Dr. Ouakil, a board-certified plastic surgeon based in Paris since 1996, provides you with all the useful information regarding blepharoplasty.
The aesthetic surgery of the eyelids involves upper blepharoplasty and lower blepharoplasty.
This information serves as a helpful and complementary resource for a potential consultation to prepare you for the blepharoplasty procedure.
Blepharoplasty offers both aesthetic and functional benefits.
It revitalizes and brightens the gaze. It combats the tired or sad appearance resulting from bags under the eyes (palpebral hernias) and excess skin on the upper eyelid.
This true lifting of the gaze alleviates eye fatigue felt at the end of the day by reducing the weight of the skin fold on the upper eyelid.
This condition is referred to as dermatochalasis or blepharochalasis.

What does blepharoplasty treat?

It addresses the aesthetic concerns observed on the eyelids. We distinguish between:

• the upper eyelids (commonly referred to in simplified and colloquial terms as simply the eyelids), which are movable elements that close the eyes. They are controlled by two muscles: the orbicularis (closure) and the levator of the eyelid (opening)
• the lower eyelids, which are less mobile and suspended beneath and in front of the eyes, attached by internal and external ligaments to the orbit, the eye cavity whose lower edge (in front of the dark circles) corresponds to the junction with the cheek, particularly the tear trough extending from the dark circle.

Upper blepharoplasty

Upper blepharoplasty treats dermatochalasis, an excess of skin and fat forming a "cap," a fold that weighs down the eyelid and sometimes comes into contact with the eyelashes. Makeup on the upper eyelid can become problematic due to the multiple skin folds. A certain degree of fatigue may be felt in cases of significant heaviness. Surgery on the upper eyelid will then be both functional and aesthetic.
It is important to distinguish this from brow ptosis, an extrinsic element, overlying, belonging to the frontal area, whose relaxation weighs on the eyelids, exacerbating the feeling of a sad and tired gaze. Its treatment will be separate (forehead lift, brow lift, lifting Botox, thread lifting, mannequin pin, Fox eyes treatment).
This should not be confused with ptosis (palpebral), generally unilateral, characterized by an abnormally lowered eyelid that partially closes the eye continuously, and whose surgery is performed by specialists in ophthalmological reconstructive surgery with coverage by health insurance.

Lower blepharoplasty

The lower eyelid presents various potential modifications:

• hypertrophy of the orbicularis muscle, which shows a bulge that becomes more pronounced when smiling
• skin folds and wrinkles
• fat hernias, known as bags under the eyes
• relaxation of the eyelid becoming hypotonic, which can transform into senile ectropion

Lower blepharoplasty addresses all these elements by re-tensioning and redraping the skin (lifting of the lower eyelid) and direct surgical reduction of the fat bags.
An external canthopexy may be associated to tighten a senile ectropion (relaxed eyelid) or a scarred one (traumatized or previously operated eyelid).
Aesthetic surgery of the eyelids is highly beneficial as it is very effective in providing a fresh and revitalized appearance, particularly to the gaze. It remains relatively light in general terms (anesthesia, recovery), resulting in almost imperceptible scars.
It is important not to confuse blepharoplasty with brow and forehead lifting, which raises the part of the brow arch that overhangs the eyelid. It is necessary to distinguish on the face, the bag under the eyes (bulge), from the hollow just below (dark circle) and the extension of this hollow at the top of the cheek (tear trough).
Aesthetic surgeons offer lipofilling or hyaluronic acid injections to fill in the hollows of the dark circle and tear trough.

At what age can one consider blepharoplasty?

Requests for blepharoplasty can sometimes be early and justified at a relatively young age. From the age of 25, fat hernias of the lower eyelids (permanent bags under the eyes) can occur, which are unaesthetic and give a constantly tired appearance, sometimes extremely pronounced upon waking. Their treatment is primarily surgical through their removal without visible scarring, via a conjunctival mucosal approach.
In older patients, progressive skin and muscle relaxation is the norm. Blepharoplasty can be performed at any age, representing a rejuvenation operation with a spectacular "fresh look" effect. There may be asynchronous aging of the upper and lower eyelids. Upper and lower blepharoplasties are often considered separately in this case. Your aesthetic surgeon in Paris will be the most specialized to answer your questions and guide you towards the right strategic choice.
In the context of a cervico-facial lift, an associated blepharoplasty will almost always be indicated (unless it has already been performed, of course).

