Given his training as a facial plastic surgeon, Dr. Shome is truly a cosmetic eyelid specialist. The eyes and eyelids are the center of facial appearances and eyelid surgery is the most critical and detailed type of facial plastic surgery. Blepharoplasty is the repositioning or removal of soft tissue from the upper or lower eyelids.
Upper eyelid blepharoplasty surgery is performed through a cosmetic lid crease incision allowing the surgeon to reshape the contours of the upper eyelid. Removal of redundant skin allows makeup to be used more effectively and brings out the natural beauty of the human eye. Many patients have furrows or worry lines between the eyebrows that can be surgically improved at the same time the upper blepharoplasty is performed.

Lower lid surgery is usually performed from a hidden incision on the inside of the eyelid. Fat bulges in the lower eyelid can be sculpted and repositioned to give a more youthful, rested appearance. Filling in the hollows in the lower eyelids also assist in resolving dark circles. Brown spots and fine wrinkles can be refined from the lower eyelids with a TCA peel or resuspension of the lower eyelids with a pleasing uplift to the outside corner.

Frequently asked questions about Cosmetic Blepharoplasty and Cosmetic Eyelid Surgery:

1) Will my insurance pay for eyelid surgery?
Insurance will often pay for eyelid surgery that is performed to improve your vision. For instance if your upper eyelids are drooping and this is blocking your vision your insurance company may pay for upper eyelid surgery. If the upper eyelids are blocking vision insurance companies require a visual field test be obtained to demonstrate that the eyelids block the peripheral vision and that the vision is improved by elevating the eyelids. If your lower eyelids are droopy and this is causing eye irritation or watering of the eyes, your insurance company may pay for correction of this problem. Insurance companies typically require that the medical need be documented with photographs which are reviewed by the insurance company during the preauthorization process. Some problems like bags in the lower eyelids do not affect vision and are never paid for by insurance companies. Other problems like excess skin in the upper eyelids effect vision when severe enough and are paid for by insurance companies when photographs and visual fields document a medical need for the surgery. The Esthetic Clinic is glad to act as your advocate to help get your insurance company to pay for medically necessary procedures. Many of the procedures we perform are done only to improve appearances and these cosmetic procedures are not paid for by your insurance company.

2) Can ptosis of the upper eyelid or droopy lower eyelids that cause eye irritation be addressed at the same time that cosmetic eyelid surgery is performed?
Yes. It is very common for patients to have surgery done to improve function at the same time that cosmetic surgery is done. The portion of the surgery that is done to improve eyelid function may be covered by your insurance company.

3) Is an incision made in the skin when performing upper eyelid blepharoplasty surgery?
Yes. In nearly all cases of upper eyelid blepharoplasty surgery there is excess skin in the upper eyelids. Removal of this excess skin is only possible with an incision in the upper eyelid. Fortunately the skin of the upper eyelid is some of the thinnest skin in the body and typically heals with little or no scarring. Furthermore, the incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing. We often use absorbing sutures that do not require removal.

4) Is fat removed from the upper eyelids when upper eyelid blepharoplasty is performed?
The tendency is to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give one a hollow appearance that is not desirable. Often the fat pad in the upper eyelid adjacent to the nose is bulging forward and is reduced in size at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance.

5) Can the eyebrows be lifted or the lines between the eyebrows removed with upper eyelid blepharoplasty surgery?
Yes.

6) Is an incision made through the skin of the lower eyelids when performing lower eyelid blepharoplasty surgery?
Typically not. Most patients with bags in the lower eyelid have little or no extra skin in the lower eyelids. The bags are typically caused by extra fat or fat that is positioned abnormally. If skin is removed from the lower eyelid when there is no extra skin to be removed it will pull down the lower lid so that the whites of the eyes show between the lower lid and the colored part of the eye. This is called lower eyelid retraction. Lower eyelid retraction is actually a sign of aging and creating this problem with surgery makes one look older. Lower eyelid retraction from removing skin from the lower eyelids during blepharoplasty surgery is probably the most common complication of facial plastic surgery. Many celebrities who have been labeled as having a “bad face lift” actually had too much skin removed from the lower eyelids. Next time you see a celebrity who is labeled as having a “bad face lift” or not looking like themselves after face lift surgery look at the lower eyelids for the signs of lower eyelid retraction. Lower eyelid retraction can be avoided in most cases by not making an incision through the skin of the lower eyelid and by not removing skin from the lower eyelid.

7) I have wrinkles and texture changes in my lower eyelid skin. Shouldn’t this be corrected by removing skin from the lower eyelids?
Patients often have wrinkles or texture changes of skin of the lower eyelids. Texture changes cannot be improved with removal of skin from the lids without causing eyelid retraction. They can often be safely improved by performing a TCA chemical peel at the same time as the lower eyelid blepharoplasty surgery is performed.

