Blepharoplasty, or eyelid surgery, is a treatment that improves the signs of aging around the eyes. During this type of plastic surgery, a top-rated plastic surgeon in New York City Dr. Gary Linkov removes skin, muscle, and sometimes fat that may be causing the area around your eyes to sag. At City Facial Plastics, located in Midtown, Manhattan, we address changes to the upper and lower eyelids with a blepharoplasty, or eyelid surgery.
What Is Eyelid Surgery?
Eyelid surgery includes a series of procedures that reestablish beautiful eyelid contours and proportions. Eyelid surgery can address the upper eyelid (upper blepharoplasty/ptosis repair) and the lower eyelid (lower blepharoplasty/canthopexy). Each eyelid surgery has its own nuances, approaches, and surgeon preferences. The key is to pick the appropriate approach to compliment a person’s anatomy and clinical situation.
It is equally important to foresee potential complications and avoid them from the beginning. Adjuvant non-surgical treatments such as neuromodulator, filler, chemical peel, and laser resurfacing can compliment eyelid surgery and create a harmonious final outcome.
Beautiful eyes are a fundamental component of the face. They serve an incredibly vital function and are also aesthetically important. As with other facial structures, eye form follows function. By restoring natural eye aesthetics, eye function may also be improved. The most long-lasting eyelid restoration results are achieved with eyelid surgery NYC.
Correct Droopy or Sagging Upper Eyelids
Excess skin on the upper eyelid is a common issue with aging. The skin becomes thinner, stretches and sags. This can make the eyes look tired and even sad. In some cases, drooping upper lids can be so prominent that it becomes difficult to completely see. In these cases, blepharoplasty surgery may even be able to improve vision. Surgery involves removing or repositioning excess skin and/or fat, as needed.
Lower Eyelid Lift for Revitalized Eyes
Under the eye, sagging skin can create bags and wrinkles. This can make you older and tired. A lower eyelid blepharoplasty or eyelid lift plastic surgery removes the excess skin and fat that creates bags under the eyes. This can smooth and tighten the area below the eye for a revitalized and rejuvenated appearance. The incision is usually discreetly placed below the lower lashes.
Complete Eyelid Lift Surgery
In many cases, our patients want both an upper and lower eyelid lift to completely rejuvenate their eyes. Upper and lower eyelid surgery can help open the eyes and reduce the bags and wrinkling. It is common for a brow lift to be combined with a blepharoplasty surgery to improve the overall upper portion of the face.
Who Is a Good Candidate for Eyelid Surgery (Blepharoplasty)?
The following clinical signs are well suited for eyelid surgery (blepharoplasty):
- Excess skin of the upper or lower eyelids
- Excess fatty deposits in the upper or lower eyelids
- Bags under the eyes
- Droopy upper eyelid
- Loose lower eyelid (with the scleral show)
What Makes an Eyelid Beautiful?
These characteristics define a beautiful eyelid, such as:
- Upper lid crease less than 10 mm above the lid margin
- The sulcus below the upper orbital rim does not define the bony margin
- The lateral upper eyelid is free of hooding or skin draping over the lateral orbital rim (no excess skin and good eyebrow position)
- Lack of lower eyelid skin crepiness and wrinkles
- Smooth lower eyelid to cheek transition
- No outpouchings along the eyelids
- The lateral canthal angle is positioned approximately 2 mm higher than the medial canthal angle
What Are the Types of Eyelid Surgery?
The primary types of eyelid surgery include:
- Upper blepharoplasty – Remove and/or reposition excess upper eyelid skin, muscle, and fat
- Lower blepharoplasty – Remove and/or reposition excess lower eyelid skin, muscle, and fat
- Double eyelid surgery – Creating an upper eyelid crease where one did not exist prior
- Canthopexy (or canthoplasty) – Tightening of the lower eyelid
- Ptosis repair – Improving upper eyelid droop by tightening muscle
How Is Eyelid Surgery Done?
Eyelid surgery is performed under local anesthesia or deep sedation anesthesia depending on patient and Blepharoplasty surgeon preference, the extent of the procedure, and if any combination procedures are planned. During every eyelid procedure, the cornea should be adequately protected with a corneal shield. Sterile technique is always maintained.
The basic surgical steps of the five primary types of eyelid surgery NYC are presented below.
