Dear Dr. Seckel, I am interested in Blepharoplasty or some form of eyelid rejuvenation or eyelid tuck. I have read that Blepharoplasty is a safe operation and that Blepharoplasty can be very effective for removing eyelid hooding and eyelid bags. I also have dark circles under my eyes and want to know if Blepharoplasty can remove the dark circles. I have read that Blepharoplasty can be done with the scalpel and with the laser but opinions vary widely about which Blepharoplasty method is better. Can the Blepharoplasty be done under local anesthesia? What is the recovery time after a Blepharoplasty? What are the risks of a Blepharoplasty? Can the eye itself be injured during a Blepharoplasty? Is there such a thing as a non-surgical blepharoplasty? Can filler like Restylane be used to get the same benefit for dark circles instead of a Blepharoplasty? Does the non-surgical facial rejuvenation program you speak about rejuvenate the eyelids and make a Blepharoplasty unnecessary? I am 42 and have early eyelid hooding of the upper eyelids and puffiness and bags on the lower eyelids. I am beginning to form a dark circle under the eyelid near the nose-in your book you call this the naso-jugal fold or tear trough deformity. Will the Blepharoplasty correct the tear trough deformity? Thank you very much, Charlene, Boston, MA.
Dear Charlene,
Thank you for your question. The eyelid rejuvenation procedures called upper blepharoplasty and lower blepharoplasty are very safe and effective eyelid rejuvenation procedures for removal of eyelid hooding and bags under the eyes when performed by a surgeon experienced in eyelid rejuvenation surgery. As you point out both upper blepharoplasty and lower blepharoplasty can be done with a scalpel (cold steel) or laser. Most blepharoplasty operations are done today with the scalpel, but I prefer the laser because in my hands, laser blepharoplasty causes less bleeding, less bruising, and results in a faster recovery for the patient. The procedure can be done under local anesthesia but I prefer to do blepharoplasty under general anesthesia.
To my knowledge there is no non-surgical blepharoplasty or non-surgical eyelid rejuvenation procedure that will correct all of the eyelid aging changes you mention. Laser resurfacing or laser skin rejuvenation can correct loose skin and remove wrinkles, but I consider laser resurfacing a surgical procedure because of the recovery involved.
I do not inject fillers around the eyes because I am concerned that the injection could damage the eye. I have also heard from patients who have had filler injection in the eyelids that they have been disappointed with the results.
Blepharoplasty alone cannot correct the tear trough deformity or dark circles under the eyes. Correction of the tear trough deformity or naso-jugal fold requires a procedure called an arcus marginalis release with fat grafting or tear trough implant which can be done at the time of the blepharoplasty.
There are risks associated with blepharoplasty as with all surgical procedures but complications are rare. The most common complication is ectropion or sad eyed look in which the outer portion of the lower eyelid is turned down. This is much more common when an incision is made on the outside of the lower eyelid-which is why I make my incision on the inside or pink portion of the eyelid-the conjunctiva. This approach, called transconjunctival laser blepharoplasty preserves the shape of the lower eyelid. The most feared complication of blepharoplasty is damage to the eye. Fortunately this is very rare and usually happens as a result of post operative bleeding. Bleeding is more common in people with high blood pressure which is why I do not operate on people who have high blood pressure which is not controlled. Since there is less bleeding when the laser is used, I feel the laser is less likely to result in this complication.
I hope I have answered your questions. My most important point is that, in my opinion, blepharoplasty can be safely performed by a skilled, experienced board certified plastic surgeon.
For more information on blepharoplasty, dark circles under the eyes, eyelid rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me.
Boston, Massachusetts