Blepharoplasty in men

Bags under the eyes frequently appear in men from the age of 40. This will be the perfect indication for lower blepharoplasty via a transconjunctival approach without scars and with a very short social and professional recovery time of 5 days. Upper blepharoplasty will also often be necessary, especially after the age of 40.
Brow ptosis is often observed in men and will be explained as a limitation to the result of upper eyelid surgery, especially since lifting in this area will only be offered exceptionally. Botox injections, botulinum toxin, will then be indicated as a medical forehead lift.
Sometimes a supra-brow lift, with a scar placed directly above the brow, may be proposed.

Asian ethnic blepharoplasty (Oriental eyelid)

Individuals of Asian descent often present an absence of the upper eyelid fold and an epicanthus (fold at the inner corner of the eye).
In a desire for Westernization, blepharoplasty is sometimes requested to allow, alongside the reduction of excess skin on the upper eyelid, the creation of a new fold and the attenuation of the inner fold.

What does blepharoplasty involve, and where are the scars located?

The goal is to restore tone to the gaze by eliminating bags and fat hernias and removing excess skin and muscle. The procedure, which lasts about one and a half hours, leaves no or very few perceptible scars in the medium term. The skin incision for upper blepharoplasty will follow the natural fold of the upper eyelid. It will extend towards the temporal area either horizontally in men or, in women, towards the tail of the brow, rising into a crow's foot line.
It may be possible to create a slight elevation at the outer corner of the eye to produce a "doe eye" effect or #foxeye.
The incision for lower blepharoplasty is made at the lash line of the lower eyelid, extended from the outer canthus for a few millimeters perpendicularly downwards into the crow's foot. These will become less perceptible within a few months. It is through this approach that the lifting of the lower eyelid is performed.
The transconjunctival approach allows for the removal of excess fat from the bags under the eyes without a skin scar by accessing from behind. This is the quintessential aesthetic procedure; it is performed as a first intention, even if there is a small pocket of skin, as it completely preserves the initial shape of the eye, preventing any complications such as ectropion or round eye. The skin retracts very well afterward.
In some cases, a canthopexy or tarsal strip may be associated with blepharoplasty to further lift the edge of the lower eyelid, particularly during a secondary blepharoplasty or preventively in older subjects with a hypotonic eyelid.

How does eyelid aesthetic surgery proceed?

Under pure local anesthesia or enhanced by sedation, it is performed on an outpatient basis. A cold compress is placed on the closed eyes for a few minutes. Vision may be disturbed by oculomotor disturbances secondary to anesthesia for a few hours. This necessitates having someone accompany you for your return home. The blepharoplasty procedure lasts from 45 minutes to 1.5 hours. The sutures are made with overlock and fine thread stitches kept for only 4 to 6 days.

What are the postoperative outcomes of blepharoplasty?

An edema (swelling) accompanied by bruising (bruises) develops gradually over 48 hours and disappears progressively over 7 to 10 days. A sensation of tension in the eyelids persists for a few days, and complete closure of the eyes may be uncomfortable for 48 hours. During the first few hours, a certain eye fatigue may prevent prolonged concentration. Reading or screen viewing should be avoided during this phase of 1 to 2 days. Driving is prohibited for 48 hours. It is possible to resume normal activities about one week after the procedure.
The stitches are removed between the 4th and 6th day. The appearance of a hematoma, characterized by an exuberant and very tense swelling of an eyelid, associated with intolerable pain or vision disturbances, should prompt an emergency call to the practitioner, regardless of the time.
Normally, standard blepharoplasty does not alter the shape of the eyes or the gaze. The skin lifting sometimes performed during lower blepharoplasty can complicate with a "scleral show." This means rounding of the lower eyelid edge that exposes the white of the eye beneath the iris (at 6 o'clock).
White microcysts sometimes appear along the scar of the upper blepharoplasty. They will be removed with a needle in the office.

In conclusion

As the quintessential aesthetic surgery intervention, blepharoplasty offers a guaranteed "fresh look" effect and a liberation of the gaze.
The scars are almost imperceptible or even absent. It can be performed at a young age in the presence of persistent and early bags under the eyes.
It is the most indicated aesthetic operation for treating facial sagging starting from 35-40 years old.
Later on, for example during a cervico-facial lift, blepharoplasty will be systematically considered and most often performed. A Botox injection for the gaze, performed separately, will optimize the result if brow ptosis is observed. The gaze will be even brighter, and the effect of blepharoplasty will be even more visible.

Download the official information sheet on blepharoplasty published by the French Society of Plastic Surgery in PDF format →CLICK HERE