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Blepharoplasty – Upper Eyelid & Lower Eyelid Surgery – Dallas, TX

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About Eyelid Surgery

There are at least 20 different eyelid rejuvenation procedures described in the Plastic Surgery literature. So how do you know which one is right for you? With more than 30 years of clinical experience and academic teaching experience, Dr. Burns chooses his approach carefully, as the lower eyelid is the area in which most complications occur. The key elements in an upper blepharoplasty technique focus on the evaluation of skin quality and excess, muscle excess and/or laxity, and fat excess. Less muscle and fat is removed in the upper eyelid in patients who want to maintain a fuller appearance.

The lower lid is the most delicate part of the face to rejuvenate and is the area where “operated looks” can occur, so a careful examination during an in-office consultation is critically important. Although different approaches to the lower lid are necessary, Dr. Burns has popularized a technique that works for the majority of patients which balances quality results and safety. Additionally, this technique does not require an external excision. This approach is not for everyone but it has proven highly satisfactory for most of his patients for the last 15 years. He teaches this technique involving laser skin tightening all over the world. During a private consultation at Dr. A Jay Burns Cosmetic Surgery in Dallas, TX, an assessment will be made to determine the best procedure choice for you. A more youthful, natural-looking upper and lower eyelid that appears natural and un-operated remains the goal.

Ideal Candidates

This cosmetic procedure is popular among both men and women. Eye aging is usually the first aspect of the aging process that is noticed, typically in the late 30s to early 40s. During the initial consultation, the treatment options will be discussed based on the symptoms presented. Generally, ideal candidates suffer from excess, hanging skin and folds above the eyes, or bloated, puffy skin below. Ideal candidates have no contraindications to the procedure such as dry eyes or prominent eyes from Thyroid disease. These conditions are not absolute contraindications but must be carefully evaluated before proceeding with eyelid rejuvenation surgery.

Candidates for the Upper Eyelid Surgery

It is important during the consultation to determine the cause of upper eyelid fullness. This can be a result of brow descent, excess upper eyelid skin, or both. Dr. Burns avoids unnecessary procedures at all cost, but brow descent must be discussed, if present, to clearly detail what exactly the upper eyelid procedure will accomplish and what the brow lift will add. Click here for more information on Dr. Burns’ brow lift procedures. Eyelid skin is very thin and is contained within the orbit. Brow lid skin has fallen from the brow above the orbit, into the orbit itself, and is thicker. The various contributors to fullness are best determined during a consultation. It is critical to move the brow lid back to its appropriate position before assessing eyelid skin if complete rejuvenation is the desired outcome. The patient always makes the final decision and is fully in charge for any elective procedure, but Dr. Burns’ goal is to clearly explain what can be accomplished so decisions are balanced with realistic expectations.

Candidates for the Lower Eyelid

The lower eyelid surgery may address skin, muscle, fat, or a combination of all three. Skin may have fine wrinkles or frank folds. Muscle laxity or excess muscle tissue, called muscle hypertrophy, must also be identified and corrected if present. Finally, puffy lower eyelids resulting from fat bulging creates not only puffiness but dark circles under the eyes by casting a shadow over the bulging fat.

Age range for eyelid procedures varies from patient to patient, but is usually one of the earliest areas of inquiry for cosmetic patients, as the eyelids begin to show signs of age typically before any other facial structure. Subtle differences can occur in the early to mid-30s, but most commonly occur in the late 30s or early 40s.

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Surgical Techniques

During blepharoplasty, general anesthesia or IV sedation is used. This procedure may be done on the upper eyelid alone, or the lower, or both during the same surgery. It is very common to perform both eyelid procedures with other facial rejuvenation techniques if indicated and desired by the patient. The approach for both the upper and lower are similar in nature, which is the removal of any fatty tissue, as well as excising any loose skin that may reside on or near the eyelid.

