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Eyelid Surgery (Blepharoplasty)

FaceliftFor many people, the first signs of aging occur around the eyes. This can be dark circles, hollowness, sagging skin, or eyelid bags – and can make you look tired or even sad. Aesthetic issues with the eyelids are not always related to age, however, and actually can be hereditary in some patients. Countless creams, lotions, and serums are marketed for eyelids and upper cheeks, but these frequently fall short because they really only treat the skin surface rather than the deeper problems in the tissue.

Eyelid surgery can be used to treat a wide variety aesthetic and functional issues in the eyelid and surrounding tissues. Some examples include excess upper or lower eyelid skin, fat bags or sagging lower eyelids, uneven or droopy upper eyelids, and hollow areas under the eyes. Multiple different surgical techniques exist and can be tailored for your specific concerns. Rejuvenation of the eyes can make you look younger, healthier, and more rested. If the eyes really are the window of the soul, why not make them look as beautiful and fresh as possible?

Lower Blepharoplasty (Lower Eyelid Lift)
Lower eyelid fullness and dark circles around the eyes make you look tired – no matter how good you feel or how much sleep you get! This is a common problem as we age, and is related to a number of changes in the face. First, the thin, “crepey” skin in the lower eyelid is stretched and dragged down as gravity pulls on the relatively heavy cheek tissues. This exposes the underlying bone of the eye socket (orbital rim), and can give a hollow appearance. Second, the fat pads that surround the eyeball begin to bulge forward. This make a line between the eyelid and the cheek and gives a “double contour” effect – where there are two curves in the lower eyelid and upper cheek, rather than the more youthful, smooth, single contour.

When there is too much skin or bulging fat in the lower eyelids, Dr. Ransom can treat this complex area with a surgical procedure called a lower blepharoplasty (lower eyelid lift). There are multiple approaches to lower eyelid rejuvenation, and different patients require specific techniques. Dr. Ransom performs a careful examination of each patient to determine the laxity (looseness) of the eyelids, presence and amount of excess skin, and distribution of adipose tissue (fat pads) around the eye and in the cheek. For younger patients or those without any loose skin, the fat pads can be treated without making an incision in the eyelid skin. This minimizes the risk of lower eyelid position problems and helps to speed up recovery. For patients that have loose eyelids, excess skin, or a hollow-appearance, Dr. Ransom performs the latest technique in lower blepharoplasty, which uses your own fat pads to fill in the hollow areas and removes extra loose skin.

Rhytidectomy Before & After Photos

Upper Blepharoplasty (Upper Eyelid Lift)
Heavy or droopy upper eyelids can make you look exhausted – even after a full night’s sleep! This is a common problem as we age, with extra soft tissue hiding the upper eyelid crease, making it difficult to apply eye makeup, and in severe cases, limiting your peripheral vision. This issue may be related to a variety of anatomic factors, including loose skin, excess fat, or even a heavy forehead or brow weighing down the eyelids. When there is too much skin or fat, Dr. Ransom can remove this tissue with a simple surgical procedure called an upper blepharoplasty (upper eyelid lift). This can be performed with local anesthesia only or with mild sedation, depending on patient preference.

In some patients, the appearance of drooping upper eyelids is related to a heavy or sagging forehead and brow region (brow ptosis). This problem may be referred to as “lateral hooding” because the skin of the sides of the forehead weighs down the upper eyelids more significantly on the sides, and creates a curtain or a fold over this area. For these patients, a browlift is a great treatment, either alone or combined with an upper eyelid lift. Treating the brow and forehead region, along with the upper eyelids, ensures a natural-appearing and long-lasting result.

Asian Blepharoplasty (Double Eyelid or Eyelid Crease Surgery)
Subtle anatomical differences exist in the structure of the upper eyelids in people of Asian descent relative to those of Caucasian or African descent. The fuller appearance of the Asian upper eyelid, and the absence of a visible crease, are related to the attachment of the muscle that raises the upper eyelid and the placement of the fat that surrounds and protects the eye. In patients who desire a visible upper eyelid crease, a simple surgical procedure called Asian blepharoplasty (sometimes referred to as double eyelid surgery) can be performed. Asian blepharoplasty is a minimally-invasive procedure and can be performed with local anesthesia or minimal sedation in the office or ambulatory surgery center. With appropriate activity restrictions, patients are typically able to return to school or work within a couple days of treatment.
All types of eyelid surgery can be performed with local anesthesia only or with mild sedation, depending on patient preference, and may be combined with other surgical and non-surgical facial aesthetic procedures such as rhytidectomy (facelift), browlift, chemical peels, or laser resurfacing for fine wrinkles and uneven pigment. For more information about eyelid procedures, please contact Dr. Ransom to schedule your consultation!

