The eyes are the window to the soul, and are the first thing we notice when meeting another person. Our eyes are so important in creating a first impression that they may mean the difference between a friendly encounter and none at all. Dr. Enzer’s years of specialized training as an ophthalmologist and oculoplastic plastic surgeon give him an unparalleled advantage in treating concerns such as heavy lids, drooping brows, or bags under the eyes, and will work with you to achieve the youthful look you desire.
Upper eyelid surgery
If you suffer from heavy upper eyelids, you may notice that people always say you look tired. You may even have to raise your eyebrows in order to see, but by the end of the day your eyes won’t stay open. When it comes to your upper eyelids, there are three possible reasons that may be causing your lids to be heavy: excess upper eyelid skin, a weakened muscle to raise the eyelid margin, or drooping brows. Dr. Enzer will evaluate each of these components and recommend one or more procedures for you.
Upper blepharoplasty involves the surgical removal of excess skin and fat tissue to give a more rested and youthful appearance to the eyes. Dr. Enzer prefers to use the carbon dioxide laser instead of a scalpel to perform the surgery in order to reduce bruising and speed healing time. Dr. Enzer has helped develop and perfect the techniques for this procedure, and has taught his techniques to hundreds of other doctors, both nationally and internationally.
A lower blepharoplasty can reduce puffiness under the eyes from fat bulges. Typically this is performed with a laser to reduce swelling and bruising. Dr. Enzer performs the majority of his lower blepharoplasties with a transconjuctival (inner eyelid) approach. This ensures that there are no scars on the skin, and minimizes the risks of the lids getting pulled down from scar tissue.
Eyelid tightening is a surgical procedure that corrects sagging or drooping lower eyelids. It can also convert a sad, rounded, or sagging eyelid appearance to a more youthful almond-shaped eye. Many lower blepharoplasty patients benefit from this additional procedure because it tightens the lids better against the eye. Eyelid tightening can also help alleviate puffiness and dark circles under the eyes, and is often combined with mid-face lifting.
Frequently asked questions
During upper blepharoplasty surgery, incisions are made in the natural folds of the eyelid so the incisions are virtually unnoticeable after they have healed. The procedure is usually performed at an outpatient surgical facility, meaning there is no overnight stay.
Most of the time, upper blepharoplasty surgery is done with local anesthesia and intravenous sedation, or “twilight” anesthesia. This means that the patient will have little or no awareness of the procedure, similar to a colonoscopy. General anesthesia is sometimes used if multiple procedures are being done together, or if Dr. Enzer anticipates a complicated surgery. A minority of patients can tolerate the procedure fully awake in our office, meaning there is only local anesthesia (no twilight anesthesia). This can allow for significant cost savings.
Similarly to an upper blepharoplasty, a lower blepharoplasty is usually done under twilight anesthesia at a local outpatient facility, meaning there is no overnight stay. Eyelid tightening procedures are performed under local anesthesia in an outpatient facility.
An upper or lower blepharoplasty usually takes less than one hour, and then the patient is brought into the recovery room. If you are interested in additional procedures that will complement the eyelid surgery, such as laser resurfacing or mid-face lifting, this may add to the total time of the procedure. Talk with Dr. Enzer about your options.
Immediately after eyelid surgery, patients are likely to have very mild pain, swelling, and bruising. The majority of the swelling will have gone down within 48 hours, and bruising is typically gone in 1 to 2 weeks. Most patients return to their full social and work activities within two weeks after the procedure.
Every medical procedure has risks. There are general risks, such as pain, bruising, or reaction to medication. Specific to eyelid surgery, our main concern is to avoid changes in eyelid shape and get the best symmetry possible. Most incision marks are barely noticeable after healing is complete, since the incisions are either made in the natural folds of the eyelid or inside the eyelid (transconjunctival approach). Over or under correction is also a consideration that we work hard to avoid. It is important to keep these risks in mind and balance them against the benefits of the procedure while making your decision. Finally, there are very rare but serious risks such as anesthesia complications, infection, bleeding, loss of vision, double vision, or inability to close the eyes.
For upper blepharoplasty surgery, some patients may be eligible for insurance to cover the costs of the procedure. In that case, the main goal of the surgery is not cosmetic, but to improve the blockage of vision due to heavy eyelids. The difference between what is considered cosmetic and what your insurance company may cover, as well as what you could expect from each of the two approaches, will be defined during your consultation.
When it comes to insurance coverage for lower eyelid procedures, insurance companies only cover lower eyelid procedures that horizontally tighten the eyelid margin and/or repair margin malpositions, such as ectropion or entropion. These procedures are only covered if the patient is having eye problems. Insurance companies generally do not cover cosmetic procedures such as lower blepharoplasty.