Eyes wide open: Understanding the benefits of eyelid surgery

If you're a woman over the age of 40, you might be having issues applying mascara to your upper eyelids without it smearing. Whether this is a new challenge or one you've dealt with for a while, chances are the culprit is loose upper eyelid skin that touches your lashes.

"The number one complaint I get is, 'I can't do my eyelid makeup anymore because I put the mascara on and it gets all over,'" said ASPS Member Surgeon Kelly Sullivan, MD.

As you age, your eyelids can begin to stretch, and the muscles that support them can weaken. The force of gravity also pulls them down. What's more, the eyebrows can descend with age, too. Both excess eyelid skin and descending brows can make you look tired when you're not and make you look older than you feel.

"The other thing people say is, 'I see myself on Zoom or FaceTime, and I just look old,' or 'People think I look tired all the time,'" said Sullivan.

The case for eyelid surgery

Beyond cosmetic concerns, dropping lids can obscure eyesight, a safety hazard.

"When it gets really severe, patients feel like they can't see when they're looking to the side or when their head is down and don't feel they have as much of a visual field capacity," said Sullivan.

Loose upper eyelids that impact sight make up only a tiny portion of Sullivan's cases – most women consult with Sullivan for cosmetic concerns. They want to regain a youthful, eyes-wide-open look through an eyelid surgery called blepharoplasty.

What is blepharoplasty?

During blepharoplasty, or an eyelid lift, the surgeon makes incisions in the eyelids' natural creases to remove excess tissue and fat, tighten muscles and create a refreshed, youthful appearance. Surgeons hide scars in the crease line. Sullivan said she does the procedure under local anesthesia in less than one hour, and patients go home afterward.

Do you need a brow lift?

According to Sullivan, patients with drooping upper eyelids often think they need eyelid surgery when they need a brow lift instead.

"I can't talk about upper blepharoplasty without talking about a brow lift because they really need to be considered in the same conversation," said Sullivan.

The appearance of upper eyelid sagging is often not due to extra eyelid skin but to brows that have dropped through the natural aging process.

Some patients have heavy lids because their brows have descended. Sullivan evaluates each patient to see if they genuinely need an upper blepharoplasty to remove excessive eyelid skin or whether repositioning the brow higher on the face will put the eyelid back into place and open up the look of the eye.

"If you don't reposition the brow then and you just try to remove that upper eyelid skin, then you can get into trouble with insufficient upper eyelid skin and have problems closing the eye," Sullivan added.

For this reason, it's essential to consult a board-certified plastic surgeon who can tell you whether you need an upper eyelid lift, a brow lift or both. But what about the lower eyelid and cosmetic concerns in this area?

Do you need lower blepharoplasty?

If you're unhappy with the area under your eyes, lower blepharoplasty can help. Aging, genetics, lifestyle habits and certain medical conditions can cause puffiness and bags under the eyes. A lower blepharoplasty can be a good solution for women bothered by these cosmetic concerns.

A delicate operation

Consulting with a qualified and experienced plastic surgeon is essential because a lower eyelid lift is a delicate operation that requires education, experience, and skill to execute well.

Plastic surgeons have to take special care to work in a way that preserves the natural look of the eye so the patient looks like themselves after eyelid surgery. Removing too much skin or pulling too tightly can make the patient look different.

When surgery goes wrong

"No plastic surgeon sets out to intentionally do that to a person, but the enemy of good is better," said ASPS Member Surgeon Adam Schaffner, MD. "And if you pull too tight, take out too much fat, or too much skin, it can significantly change their appearance."

We've all seen celebrities who have looked remarkably different after eyelid operations. That's because the surgeon changed the landmarks and ratios of the patient's eye anatomy. According to Schaffner, this makes them look different to facial recognition software and the human eye. The goal, however, is to look natural.

Looking like yourself

"Any cosmetic plastic surgery, especially on the face, and especially of the eyes, one needs to take those into consideration," said Schaffner.

Schaffner said the goal of upper and lower eyelid surgery is to look like yourself, just younger and more refreshed.

So, if you're in the over-40 club and finding mascara smearing on your upper eyelids is upsetting, don't worry – you're not alone! Unfortunately, aging plays tricks on everyone's eyelids and brows, but you can discover the secret to turning back the clock through upper blepharoplasty and brow lift surgery. And, while we're at it, let's remember the wonders of lower blepharoplasty for those pesky under-eye concerns.

But remember, this is some delicate artistry, so finding a skilled plastic surgeon who is an ASPS Member Surgeon and keeps you looking like you is the name of the game. It's all about looking naturally rejuvenated and embracing your unique look. So, here's to looking like yourself, just a bit more revitalized!

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.