In Nashua, near Boston, Massachusetts – Eyelid Surgery (Blepharoplasty)
Blepharoplasty is aimed at reducing the aging changes that occur in the eyelids: looseness and puffiness of the upper and/or lower eyelids. In its most complicated form, blepharoplasty involves an incision in each upper lid at the crease, through which bulging fat and excess skin or muscle are trimmed. If you have puffiness from protruding fat as well as excess skin and muscle, that sometimes requires a similar incision just below the lower lid lashes. Patients with puffiness in the lower lids but without much extra lower lid skin can often undergo fat removal through the inside of the lower lid, thereby avoiding the external scar and giving a quicker recovery.
Another common aging change in the lower lids not appreciated by many patients is a loss of elasticity in the lid margin itself, so that, when the lid is pulled down by a finger, it does not “snap” back into position youthfully, but “floats” back toward the eye. If this is the case, the strength of the lower lid can be tightened at our Nashua practice, near Boston, Massachusetts, with eyelid surgery (blepharoplasty). This procedure supports the lid better and also helps avoid a droopy lower lid after surgery.
The Nature of Blepharoplasty
Eyelid surgery can be performed as an outpatient procedure. Ordinarily, there is only mild discomfort following eyelid surgery. You will apply ice compresses to the eyelids after surgery and use drops and protective ointment.
Among all facial rejuvenation procedures, eyelid surgery is the one that requires dedicated “physical therapy” by the patient. Eyelid surgery can temporarily weaken and stiffen the muscles that close the eyelids, and if uncared for, can let the eye become dry or irritated. We will very carefully instruct you in eyelid exercise after surgery and show you how to use protective drops and ointment so that your eyelids regain their strength and suppleness quickly and they will not become irritated. Assuming that you have normal tear production after surgery, temporary dry eyes following blepharoplasty are no more than a nuisance, but obviously it is nice to avoid this problem if possible. Unlike the facelift and the brow lift, which get better with time alone, the eyelids heal much faster with conscientious patient care and adherence to the exercise program.
Eyelid sutures are removed within three to five days. If very little swelling has occurred, you can return to many activities after one week with camouflage makeup. The eyelids look generally presentable at two weeks, but like all facial rejuvenation surgery, improvement continues for months after surgery.
In the past all lower blepharoplasties were performed from the skin surface, dividing skin and muscle to remove the excess fat.
However, even minimal muscle surgery temporarily impairs its function. The lids are functional structures that move the tear film and protect the eye, not just cosmetic ones. I have therefore moved to the “no touch” blepharoplasty (pioneered by Dr. Glenn Jelks) for virtually all of my patients, except in a few special circumstances, such as the patient with Graves’ disease (hypothyroidism).
The “no touch” term refers to not touching the orbicularis muscle, the lid muscle that closes the eye. Protruding fat, which makes “the bags”, is removed from the inner (conjunctival) surface, without touching the muscle from behind. Any excess skin is removed just below the lashes from the front, without touching the muscle on its surface. Thus, muscle function is not disrupted, recovery is quicker, and the chance of temporary dry eyes after surgery is much lower. The “no touch” blepharoplasty is a far superior method to the traditional approach.
Questions about Blepharoplasty
The following are some common questions that patients at our Nashua practice, near Boston, Massachusetts, ask about blepharoplasty, or eyelid surgery.
- “My upper lids don’t open as much as they used to. Does blepharoplasty treat this?”
- Weakening elevation of the upper lids (called “ptosis”) is characterized by a lid that no longer clears the pupil sufficiently when the eyes are open. In some patients, the lid margin rests at the level of the upper pupil, and in others the lid crosses the mid-pupil. In either case, vision is partially obstructed and the eye looks constantly “sleepy.” Ptosis often occurs as an aging change because the tendon that lifts the upper lid can stretch or separate from the lid margin as the tissues age.
These problems can be corrected at the time of the blepharoplasty procedure. While health insurance has covered ptosis repair in the past, it ordinarily no longer does, even if an ophthalmologist has tested the patient’s vision and performed “visual field examinations” that indicate that the patient doesn’t see fully. Even though correction of obstructed vision ought to be insurance reimbursable, it unfortunately almost never is. These are economic decisions, not logical medical decisions, made by the insurance carriers. Nevertheless, ptosis repair can be carried out by itself or in conjunction with upper blepharoplasty and ordinarily produces substantial improvement in the lid appearance and vision.
