Popular Blepharoplasty: San Francisco’s Dr. Stanley Jacobs Breaks Down Eyelid Surgery

If eyes are the windows to the soul, it seems natural to want to keep them open. In the past year, Americans have started to pay greater attention to a less talked-about cosmetic issue: droopy eyelids. Eyelid surgery or blepharoplasty, according to San Francisco’s Dr. Stanley Jacobs, is becoming an increasingly popular choice for individuals looking to correct the source of impaired vision, pronounced appearance of aging, or both.

The latest statistics collected by the American Society of Plastic Surgeons show that blepharoplasty is one of the top five cosmetic surgical procedures of 2016.

The aging process can cause the eyelid skin to sag, and can also weaken the supporting muscles and tendons over time. Excess fat, too, gathers below the eyelids, creating bags under the eyes.

These changes can create one or both of the following issues: The sagging skin around the eyes can impair a person’s field of vision, and the droopy, less-elastic eyelids can make a person look much older than she or he really is.

Eyelid surgery repairs these drooping eyelids. The procedure usually involves removing excess skin and/or fat, as well as repairing or tightening weakened muscles in the targeted areas. Blepharoplasty can possibly reduce vision problems related to droopy eyelids, but mainly will make a patient’s overall appearance much more youthful, refreshed, and alert.

Typical candidates for blepharoplasty tend to have one or more of these issues:

• Droopy or baggy upper eyelids
• Excess skin on the upper eyelids that interferes with peripheral vision
• Droopy lower eyelids (this often causes extra white area to show below the iris or colored portion of the eye)
• Excess skin or undereye bags on the lower eyelids

Broadly speaking, there are two types of blepharoplasty: upper lid and lower lid. Each may be performed separately or together, depending on the patient’s unique concerns and desired goals of treatment.

While an upper lid surgery is mainly performed to correct droopiness, the lower lid surgery is used to remove puffy bags under the eyes. A lower lid blepharoplasty can also include tightening the skin and tendon in the area to correct fine lines and drooping. A transconjunctival blepharoplasty is sometimes performed on select patients if they want to address puffy bags that occur due to fat deposits underneath the eye, and these patients have no loose skin.

Entropion, a not-uncommon side effect of lower-lid blepharoplasty, can cause the lower lid to roll outward and expose the lower portion of the eye. This problem, which can also be caused by the natural aging process, can be addressed with a surgery known as canthopexy, which tightens the canthal tendon and restores the lower lid to a position that better conforms to the lower portion of the eye. Though Dr. Jacobs routinely performs this procedure, it is not a typical part of blepharoplasty for most surgeons. He has published a medical peer-reviewed paper on this, titled “Prophylactic Lateral Canthopexy in Lower Blepharoplasties.”

Blepharoplasty surgery is normally performed on an outpatient basis. A typical surgery can take about an hour or two, depending on the extent of change the patient desires.

A blepharoplasty begins with the administration of an anesthetic: Sometimes just a local anesthetic can be used, or intravenous sedation is used. A careful surgeon will mark in advance where any incisions will be made to ensure that any faint scars will be well-hidden. The best areas for these tend to be the natural creases and folds of the eyelids. Excess skin and other tissue will be removed from the areas of incision, and fat and muscle will be repositioned or adjusted as needed to best display the natural contours of the eyes. At the end of the surgery, the incisions will be closed with fine sutures.

The incisions made on the outside of the eyelids may need to be covered with small strips of surgical tape while they heal. Bruising and swelling in the days after blepharoplasty surgery is normal, and many patients wear sunglasses during this period to conceal these temporary side effects. The eyes may also be itchy and dry, and while sunglasses are not medically necessary, they can stop patients from rubbing or scratching the operated areas while they are still vulnerable.

Keeping the head elevated aids blood flow and can minimize swelling and bruising, as can cool compresses. The blepharoplasty surgeon may also prescribe some medications or topical products to manage comfort levels and keep the skin moist. There is usually no to very little pain.