Am I a Good Candidate for Upper or Lower Eyelid Surgery?
Are you often asked if you’re tired because of how your eyelids look, even though you feel well-rested?
Over time, the tone and shape of your eyelids can change. Whether a result of aging, genetics, or sun exposure, any or all of these factors can cause your upper eyelids to become puffy or droop over your eyes. Similarly, your lower eyelids may become puffy and swollen looking. This can, in serious cases, affect your vision or the health of your eyes and make you a good candidate for eyelid surgery.
This type of surgery is called blepharoplasty, and it removes the excess eyelid skin or fat that obstructs your vision in order to expand your field of view. It has helped many Dean McGee Eye Institute (DMEI) patients not only see better but feel better with their new, youthful appearance.
If you’re interested in learning more, DMEI’s Nathan W. Blessing, MD and Jeremy F. Tan, MD, who both specialize in ophthalmic plastic and reconstructive surgery as well as eyelid and facial cosmetic treatments, are sharing answers to commonly asked questions about eyelid surgery.
What Symptoms May People Notice Before Eyelid Surgery?
There are several telltale signs you may start to experience before seeking eyelid surgery.
“Patients may feel there is a weight they have to lift off their eyes so they can see,” Dr. Tan explains. “You may even get some headaches toward the end of the day from using your forehead muscles to lift the weight of the lids out of your line of sight.”
Other physical signs that may indicate a blepharoplasty is necessary include crepey skin (skin that is thin and finely wrinkled) that touches the lashes, upper or lower eyelid puffiness, or droopiness, especially in the outer corners of the eyes.
What Conditions Can Cause Someone to Need Upper Eyelid Surgery?
Most conditions requiring upper eyelid surgery involve extra skin due to aging, or puffiness that blocks your peripheral vision. Others may include:
- Blepharoptosis (Ptosis) – Most commonly age or genetic-related weakness or stretching of the eyelid lifting muscle.
- Brow Ptosis – Age or genetic-related descent of the brow tissues at rest.
- Lid retraction or lagophthalmos – Lids that open too wide or won’t close as a result of conditions such as thyroid eye disease, trauma, or previous surgery.
What Conditions Can Cause Someone to Need Lower Eyelid Surgery?
Conditions requiring lower eyelid surgery slightly differ from upper eyelid surgery. According to Dr. Blessing, those who experience lower eyelid puffiness or bags under their lower eyelids are the best candidates for lower eyelid blepharoplasty. Those with lower eyelids that droop to the point where there is excessive white of the eye between the iris (the colored part of the eye) and the eyelashes are also candidates for surgery, particularly when accompanied by ongoing tearing, redness, and irritation.
“Additional situations may include eyelids that won’t close all the way as a result of aging or prior surgery,” Dr. Blessing explains. “Or if a lower eyelid turns in (entropion) with the lashes rubbing against the front of the eye or out (ectropion), causing watering or irritation.”
Dr. Tan adds that lower eyelid conditions are mostly age-related. These issues are caused by the thinning or weakening of the normal tissue that holds the normal eye socket fat and eyelids in place, along with the loss of volume of the normal fat pockets of the cheeks.
Do Most Candidates Qualify for Eyelid Surgery Using Insurance?
We recommend all patients come in for a consultation to determine if your surgery will be covered.
“Most candidates qualify for eyelid surgery that addresses issues with eyelid function or issues affecting vision,” Dr. Blessing says. “Cosmetic upper and lower eyelid surgery is not covered by insurance. However, a careful examination can distinguish between functional and cosmetic issues.”
Why Are Brow Lifts Sometimes Recommended with Eyelid Surgery?
The eyebrows are intimately connected to the function and appearance of the upper eyelids and should be addressed when discussing upper eyelid surgery. Dr. Tan explains that the brows set the stage of the upper eyelid, and if someone truly has brow ptosis, eyelid surgery alone will not address the weight and excess tissue being contributed by the brows.
“Some people will subconsciously elevate the brows to lift the excess skin blocking their peripheral vision,” he says. “Once the excess skin is removed, their brows may relax, descending to a lower resting position.”
What Can a Patient Expect During Their Consultation?
You can expect a full inspection of your eyes during your consultation. We will look for any problems with your eyelids or brows that may be causing interference with your vision.
“We will check for normal eye functioning parameters (vision, intraocular pressure, etc.) and take a full medical history,” Dr. Blessing says. “We will also take photos and perform visual field testing or testing with drops to support insurance approval for surgery.”
During your consultation, you will also be examined by your physician for any underlying ophthalmic issues. Any eyelid or related oculoplastic issues will also be discussed, along with the risks, benefits, and alternative treatment options.
Following your consultation, an individualized plan of action will be put in place. This is when we will decide if surgery, laser treatments, or other in-office procedures may help you reach your goals.
“You will then meet with our assistant team to discuss logistics of when and where the surgery will take place, insurance involvement, price estimates, and go over which procedures you would like to proceed with,” Dr. Tan says. “Then we will see you on the day of surgery, but we are always available for more questions or clarifications in the meantime and after the procedure.”
What Is the Recovery Process Like Following Eyelid Surgery?
As far as the recovery process, we call all patients approximately 24 hours after surgery to check in. We will also make an appointment to see you within four to 10 days. Recovery following a blepharoplasty typically consists of bruising and swelling (although this will vary depending on the patient and surgeon) that should resolve within 10 to 14 days.