Eyelid surgery – Blepharoplasty

Eyelid surgery – Blepharoplasty

Upper and lower eyelid surgery

The most common cosmetic/aesthetic face surgery procedures include modification of the eyelids (called “Blepharoplasty“). The skin of the upper and lower eyelid is the thinnest on the body. This area, which is exposed to extreme strain due to facial expressions, therefore shows visible signs of ageing rather early compared to other parts of the face.

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Drooping upper eyelids are due to many external and internal factors including bad lifestyle, smoking or large weight loss; inner factors include genetic predispositions, hormonal disorders and, last but not least, age. Swollen eyelids and lower eyelid “bags”, so called “fat prolapse”, are fat pads pushed out of the orbit through the thin membrane right into the area of eyelids.

Examples of eyelid surgery


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How is eyelid surgery performed?

The upper eyelid surgery consists in removing excess skin (sometimes including the muscle) and fat pads, if they are prominent. The procedure is usually performed only under local anaesthesia.

Lower eyelid surgery consists mainly in removing fat pads and strengthening of the orbicularis oculi muscle. Only small strip of the skin is removed due to possible postoperative complications associated with more radical approaches. Lower eyelid surgery can be performed with conventional method or with CO2 laser beam in transconjunctival blepharoplasty.

Skin incisions are made so as to be as little noticeable as possible – ie., in the inward bend of the upper eyelid in upper blepharoplasty or just below the lashes in case of lower eyelid surgeries. They are usually directed laterally to merge with mimic wrinkles. Stitches are usually removed 5-7 days after the surgery according to the surgeon’s practice.

Types of blepharoplasty:

  • Upper eyelids surgery
  • Lower eyelids – Transconjunctival blepharoplasty with laser
  • Lower eyelids – conventional surgery

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UPPER eyelids surgery

The upper eyelids usually present dominant, large skin excesses, which may even protrude and hang over the inside corner of the eye. Upper eyelid surgery is performed under local anaesthesia and takes about 50 minutes.


During the upper eyelid surgery a delineated strip of the skin is resected using a normal scalpel or laser; the width of the strip is usually 10-20 mm. In the created open surgical field, the orbicularis oculi muscle must be cut lengthwise at the inside corner of the eye to gain access to the fat pads pushing from below. This way they can be fairly easily removed. The muscle is then sutured with a very delicate, absorbable fibre. To improve the contour of the outer half of the upper eyelid, corrective surgery of the orbicularis oculi muscle is carried out.

As the last step in the upper eyelid remodelling, sutures are applied to the skin cover of the eyelid using a thin nylon fibre. The resulting scar is located in the natural crease of the eyelid. Stitches are usually removed after 5-7 days according to the surgeon’s practice.

Sometimes it is appropriate to combine upper eyelid surgery with lower eyelid laser surgery or conventional surgery. Upper eyelid surgery is also often performed during eyebrow surgery or facelifting.

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lower eyelids – transconjunctival blepharoplasty with laser

The lower eyelid plastic surgery involves removal of the fan-shaped wrinkles and the fat pads pushing from below that protrude and change the shape of the area.


Laser scalpel is used to make an incision through the mucosa of the lower conjunctival sac, approximately 20 mm long. In this way it is possible to gradually and very easily penetrate down to the depths where fat bodies are located in three chambers and remove the fat pads. The conjunctival mucosa is then only sealed; there is no need for suture.

Laser beam is used for treatment of wrinkles: it can refine or smooth wrinkles and furrows and increase the flexibility of the skin covering the treated areas.

Transconjunctival lower eyelid blepharoplasty is performed under short general anaesthesia. Surgical treatment of both lower eyelids takes less than 30 minutes.



CO2-laser beam with adjustable levels of penetration is used to cross the inner mucosa of the eyes and remove excess fat from the fat body under the lid. CO2 laser beam also carefully vaporizes (peels) the top layer of the skin, restoring its surface and finely smoothing the lower lid.


Laser method is a modern and efficient method of smoothing wrinkles around the eyes delivering excellent aesthetic results. Compared to conventional surgery of lower eyelid surgery, CO2 laser beam offers numerous advantages – the main are these:

  • precision
  • virtually no bleeding
  • lesspost-operative pain
  • minimal swelling and bruising
  • quick healing
  • no visible scars

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After the blepharoplasty, patient should remain under strict bed rest, lie in the supine position, keep the head higher and apply sterile cooling eye pads and elastic compression band for the night until swelling of the eyelids subsides.

A laser surgery further requires administration of eye ointment or eye drops into the conjunctival sac for a few days after the procedure.

WHAT ARE RESULTS OF the surgery?

Outwardly, slight reddening of the skin is visible for several weeks, which, however, can be easily covered with make-up. There are no visible scars.

The outcome of the surgery is that “bags” under the eyes disappear, wrinkles are smoothed, eyelids lifted and the skin around the eyes has a generally younger appearance.

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lower eyelids – conventional surgery

Lower eyelid surgery consists mainly in the removal of protruding skin and strengthening of the orbicularis oculi muscle. Upper and lower eyelids can be reshaped during one procedure; it always depends on the discretion of an experienced plastic surgeon which has assessed the case.

During the eyelid surgery only a very limited part of skin is removeddue to possible postoperative complications associated with a more radical approach.


Skin incisions are made so as to be as little noticeable as possible, below the eye lashes. Conventional surgery of the lower eyelids is performed under local anaesthesia.

However, it is rather unpleasant and leaves scars below the eye-lashes in the outer corner of the eye. Moreover, it is associated with a range of post-operative complications. Therefore rather transconjunctival blepharoplasty is recommended.


After the blepharoplasty, patient should remain under strict bed rest, lie in the supine position, keep the head higher and apply sterile cooling eye pads and elastic compression band for the night until swelling of the eyelids subsides.

Bruises around the eyes are usually not noticeable, post-operative pain can be normally managed only by applying iced eye pads and administering standard analgesics. It is recommended that the patient avoid strenuous activity for 1 week after the lower eyelid surgery.

Stitches are removed 5-7 days after the surgery. After removing the stitches, eyelids are treated with ointment for several weeks and it is recommended that the scars be gently massaged.

The patient is able to fully return to their normal activities already after 2 weeks, sports and physical exercise is permitted 1 month after the surgery. In women, facial cosmetics can be used about 14 days after the surgery.

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