  • Upper
    Upper eyelid surgery is performed to eliminate hanging folds of skin that impair vision and creates a more flattering eyelid appearance. During an upper eyelid surgery, a small incision is commonly made in the natural creases of the lid to remove excess fat and saggy skin.
  • Lower
    Lower eyelid surgery is used to reduce and improve puffy or bloated skin underneath the eyes. During this procedure, an incision is made just below the lower lash line so fatty tissue can be removed and the skin lifted and tightened to create a flatter, smoother surface. In some cases where volume is depleted, a filler will be injected to add volume for additional softness. Special care is taken to avoid removing too much lower lid fat, as hollowness can be counterproductive.

What to Expect

Eyelid surgery can take up to 2 hours depending on what is being addressed and if both eyes are being treated, but in most cases, Dr. Burns' techniques can address both upper and lower lids in under an hour. After surgery, you should allot several days to rest and avoid strenuous activities. A cold compress and pain medication can help reduce discomfort and swelling. NSAIDS and aspirin are to be avoided. No ibuprofen or Advil for 3 weeks postoperatively. You may experience dry eyes following surgery, but this normally subsides after 2 - 3 weeks. The results from upper and lower eyelid surgery can last a decade or longer before it needs to be addressed again. The lower eyelid puffiness is much slower to recur than skin excess and skin quality deterioration. Repeat laser treatments can be conducted as necessary, each time having the lowest incidence of lid retraction and an “operated look.” However, a concept that must be realized is understanding as long as we live on a planet with gravity and as long as human tissue ages faster and faster with each decade, the recurrence will continue. Once corrected at surgery and your look is “reset,” the patient must realize that from that new “reset position,” every year forward the patient will age. Although eyelid surgery corrects droopy and bagginess above and below the eyes, it does not stop the aging process and does not eliminate dark circles under the eyes entirely. However, there are nonsurgical treatments or even more aggressive surgical procedures that can help reduce or eliminate resistant dark circles. That is why the consultation is critical to determine a procedure that fits each patient’s risk versus reward comfort level.  

As for complications after your surgery, you may experience dry eyes, a change in vision (blindness is rare and has never been seen in Dr. Burns’ personal practice), rounded or depressed lower eyelids, infection or bleeding.

Other Considerations

All information below on what you can expect during recovery is based on an average patient, including 2 standard deviations (95% of all patients). Some patients fall outside these descriptions and will have a better or worse recovery than the average patient, for unexplained reasons. Dr. Burns cannot guarantee perfection, although that is his goal. What he can guarantee is being fully prepared for each surgery and commitment to his patients not only during the surgery but postoperatively. If a complication does occur, although uncommon, he is dedicated to finding a solution and doing everything he can to get you through the postoperative period no matter what the course.

Social Return
Upper blepharoplasty and simple lower blepharoplasty techniques in which the muscle is not addressed aggressively usually allow the patient to return to work within a few days if bleeding and bruising are not significant. However, the eyelid is a vascular structure and once bruising is noted, there is no easy way to resolve this quickly and 10 days - 2 weeks are needed to resolve any bruising.

Pain is usually not a significant problem with upper and lower blepharoplasty. It is more of a nuisance with the ointments and drops that need to be applied to the eyes in the first few days. Reading and watching TV can sometimes tire the eyes out quickly in the first week of surgery, but in most cases it resolves quickly thereafter.

Drains are not used in blepharoplasty.

A steroid dose pack is given for 5 days and minimizes swelling in the first 48 hours. Maximal swelling typically occurs between 3 - 5 days post operation and begins to decrease steadily thereafter..

There is no absolute time that driving is restricted; there are only reasonable guidelines. The patient must take full responsibility for the decision to drive. That decision is predicated purely on your ability to drive and ability to not cause harm to others. You can be a liability so when you feel comfortable that you can see blind spots, have the range of motion to manage full and accurate vehicle control, then you can drive. A rough guideline to manage expectations is that most patients begin to drive within 5 - 7 days post operation, but everyone is different.

Look More Awake

If you are having a hard time seeing because of excess or protruding skin above your eyelids, or suffer from puffy bags below your eyes, then eyelid surgery may be the right procedure for you. It addresses all these issues and creates a long-lasting, flattering look that will enhance and elevate your eyelids. You will look younger and will feel rejuvenated. Call our office today to schedule your consultation and allow us help you turn back the hands of time.

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.