Eyelid Surgery (Blepharoplasty): What You Need to Know?

Eyelid Surgery (Blepharoplasty): What You Need to Know
Eyelid Surgery (Blepharoplasty): What You Need to Know


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Learn about upper and lower eyelid surgery (Blepharoplasty)  from Lisa Ishii, a Johns Hopkins facial reconstructive and plastic surgeon.

Lisa Ishii, MD, M.HS
Lisa Ishii, MD, M.HS
Eyelid Surgery: 6 Things You Need to Know

What are the treatment options for puffy eyes?

Treatments for puffy eyes, and that’s typically when we’re referring to patients who say they feel like they have bags under their eyes.
Which typically is a result of the fat around the eyeballs starting to poke through the skin a little bit.
Many times this is a genetic problem, so patients can identify other members of their family, like their parents who have had a similar problem.
There are two different ways that one can treat puffy eyes.
The first method is to inject a filler underneath where the fat is poking out, to basically smooth the puffiness, so that there’s a smooth contour from the lower eyelid to the cheek.
The alternative method is to remove the fat with surgery with a procedure that’s called the lower eyelid blepharoplasty.
Either of those options are good options, depending on the patience situation and what they desire.
There are some patients who present with one important event that they want their face to look fantastic for like a wedding.
And for them, they want a simple option appreciating that it’s going to be a temporary solution, that if they want to maintain it they will need to do it again in the future.
There are other patients who have as their frame of mind, that they want one intervention that they can do at a single point in time, and be done with it.
And for those patients, surgery is a better option.
Either option can achieve a very good result, obviously depending on the patient’s particular anatomy.

Can upper eyelid surgery be done under local anesthesia?

Upper eyelid surgery is very often done with just local anesthesia. It’s one of the reasons that it’s one of my absolute favorite procedures to perform.
So, that means that we can do it in the office many times with the patients awake.
I simply numb up their upper eyelids and then perform the surgery, which is typically to remove the skin and fat of the upper eyelids to improve the overall appearance.

Upper and lower eyelid incision line
Upper and lower eyelid incision line

What is recovery like after eyelid surgery?

The recovery from eyelid surgery, either upper eyelid surgery or lower eyelid surgery, is generally a very easy recovery.
The one problem with it is that most patients will get bruising around the eyes.
So from a cosmetic standpoint, they’ll have to be aware that people who see them, their friends, their family, their colleagues at work will see some bruising.
From a pain standpoint, most patients have no pain at all.
Most patients don’t take any pain medication besides, perhaps, a Tylenol or an Ibuprofen immediately after the procedure.
Another one of the reasons that it’s one of my favorite procedures, both upper and lower eyelid surgery, is because the impact that one gets on their appearance when they have those procedures, as compared to the recovery, which is a very easy recovery, is dramatic.
So, in terms of bang for the buck, in terms of time for investment of time and money, the outcomes are amazing.

Can upper eyelid surgery be billed to insurance if one’s vision is impacted?

Many patients are delighted to hear that if their upper eyelid skin is hanging so much that it’s blocking their vision, then their insurance company will consider it a medically necessary procedure that they’ll pay for.
They’ll have a visual field exam by an Ophthalmologist or an Optometrist that will show that indeed, the upper eyelid skin that is in excess is blocking their vision.
So, for those patients we’re able to submit that to the insurance company, we’re able to treat them, improve their vision.
And as a nice bonus, improve their appearance as well.

If I only do my eyes, will my face look mismatched without an entire facelift?

Many times, patients will ask me if they need to treat all portions of their face at the same time.
They’re concerned that if we address only their eyes, for example, then their face will appear mismatched with other areas of their face looking older.
That’s absolutely not the case.
Many times, we’re able to address just one area of the face, and in particular the eyes.
For different people, the aging process occurs differently.
Some patients experience more aging around the jawline and the neck.
Other patients experience more aging changes around the eyes.
And certainly, what bothers patients about the aging changes will differ based on the patients themselves.
So, it’s absolutely the case that there is not a one size fits all for all patients.
And we’ll tailor our interventions based on what it is that the patient desires, and what we think we can achieve for them with the treatment plan that we develop together.

After my recovery, will people be able to tell I have had cosmetic facial surgery?

The goal with all of our facial rejuvenation procedures, including eyelid surgery (blepharoplasty), is to achieve natural looking results.
What we want is an improved, fresher you.
We don’t want you to look different.
What we want is for you to look rested and happy.
And like, things are going very well in life.
And so, our patients are very pleased with what we’re able to give them in terms of very natural looking results.
In other words, if someone knows that you have had a procedure, then it wasn’t a good procedure.

Eyelid Surgery before and after photo
Eyelid Surgery before and after

See more articles about plastic surgery.

Lisa Ishii, a Johns Hopkins facial plastic and reconstructive surgeon.

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