8) Is removal of skin from the lower eyelids ever warranted?
Removal of skin is done when there is so much excess skin in the lower eyelid that it cannot be tightened with a chemical peel.

9) Where is the incision made to correct bags in the lower eyelids?
The incision is made through the pink tissue on the back side of the lower eyelids. Using this incision site the surgeon can remove excess fat in the lower eyelids or reposition the lower eyelid fat into the dark circle in the lower eyelid. This incision is hidden behind the lower eyelid and is not visible when healing.

10) Does lower eyelid blepharoplasty surgery simply involve removing fat from the bulges in the lower lids?
It is often more complicated than that. Well done cosmetic eyelid surgery needs to correct all of the problems that have occurred with facial aging to make the lid look more youthful. Some patients only have extra fat in the lower eyelids. This is typically not an aging change as it is first noted as early as high school. This tendency to develop eyelid bags at a young age tends to run in families. In these patients fat removal alone can often correct the entire problem. However, most patients develop bags in the lower eyelids as a result of facial aging. In this situation the changes that need to be addressed are more complicated than simply removing fat from the lower eyelids. Simply removing fat from the lower eyelids of an aging face can cause a hollow appearance and hollow lower eyelids make one look older, not younger.

11) What is the relationship between dark circles in the lower eyelids, bags in the lower eyelids, and facial aging?
A number of changes may occur in the lower eyelid that causes bags and dark circles. A young normal lower eyelid is full, short, and has no dark circle under it. With aging of the face the fat from the cheek and the lower eyelid separate. This occurs because the cheek descends or droops with aging which makes the lower eyelid look longer and allows the eyelid fat to moves forward. This creates an empty space between the fat of the lower eyelids and the fat of the cheek just at the edge of the bone along the lower eyelid. The situation can be described as two mountains separated by a valley. The first mountain is the bulging lower eyelid fat. The second mountain is the drooping cheek fat. The valley lies between. We are normally in overhead lighting so that the bulging fat of the lower eyelid creates a shadow in the valley making it appear like a dark circle at the intersection of the cheek and lower eyelid. This can be tested by illuminating the lower eyelid with a flashlight while observing in a mirror. If the flashlight is pointed directly at the lower lid the dark circle nearly disappears in most patients because the lower lid is no longer casting a shadow. In some patients of color there is a real deposition of pigment in this area that will still be observed when doing the flashlight test.

12) How can lower eyelid blepharoplasty surgery correct bags and dark circles?
The operation needs to be customized to the patient. In most patients the result is best if the drooping lower eyelid fat is transposed as apposed to removed. In some patients the result is even better if the drooping cheek or midface is also lifted.

13) What is fat transposition?
Fat transposition involves moving fat from the eyelid into the valley between the cheek and the eyelid. In other words, the fat from the lower eyelid is moved down to fill in the dark circle.

14) Where is the incision made to lift a drooping cheek?
This varies from patient to patient, but it may be made either in the upper eyelid, the lower eyelid, or behind the temporal hair line. You should discuss this with the doctor.

15) What is involved in recovery from eyelid surgery?
Recovery varies on the exact procedure performed and the individual patients. Generally, eyelid surgery results in bruising and swelling of the eyelids. We ask that patients plan on being at home on the day of surgery and two additional days. During these first days ice is applied to the eyelids to reduce bruising and swelling. After the third day most patients can drive a car and get about without much difficulty. We ask that patients avoid heavy lifting and strenuous exercise for two weeks after the procedure. Most patients will wear sunglasses for 2-3 weeks to hide bruising and swelling. The Center for Facial Appearances will provide you with detailed written instructions prior to your procedure.

16) What is double eyelid surgery?
Asian patients have slightly different anatomy than occidental patients. Some Asian patients are born with a fold in the upper eyelid and others are not. When the fold is present, it is called a double eyelid. The fold in the upper eyelid of Asian patients is much nearer to the eyelashes than it is in the occidental eyelid. It is often said that Asian patients wish to have their eyelids westernized. In our experience, Asian patients seeking double lid surgery want their eyelids to look like those Asian patients that are born with a fold in the eyelid and do not wish to have their eyelids look like occidental or western eyelids. This form of cosmetic eyelid surgery is performed at the Center for Facial Appearances. If you are considering this type of surgery it is very useful to bring a photograph of a model with eyelids with the appearance you hope to achieve.

17) Can eyelid surgery cause complications?
Yes. All medical procedures have some risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed.