Eyelid Surgery in Beverly Hills:
What Blepharoplasty Can and Cannot Do

The eyes are the first feature most people notice. They are also, for many patients, the earliest area to show visible signs of aging. Upper eyelid skin begins to accumulate and drape as early as the late thirties. Lower lid puffiness from fat herniation develops in the forties and fifties. The effect is a face that looks tired, heavy, or older than the patient feels.

Blepharoplasty corrects these changes with precision. It is among the most consistently natural-looking procedures in facial plastic surgery when the anatomy is well understood and the technique is matched to it. This guide covers how both upper and lower blepharoplasty work, who is a good candidate, and how to have realistic expectations going in.

Upper Blepharoplasty

The upper eyelid changes with age in two primary ways: the skin accumulates and begins to drape over the lid, and the underlying fat pad may become visible as the supporting structures weaken. Upper blepharoplasty addresses both.

The Procedure

An incision is made within the natural crease of the upper eyelid, where the resulting scar is essentially invisible when the eye is open. Excess skin is excised in an amount calculated to restore the natural lid appearance without creating tension or preventing complete lid closure. Fat is addressed conservatively if present. The procedure typically takes 45 to 60 minutes and is performed under local anesthesia with mild sedation or general anesthesia depending on whether other procedures are being combined.

Functional vs. Cosmetic Upper Lid Surgery

When excess upper lid skin is severe enough to impair vision, upper blepharoplasty becomes a functional procedure. Visual field testing by an ophthalmologist documents the degree of impairment. In documented functional cases, the procedure may be covered by insurance. The surgical technique is identical whether the indication is functional or cosmetic; the distinction affects only billing and preauthorization.

What Upper Blepharoplasty Does Not Address

Upper blepharoplasty does not lift a drooping brow. If brow ptosis is contributing to upper lid fullness (the brow has descended and is pushing skin onto the lid), treating the lid alone will produce a suboptimal result. A brow lift, in combination with or instead of upper blepharoplasty, may be more appropriate. This distinction is determined at consultation by evaluating the lid and brow anatomy together.

Lower Blepharoplasty

Lower lid aging presents differently than upper lid aging. The primary concern is usually fat herniation, which produces the puffy, shadowed appearance commonly called under-eye bags. Excess lower lid skin and fine wrinkling are secondary concerns that become more prominent with age.

Transconjunctival Approach

For patients whose primary concern is fat herniation without significant excess skin, the transconjunctival approach places the incision on the inner surface of the lower lid, leaving no external scar. Fat is removed or repositioned through this internal access. This is an excellent option for younger patients with good skin quality who need only fat management.

External Approach

When excess lower lid skin is also present, a subciliary incision placed just below the lash line allows skin excision in addition to fat management. The scar heals within the shadow of the lower lashes and is typically imperceptible. This approach is more appropriate for patients in their fifties and beyond where skin laxity is a significant component of the lower lid aging.

Fat Repositioning vs. Removal

Lower lid fat can be either removed or repositioned depending on the anatomy. In patients with a hollow tear trough (a depression between the lower lid and cheek), fat repositioning may produce a more natural result than removal, filling the depression while reducing the puffiness above it. The choice of technique is anatomy-dependent and is determined at consultation.

Recovery Timeline

Blepharoplasty recovery is well-tolerated by most patients and has a predictable course.

• Days 1 to 3: Swelling and bruising are maximal. Cool compresses and head elevation reduce both. Vision may be slightly blurred from lubricating ointment used to protect the cornea.
• Days 4 to 7: Sutures are typically removed at 5 to 7 days. Bruising begins transitioning from purple to yellow-green. Most patients are mobile and functional at home.
• Days 7 to 14: Swelling continues to reduce. Most patients are presentable in public with light makeup coverage of residual bruising by day 10 to 14.
• Weeks 3 to 6: Residual swelling resolves. The eyelids continue to soften and settle. Incision lines are still pink but fading.
• Months 2 to 3: Final result is visible. Scars have matured significantly and are typically imperceptible in the natural lid crease or lower lash line.

Setting Realistic Expectations

Blepharoplasty produces a refreshed, rested appearance that reads as natural to observers. It does not produce a dramatically different face. Most patients find that people remark that they look well-rested rather than identifying that they had surgery, which reflects the goal of the procedure executed well.

The procedure does not address crow's feet, overall facial volume loss, or brow position. Patients with multiple concerns may benefit from combining blepharoplasty with other facial procedures, which Dr. Newman can discuss during consultation.

Frequently Asked Questions