Eyelid Surgery

Eyelid surgery, both for upper and lower eyelids, is called blepharoplasty. Blepharoplasty can be either functional or cosmetic in nature. The procedure can be performed on the upper eyelids, lower eyelids, or both at the same time.
Upper eyelid blepharoplasty is performed for patients that have excess skin of their upper eyelids, with possible fat (herniated orbital fat) coming forward. When the fat comes forward, it causes puffy upper eyelids. Upper eyelid surgery can be performed in-office under a local anesthesia injection with minimal discomfort and takes just under an hour. An incision is made in the upper eyelid crease. This is done with either a surgical knife, CO2 laser, or Elman radio-frequency. Whichever type of incision is made, it is done perfectly within the upper eyelid crease. If a new crease must be made, it is a much more difficult surgery and must be discussed in detail with the patient prior to the procedure, as a new upper eyelid crease can change a person's eye appearance completely.
Since an incision must be made in the upper eyelid crease, there is going to be a scar in that area. Some people often have a misconception that there will be no scarring with upper eyelid blepharoplasty. Scarring will happen, but the scar for upper eyelid surgery is very inconspicuous. Although a hint of a scar may remain, it will take a few weeks to months for the surgical scarring to dissipate. Recovery time for upper eyelid blepharoplasty varies but usually takes one to two weeks.
When considering upper eyelid surgery, the excess amount of upper eyelid skin should be evaluated for removal prior to surgery. The surgeon, preferable a board-certified oculoplastic surgeon, has to make sure not to take too much of the upper eyelid skin, since that could interfere with the proper blinking function of the upper eyelid. If not done properly, one could develop severe dry eye syndrome and other more serious complications. In addition to removing excessive upper eyelid skin, the removal of too much upper eyelid fat can cause a hollow appearance, which is called a superior sulcus deformity. Most board-certified oculoplastic surgeons will try to save as much fat as possible by sculpting the fat instead of removing it. This helps to minimize upper eyelid complications.
There are multiple approaches to performing lower eyelid blepharoplasty, which is considered mainly a cosmetic procedure. Lower eyelid surgeries are safest to perform within an outpatient surgical center under the administration of a mild anesthetic and usually takes about an hour to perform. In some lower eyelid surgeries, only fat needs to be removed to help the appearance. In these cases, a surgeon makes an incision through the conjunctiva (inside of the lower eyelid). Since the incision is on the inside of the lower eyelid, there is no visible scarring. The ideal patient for cosmetic lower eyelid surgery for fat removal is younger, with minimal lower eyelid skin aging and laxity. This procedure can be combined with laser treatments of the skin and/or chemical peels.
Another approach to cosmetic lower eyelid surgery is to make an incision along the lower eyelid margin right below the eyelash line. With this approach, the laxity of the lower eyelid skin can be addressed along with fat removal. In some cases, there can also be fat repositioning of the lower eyelid to correct for tear trough deformities. A tear trough deformity is an indentation at the orbital rim or the lower eyelid connection to the cheek which becomes more prominent as a person ages and the cheeks drop. This deformity can cause dark circles around your lower eyelids to become more pronounced. Injecting dermal fillers (Juvederm Ultra, Perlane, Radiesse) in this area, in conjunction with cosmetic lower eyelid surgery, can help to greatly resolve this deformity. The surgical incision made with this type of lower eyelid surgery is called a subcilliary incision and heals beautifully with very little scarring. A patient may lose some eyelashes during a cosmetic lower eyelid blepharoplasty, but the lashes re-grow with usually no complications. The lower eyelid region is also very vascular, which can cause easy bruising and bleeding. Recovery time for lower eyelid surgery varies but usually takes two to three weeks because of the sensitivity of the lower eyelids.
As there is with any type of surgical procedure, there are risks and complications associated with upper and lower eyelid blepharoplasty. These complications, although not common, can include, but are not limited to:

- Bleeding
- Infection
- Change of eyelid function
- Change in eyelid appearance
- Scarring
- Ectropion (eyelids turning away from the eye)
- Entropion (eyelids turning towards the eye)
- Loss of eyelashes
- Trichiasis (misdirected eyelashes)
- Dry eye syndrome
- Blindness

When considering upper and/or lower eyelid blepharoplasty, it is recommended that you choose a board-certified oculoplastic surgeon. This is typically an ophthalmologist who has been certified in plastic surgery in and around the eyes. It is very important for a surgeon to be familiar with the eyes and their functionality to best perform upper and lower eyelid surgery.
Dr. Soheila Rostami is an ophthalmic plastic and reconstructive surgeon, board-certified and specializing in lacrimal, orbital and cosmetic eyelid surgery. Dr. Rostami has been in private-practice in the Northern Virginia area for over 8 years. Her office is conveniently located in Reston as part of the Reston Hospital campus (near the Reston Town Center) and is just minutes away from Vienna, McLean, Great Falls and Fairfax. Dr. Rostami is currently accepting new patients and would love the opportunity to show you how upper and/or lower eyelid surgery can greatly improve your appearance and outlook. Schedule your appointment for our Reston location today - 1860 Town Center Drive, Suite 250, Reston, VA 20190 - (571) 203-1300 begin_of_the_skype_highlighting              (571) 203-1300      end_of_the_skype_highlighting.


Dr. Soheila Rostami is an ophthalmic plastic and reconstructive surgeon. If you need more information about Droopy eyelids and eyelid surgery, you can check out .