Concept - Blepharoplasty procedures may be done to both the upper and lower eyelids. The problems associated with the eyelids are usually related to excessive, environmentally damaged skin and also protrusion of periorbital fat around the eyes secondary to weakening of the fascial structures that maintain the position of the fat. The lower lid fat pads are also accentuated by the descent of the midface. In some cases, operating on the lower eyelids is inappropriate and creates a sunken appearance beneath the eyes. These are patients that should consider a mid-facelift. This situation is typical when the distance from the lid margin to the cheek pad is significant and the patient has shallow orbits.

As we age, the upper eyelids descend and shroud over the lashes. In some cases, this obstructs the visual fields. When a significant proportion of the visual fields are obstructed, insurance may cover the cost of the blepharoplasty. In most cases, a simple procedure may be done under local anesthesia which excises the excess skin and protruding fat pads.

Blepharoplasty

Blepharoplasty
Before	After

Transconjunctival Blepharoplasty

Lower eyelids may be approached through direct incisions along the lid margin followed by removal of the periorbital fat pads or through the conjunctival surface of the eyelid , leaving no external scar.
Transconjunctival Blepharoplasty - Before	Transconjunctival Blepharoplasty - After	Surgical Approach

Laser Blepharoplasty

In addition to excisional surgery, laser blepharoplasty may also be performed in the office under local anesthesia. This involves using a CO2 laser to smooth and tighten the eyelid skin hand to vaporize the periorbital fat.

Laser Blepharoplasty
Before	After

Recovery - there will be swelling and bruising for 1 week. Full mobility of the lids may not return for 3 to 4 weeks.

Return to Work - 1 week

Full Activity - 1 week

Complications - Bleeding, infection, scar, ectropion(pulling the lower eyelid down), double vision. There have been rare cases of blindness in patients with uncontrolled hypertension and diabetes.

Endoscopic Brow Lift

Concept - When it is a combination of redundant eyelid skin and ptosis of the eyebrows, an endoscopically assisted browlift may be a better answer.

This procedure lifts the brows and eyelid skin that is redundant secondary to the brow ptosis. The additional advantage is that glabellar frown lines may be diminished, minimizing the severe, tired look that occurs with age and eye strain.

Surgery - This surgery is performed as an outpatient procedure under anesthesia. This is done endoscopically; no hair is cut or removed.

Recovery - 1 week

Return to Work - 1 week

Full Activity - 4 weeks

Complications - Relapse. loss of feeling of forehead or scalp, small area of hair loss near scars.

Endoscopic Brow Lift
Before	After