- “Are there ancillary procedures to eyelid surgery?”
- Eyelid surgery flattens the lower lid, tightens it, and smoothes the excess skin, but the surgery does not remove lines from the skin itself. These separate problems can be improved by good skin care. Many patients choose to continue the skin care program when they see what it can do for their skin, but that is entirely the patient’s option. However, the eyelid skin ages in texture as well as tightness, and you will achieve the best result by treating both problems through skin care as well as surgery.
- “I have had eyelid surgery but still seem to have puffy upper lids. What can be done?”
- The amount of hooding in the upper lid depends partially upon the position of the eyebrow. If you look in the mirror and push your eyebrow down, you will see that the upper lid looks looser; and if you raise it, loose skin in the upper lid often smoothes out, sometimes completely. The eyebrows should normally sit about ½” above the upper edge of the bone that forms the eye socket. If the brows have become droopy with time, the upper lid may appear hooded even if it is smooth; or the position of the eyebrow may make a puffy or wrinkly upper lid look worse than it really is. If the brows are very low, the excess skin over the upper lid is not really eyelid skin but eyebrow skin, and cannot be optimally improved by eyelid surgery alone.
A brow lift done at the same time raises the brow, smoothes the upper lid, and makes the eye look larger. Brow lift (discussed in more detail in our section on Other Facial Procedures) also can reduce frown lines between the brows or smooth the transverse creases that cross the forehead. The procedure is performed through an incision in the hairline or in the scalp and can be done at the same time as eyelid surgery or facelift. Even if a brow lift is performed at the same time as blepharoplasty, both procedures are still done as an outpatient.
- “I have heard that you consider eyelid surgery a “best buy” when you do surgery on the aging face. Why?”
- Pick up a magazine and look at a full-face picture of someone. Notice what area you look at first: It is almost always the eyes. As you scan the face, you may start with the eyes, go to the nose or mouth or look at other areas, but you keep returning to the eyes. When we talk to people or see their faces for the first time, we look into their eyes. Thus, droopy upper lids, sagging of the upper lids, and sagging or puffiness of the lower lids are quickly noticed, even subconsciously. Frequently, patients report to me that, “Everyone says I look tired”: Ordinarily this means that people are looking at their eyes. Even though we may become self-conscious about the neck skin loosening or the appearance of jowls, the eyes tell just as much about aging; and conversely, eyelid surgery can make a disproportionate improvement in the appearance of the face and in the degree of “restfulness” and “alertness” that the face shows. Because eyelid surgery produces such an important change and because recovery is usually short, I consider it a “best buy.”
Many patients are not conscious of the importance of eye appearance when they come for their consultations. They tell me that they have just become dissatisfied with their facial appearance and don’t like the aging changes that they see, so they have come in to ask me about a facelift. When I ask them to describe what they see in the mirror that they don’t like, many will say, “I feel like I look tired all the time.” If this is your case, you may be talking about aging of the eyelids rather than changes in the forehead, cheeks, or neck, even if they are also present.
Because eyelid surgery is an outpatient operation with a quicker recovery and is generally less expensive than a facelift, patients who have significant eyelid changes can often accomplish a great number of their goals by having blepharoplasty, even if the facelift waits for another day. Obviously, it would be optimal to correct everything that needs correction, but that may not be financially or logistically possible for many patients who lead busy lives. That is why a consultation is so important. It will allow you and I to get to know each other, and it gives me an opportunity to find out what bothers you so that the solution can be customized to produce the maximal improvement and achieve as many of your goals as possible, safely and in a manner that respects your priorities and concerns.
The consultation fee for Blepharoplasty (Eyelid Surgery) is $250.00. Dr. Constantian’s surgical fee ranges are:
- Upper Eyelids – $2,300.00 to $2,500.00
- Lower Eyelids – $2,925.00 to $3,500.00
- All four Eyelids – $3,900.00 to $4,545.00
Because Dr. Constantian operates in a hospital setting, the hospital and anesthesia fees are not within his control and may change from time to time. If you would like more information regarding the hospital and anesthesia fees, please call our New Hampshire office.