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.

No-Touch Blepharoplasty

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?”
“Are there ancillary procedures to eyelid surgery?”
“I have had eyelid surgery but still seem to have puffy upper lids. What can be done?”
“I have heard that you consider eyelid surgery a “best buy” when you do surgery on the aging face. Why?”


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.

Contact Our Practice

Contact our office in Nashua, north of Boston, Massachusetts, to learn more about blepharoplasty or to schedule an eyelid surgery consultation with Dr. Mark Constantian.

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