Who is a candidate?
Anyone who wants to improve the appearance of the eyelids is a candidate for eyelid surgery. For patients with lower eyelid bags, extra or loose skin and muscle, tired-appearing eyes, or hollow eyes with dark circles, a lower eyelid lift is indicated. During your consultation, Dr. Ransom will closely examine your upper eyelid area, including skin laxity, position at rest, movement, eye closure, and tear film (lacrimal status, or dry eyes). Anyone with heavy upper eyelids, loose skin, or tired-appearing eyes may be a candidate for an upper eyelid lift. During your consultation, Dr. Ransom will closely examine your upper eyelid area, including skin laxity, position at rest, movement, and eye closure.

In some cases, the unaesthetic appearance of the eyelids is related to a more complex medical issue. In the lower eyelids, this may include thyroid problems (myxedema). In the upper eyelids, there may be issues with the eyelid elevating muscles (levator palpebrae superioris); when this happens, the diagnosis is blepharoptosis, and the treatment may include a ptosis repair with or without an upper eyelid lift. In other cases, the sagging or baggy appearance of the upper eyelids is related to a heavy or falling forehead and eyebrow region; when this happens, a browlift may be indicated, with or without an upper eyelid lift. Dr. Ransom is happy to discuss these issues in detail with you during your consultation.

Dr. Ransom see patients from all over Bay Area for an eyelid lift or blepharoplasty, including Mill Valley/Marin County, Napa/Sonoma, San Raphael/Petaluma and the world.

Frequently asked questions

Q: What can I expect after my eyelid surgery?
A: Immediately following the surgery, the eyelids will have some bruising and swelling. In most cases, this is relatively mild. Swelling generally reaches a maximum by the second day after the surgery, and then begins to recede over about a week. After the sutures are removed on the fourth or fifth day, incisions are well-camouflaged by the eyelashes. Eye makeup can be worn after the first week, and the incisions are almost invisible within a couple weeks of the procedure.

Q: Will an eyelid lift change the shape of my eyes?
A: Having an upper or lower eyelid lift will not change the shape of the eyes. In the first few days after surgery, when the area is still swollen and the sutures are in place, the eyes will look puffy and it may be difficult to see their exact shape. However, after healing, the improved contour and smoother surface is seen. An exception is Asian blepharoplasty, which is a procedure designed to change the shape and appearance of the upper eyelids.

Q: Will eyelid surgery affect my vision?
A: No long-term effect on your vision is anticipated with most eyelid surgery. An exception is upper eyelid surgery performed to repair ptosis or to remove skin that is blocking part of the field of vision. During the immediate postoperative period, swelling my limit peripheral vision somewhat. However, after the swelling resolves, there is no change to the visual acuity or visual fields (peripheral vision). Head elevation and continuous use of cold compresses can dramatically reduce swelling.

Q: I have dry eyes. Can I still have an eyelid lift?
A: In the majority of cases, having some dry eye symptoms does not preclude the possibility of having an eyelid lift surgery. For patients with severe symptoms, including prior damage to the cornea (surface of the eye), an examination by an ophthalmologist may be required. Many people have some dry eye symptoms related to age, allergy, or other causes, but attentive care and use of preservative-free moisturizing drops is adequate in most instances.

Q: I have droopy eyes and a heavy brow. Should I have a brow lift, or an eyelid lift, or both?
A: To determine the contribution of brow fullness or sagging vs. excess upper eyelid skin, an in-person exam is needed. In many cases, a combination procedure is most beneficial. This allows Dr. Ransom to elevate the brow and forehead tissue and then remove only the minimum necessary amount of extra skin from the upper eyelids. With this approach, patients are able to get a refreshed, natural look without the hollow appearance of an overdone eyelid surgery.