Aesthetic plastic surgery of the face Upper blepharoplasty

As we grow older, the orbicularis oculi muscle weakens, relaxes, and descends, pulling the eyelid skin along with it. As a result, the tear trough becomes more pronounced, the lower eyelid lengthens and loosens, and in advanced age may develop ectropion and tearing. The upper eyelid also shows skin laxity and drooping.

Laxity also occurs in the septum (the supportive tissue beneath the eyelid skin), allowing fat to protrude and form small herniations under the skin (commonly known as “eye bags”), while the eyeball gradually recedes inward. With age, the eyelid skin atrophies, becoming thinner and containing fewer elastin fibers. It is therefore clear why blepharoplasty should be performed by a plastic surgeon with a thorough understanding of the aging processes affecting the eye area.

Depending on the needs, upper, lower, or a combination of both blepharoplasties can be performed. Preoperative examination and proper planning are of great importance.

In upper blepharoplasty:

• The incision is made in the skin (in the eyelid crease), and skin along with a small portion of the muscle is removed. If fat pads are present, they must be carefully removed or repositioned in their proper place.

• The wound is closed with non-absorbable sutures, which are removed on the 5th day.

• There is no pain, but swelling and minor bruising occur, which usually resolve within the first week.

In lower blepharoplasty:

• The incision is made in the skin a few millimeters below the eyelashes, or through the conjunctiva (when skin removal is not necessary).

• Primarily fat is removed, and less skin (when bags are present), while often the outer canthal ligament needs to be reinforced (canthoplasty) to restore the youthful shape of the eye.

• The wound is closed with non-absorbable sutures, which are removed in 5–6 days.

• As in upper blepharoplasty, there is no pain, but swelling and minor bruising occur, which typically resolve within 1–2 weeks.

Blepharoplasty is intended for those who wish to give their eyes a more refreshed appearance, and consequently improve the overall look of their face, usually between the ages of 40–50. Individuals with a family history of eyelid laxity, pronounced wrinkles, under-eye bags, or dark circles may consult a plastic surgeon about a decade earlier.

A special category includes women with floppy eye syndrome, who experience significant fluid retention around the eyes during their menstrual cycle and may seek surgical correction for eyelid laxity at an earlier stage.

Surgery is also indicated for all patients whose vision is mechanically obstructed by excess upper eyelid skin, as well as for those who have already undergone a facelift and wish to restore a more youthful overall facial appearance.

Blepharoplasty can be performed under local anesthesia (with or without sedation) or general anesthesia. The duration of the procedure is approximately one hour for the upper eyelids and 1.5 hours for the lower eyelids.

In standard blepharoplasty, the incisions are made along the natural eyelid crease of the upper eyelid and just below the eyelashes of the lower eyelid. Both incisions have a small extension laterally, towards the “crow’s foot” area.

Incisions that are hidden within the natural folds of the eyelids are initially red, gradually fade in color, and after 8–12 months are barely noticeable.

Specifically for the lower eyelid, when the problem is protruding fat pads and there is no excess skin, the incision can be made internally through the conjunctiva, leaving no visible scar on the skin of the lower eyelid.

The results are long-lasting; however, it also depends on the patient to modify their daily habits in order to maintain them. In addition to general guidelines for proper hydration, nutrition, and adequate rest, instructions will be provided regarding specialized cosmetic and sunscreen creams, the preventive use of Botox to limit wrinkles in the “crow’s feet” area, and the use of specialized fractional lasers (Erbium-YAG) or herbal peels that rejuvenate the skin around the eye socket.

Over time, the skin gradually loses its elasticity again and the muscles relax, which may result in the need to repeat the surgery after 10–15 years.

It is important to understand that blepharoplasty reduces excess skin, along with existing wrinkles on the upper and lower eyelids, and improves the contour of the eyes by reducing the fat beneath the eyelids and restoring the proper, youthful tilt of the outer canthus.

However, it does not significantly affect wrinkles in the “crow’s feet” area and does not change the position of the eyebrows. These can be temporarily corrected with the use of Botox and threads, or surgically with a brow lift.

Your doctor will evaluate your overall health and medical history, and if you are considered suitable for surgery, you will be informed about the possible complications and what needs to be done to reduce the likelihood of their occurrence. You will also be asked to stop smoking and avoid supplements that affect blood clotting.

The anesthesiologist will then discuss the type of anesthesia you will receive and the potential complications associated with it.

Depending on your age, you will be given instructions regarding any medications you may be taking and those you may need afterward, as well as any additional tests you may need based on your medical history. If you have a history of chronic allergic conjunctivitis, glaucoma, Graves’ disease, or other conditions, you will need to be examined by an ophthalmologist.

Your doctor will explain the importance of quitting smoking and maintaining proper nutrition for wound healing. One week before the surgery, you will be photographed and asked to sign the consent form.

The cost of the procedure ranges from €1,000 to €1,500 + VAT.