Eyelid Refresher: Surgical vs. non-surgical treatment of the eyelids

Many people often approach me asking them to look ‘less tired’ or ‘more rejuvenated’.  The periocular (eyelid) area is an important area of the face where cosmetic surgery can help take 10 or more years off an aging face.

However, it is very important to choose the right procedure tailored to you!  I have seen too many patients who have had eyelid filler, botox and surgery which was inappropriate.  The decision to perform these procedures, or a combination of them, is a case by case decision and should be left up to a surgeon who is experienced and trained in facial anatomy around the eyes.  Many patients are not aware of the severity of receiving this type of care from a specialized surgeon.  As a result, a large number of surgical and non-surgical (botox and filler) are performed by doctors, PAs or RNs who may not be adequately trained to evaluate and treat the eyelids, brow and other facial areas.  For example, a plastic surgeon, who is trained in treating the whole body, may not have the experience and required training to address both cosmetic and functional conditions related to the eyes. (And same for myself, I have no business assessing a patient for a tummy tuck! )

An Oculoplastic and Oculofacial Plastic Surgeon is a surgeon who has gone through extensive training, regulated by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and is someone who has the most experience appropriate qualifications to perform these surgeries/procedures and make preoperative decisions.

An oculofacial plastic surgeon has to complete three years of residency training in Ophthalmology, followed by another two year rigorous surgical training in Ophthalmic Plastic and Reconstructive Surgery (Oculoplastics). This skill set becomes critically important to surgically treat the areas in and around the eyes in a safe and effective manner. An Oculoplastic surgeon will closely understand the complex anatomy of the eyelids and the subtleties of surgery in this area, leaving you with the best functional as well as cosmetic outcome.

For example, patients who have eyelid bags may not be candidates for filler and may require surgery in conjunction with filler.  Facial filler, in the right patient, can be used solely to rejuvenate the eyelids but in the wrong patient, can cause poor outcomes and distres.

More specifically, a patient who has significant lower eyelid bags (fat prolapse) or excess skin would not benefit from filler.  Filler alone will actually worsen the patient’s appearance. In these cases, a surgical approach called a blepharoplasty is important to consider. A lower blepharoplasty can be performed using several different techniques, once again, based upon initial clinical evaluation.  There are different approaches (through the lower eyelid skin, within the lower eyelid) as well as techniques (fat removal vs. fat transposition). 

Let’s not forget the eyebrows! Brows play a crutial role in how the eyelids (especially upper eyelids) look. It is therefore of utmost importance to consult with an experienced surgeon who can evaluate these different areas of the face as a whole, giving each patient a unique approach based upon their anatomy.

Sana Bautista, M.D.


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