Upper and Lower Blepharoplasty?

While most surgical procedures leave scarring, the incisions from upper and lower eyelid surgery are very discreet and often result in virtually undetectable scars after surgery (given time to heal). Due to the thinness of the skin, these incisions in the eyelids typically heal to the point of being almost imperceptible. Additionally, incisions are placed in areas where they are hidden in the natural folds, curves, and lines of the eyes.

Upper Lid Blepharoplasty Incisions

Incisions during upper eyelid surgery are:

• Placed in the natural lid crease
• Made in this location so the scar will be hidden when the eyes are open
• Inconspicuous, allowing a virtually invisible scar even when the eyes are closed

Lower Lid Blepharoplasty Incisions

The incision of the lower lids can be made in one of two ways:

• Open/Transcutaneous Approach: Under the lash line. This incision heals remarkably well and is easily hidden with any type of eye makeup.
• Closed/Transconjunctival Approach: On the inside of the lower lid. The incision is made on the inside of the lid; therefore, there is no external scarring whatsoever. This technique is used when no skin removal is necessary.

How Much Does Blepharoplasty Cost?

The cost of eyelid surgery at Yorkville Institute of Plastic Surgery depends on whether you undergo upper Blepharoplasty, lower Blepharoplasty, or both procedures. In general, the price of either upper or lower eyelid surgery ranges between $6,000 and $7,700 + HST depending on the complexity of your treatment plan, while both procedures can cost between $10,900 and $12,100 + HST. Our patient care coordinator will provide you with a full price breakdown after your concerns are assessed in a consultation with Dr. Tong. We accept plastic surgery financing plans from Medicard®, a highly reputable third-party healthcare lending company that can make Blepharoplasty expenses more affordable for qualified patients. If you have any questions about the flexible financing options offered by Medicard®, or if you would like to speak to a friendly member of our team, please contact our practice today.

Blepharoplasty Consultation in Toronto

It is very important that you feel confident in your choice to undergo cosmetic surgery and in the plastic surgeon you have chosen to conduct the procedure. During your Blepharoplasty consultation, you will have Dr. Tong’s undivided attention when discussing concerns and asking questions. You will have the opportunity to view many before-and-after photos of his Blepharoplasty work as well. There is a great deal of information to digest during your initial consultation and our goal is to have you become an educated patient. We know that the educated patient will make better decisions about their surgery and their surgeon.

To learn more about how Dr. Tong can help you with Blepharoplasty and facial rejuvenation, set up a Blepharoplasty consultation by giving us a call at (416) 972-0999. You can also let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No doctor’s referral is needed.

See Dr. Tong’s work in our Blepharoplasty before-and-after photos.

References
^{1 Mayo Clinic. Blepharoplasty. Available at: https://www.mayoclinic.org/tests-procedures/blepharoplasty/about/pac-20385174. Accessed March 20, 2020
2 Nguyen MQ, Hsu PW, Dinh TA. Asian blepharoplasty. Semin Plast Surg. 2009;23(3):185–197. doi:10.1055/s-0029-1224798.}