- Upper blepharoplasty
Upper eyelid skin is marked in an ellipse leaving adequate distance below the eyebrow and hiding the incision in the upper eyelid crease. The skin between the markings is pinched to confirm that the lash line is not being everted. Next, lidocaine with epinephrine is infiltrated just under the skin. An incision is made through the skin along the marked lines. A scissor is used to remove the skin, leaving the underlying muscle intact. Some surgeons choose to remove a portion of this orbicularis muscle. If the fat pockets need to be addressed then the muscle is split as well as the orbital septum in order to approach these fat pockets. Hemostasis is obtained with bipolar cautery. The upper eyelid surgery incision is carefully closed with suture.
- Lower blepharoplasty
It can be performed through a transconjunctival (internal) or a subciliary (external) approach. Additionally, once the fat is reached it can be removed or transposed over the cheek. Dr. Linkov, as the best eyelid surgeon NYC, prefers the internal approach. Once numbing is complete, the lower eyelid is retracted. An incision is made through the conjunctivae along a horizontal line close to the tarsus. A conjunctival flap is developed and suspended over the corneal shield temporarily. Dissection is performed down over the septum separating it from the orbicularis oculi muscle and palpating down onto the orbital rim. The septum is then cut over the areas of the prominent orbital fat compartments. The fat is then cautiously removed or mobilized and repositioned over the lid/cheek junction. This procedure can be combined with fat transfer as well. The internal incision is usually left open after lower eyelid surgery.
- Double eyelid surgery
Commonly employed for Asian eyelid surgery (upper blepharoplasty) to create a supratarsal crease. After numbing is complete, the inferior limb of the incision is marked – this is where the crease will ultimately be. The ellipse of skin is removed with additional muscle and preseptal tissue removed at the inferior edge. The fat is identified, staying above the levator muscle, and the septum is opened. Once the levator is fully exposed, crease fixation sutures are placed from the inferior edge of the skin down to the levator and out at the superior edge of the skin. The skin is then closed with suture.
- Canthopexy (or canthoplasty)
The lateral canthus can be elevated by passing a suture through a small incision made at the lateral canthal angle and anchored to the orbital periosteum. Placement of this suture provides an excellent means of altering the vertical placement of the canthus as well as of augmenting horizontal fissure length. It allows the canthus to be placed in a variety of positions, supraplaced or infraplaced. As such, it is important to verify symmetry when performing this surgery. More advanced maneuvers that involve cutting of the lower eyelid may be warranted in certain instances.
- Ptosis repair
Often performed at the same time as an upper blepharoplasty. It can be performed using an external or an internal approach. The external approach involves removing a small strip of preaponeurotic/fat tissue to expose the tarsus and levator aponeurosis. A partial-thickness incision is then made into the tarsus. A suture is then placed through the levator and part of the tarsus and tied down. Slight adjustments are made depending on patient appearance. The internal approach involves applying a clamp to include conjunctiva and Muller’s muscle and a suture is secured at one end and run back and forth under the clamp. A cut is made under the camp and the suture is brought out of the upper eyelid to the skin and secured down. The external approach requires patient cooperation during the procedure but can be done through the upper blepharoplasty skin incision. Eyelid ptosis surgery is best performed by a highly experienced oculoplastic surgeon.
How to Prepare for Eyelid Surgery?
Once you have decided to undergo eyelid surgery, the best-in-class plastic surgeon in Manhattan, NY Dr. Linkov will discuss in detail how to prepare for your procedure at plastic surgery clinic.
There are a few steps you should take before your eyelid surgery to get the best results. These steps include:
- Avoiding certain medications and supplements that may thin the blood, such as:
- NSAIDs – ibuprofen (Motrin) and naproxen
- Vitamin E
- Stop smoking, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site
- Pick up medications at a pharmacy if prescribed, such as:
- An antibiotic (oral and topical)
- Pain medication
If you have any dry eye symptoms it is critical that you report that to your doctor. Most eyelid surgeries can worsen dry eye and a thorough eye exam by an ophthalmologist is necessary before any eyelid surgery.
What to Expect on the Day of the Procedure?
On the day of your eyelid (blepharoplasty) surgery at City Facial Plastics in UES, Manhattan, if you are getting deep sedation anesthesia, it is important not to eat or drink 6 hours before your scheduled surgery.
If performed under deep sedation with an anesthesiologist, you will be asked to change into a surgical gown and women of child-bearing age will need to take a pregnancy test. The intake process can take about an hour, the surgery usually takes 1-3 hours, and recovery will be about another hour. If performed under local anesthesia, the area is thoroughly numbed before any incision is made and fasting is not necessary.
What Is the Recovery From Blepharoplasty?
A special eye antibiotic ointment is provided for either use on the skin incision or in the eye, depending on the exact eyelid surgery performed. It is okay to shower the day after the procedure. When lying down, it may be helpful to elevate the head of the bed for at least one week. Light activity is recommended for the first two weeks.
Localized bruising and swelling are expected for 1-2 weeks, with some degree of swelling lingering for months. If non-dissolvable sutures are placed they are removed on day 5-7 after surgery. An external incision can stay red for weeks to months. It is best to avoid direct sun exposure to the treated area for several months after eyelid surgery.
What Are the Risks and Complications From Blepharoplasty?
The risks and complications after eyelid surgery (blepharoplasty) include:
- Corneal abrasion
- Poor scarring
- Undesirable aesthetic result
- Nerve damage
- Vision changes
- Lagophthalmos (incomplete eye closure)
- Lacrimal gland injury
- Sulcus deformity
- Canthal webbing
- Suture granuloma
As you can see, many issues can arise from eyelid surgery. It is important to choose the best blepharoplasty surgeon NYC who understands these potential problems and has strategies in place to avoid such eyelid surgery complications.
What Are the Contraindications for Eyelid Surgery?
There are patients who may not be good candidates for elective eyelid surgery, including:
- Blood thinners that cannot be stopped
- Medical conditions not suitable for anesthesia
- Dry eye
- Unrealistic expectations
What Are the Alternatives to Eyelid Surgery?
There is no true replacement for eyelid surgery in the correct setting. However, complementary treatments that address the skin, muscle, or volume loss may be beneficial. These include:
- Filler (hyaluronic acid or fat transfer)
- Chemical peel
- Laser resurfacing
Are Patients Satisfied After Blepharoplasty?
Lifelong satisfaction is possible after blepharoplasty NYC. A study in 2017 of 45 patients (90 eyelids) found that all patients were satisfied with the postoperative result and would undergo the surgery again if they had to make the choice again. As with any surgery, proper patient selection is key.
Can eyelid surgery improve vision?
Yes. Sometimes upper blepharoplasty surgery improves your vision by creating a less obstructed field of view after the excess skin or droopy eyelids are corrected (droopy eyelid surgery). If you have concerns about your vision it is best to get a baseline vision assessment before eyelid surgery, in order to properly compare it to your vision after surgery.
Can Eyelid Surgery Be Done in the Office?
Yes. Some types of eyelid surgery (such a skin-only upper blepharoplasty) are amenable to being performed in the office under local anesthesia with or without oral sedation. However, other eyelid surgeries (transconjunctival lower blepharoplasty) are best done in the operating room setting under deep sedation for a more controlled surgical setting and improved patient comfort.
Is Eyelid Surgery Covered by Insurance?
Sometimes. Insurance will not cover eyelid surgery, or blepharoplasty, done for cosmetic purposes only. If symptoms exist, such as poor vision or other functional problems, then your health insurance carrier might cover the expense.
You will need a thorough vision screen with an ophthalmologist before eyelid surgery to be considered for insurance coverage. Check in advance with your insurance provider regarding the details of your healthcare plan. Please keep in mind that top-rated plastic surgeon in New York, Dr. Linkov is an out-of-network provider, but does offer financing options.
What Is the Cost of Eyelid Surgery in Manhattan, NYC?
If you are paying out of pocket, the eyelid surgery cost will vary based on several factors. Practice location and expertise of the surgeon are two of the main factors that will determine how much blepharoplasty will cost. Additionally, often eyelid procedures are combined which may raise the total price. Anesthesia and facility fees also contribute to total costs. In New York City, the cost range for eyelid surgery, including upper and lower blepharoplasty separately, is $3000-$10000 per procedure.
Who Is the Best Eyelid (Blepharoplasty) Surgeon in NYC?
Dr. Gary Linkov is a board-certified facial plastic surgeon in New York, specializing in facial aesthetic surgery. Dr. Linkov is the best specialist with extensive experience treating all conditions of the head and neck. He is the Chief of Otolaryngology and Facial Plastic Surgery for the Veterans Hospital in Brooklyn, NY, where he operates on complex facial conditions impacting our country’s veterans.
Dr. Linkov’s private practice in New York City focuses on cosmetic and reconstructive facial surgery, including most types of eyelid surgery (upper blepharoplasty, lower blepharoplasty, double eyelid surgery, and canthopexy).
Eyelid Surgery (Blepharoplasty) Before and After
If you have eyes that look tired, sad or aged due to sagging upper or lower eyelids, contact City Facial Plastics today at our Manhattan’s Upper East Side office to schedule an eyelid surgery consultation. Dr. Linkov is an experienced facial plastic surgeon in New York who can create incredible results to rejuvenate your eyes.