Written By: Erin Storm, PA-C
For everyday skincare essentials, pre- and post-treatment support, procedure enhancers, or even treatment alternatives, we’ve got you covered.
The Skinny
Drooping eyelids or hooded eyelids can be a frustratingly noticeable concern for men and women of all ages (check out our complete guide to Sagging & Hooded Eyelid Concerns). The American Society of Plastic Surgeons (ASPS) reports that over 200,000 blepharoplasty procedures were performed in 2018, making eyelid surgery one of the top five cosmetic surgeries of the year. Eyelid surgery can correct both the upper eyelid and lower eyelid to create a more youthful appearance and, in some cases, improve eyelid function. A plastic surgeon can determine which upper eyelid surgery or lower eyelid surgery is most appropriate. Some candidates may consider augmenting an eyelid procedure with a brow lift or facelift.
The Specifics
Who may consider eyelid surgery?
Eyelid malpositioning can refer to a number of upper eyelid and lower eyelid abnormalities. Men and women of all ages who suffer from drooping, sagging, or hooded eyelids may benefit from an eyelid procedure. Some eyelid abnormalities can be caused in part by conditions known as entropion (inward curling of the eyelid) and ectropion (outward curling of the eyelid). The subcategories of eyelid concerns are outlined below:
- Eyelid Ptosis: Refers to drooping of the upper eyelid, and may be caused by genetics, age (think skin sagging from collagen and elastin loss), or trauma.
- Sagging Lower Eyelid & Sagging Upper Eyelid: Describes a condition in which the eyelid’s structural integrity is compromised leading to poor positioning over the eyeball. This can cause both aesthetic and functional concerns.
- Upper Eyelid Fold: Sometimes referred to as hooded eyelids, this is most commonly a concern for men and women of Asian descent as they are more genetically predisposed to lacking a definitive upper eyelid crease.
The Anatomy of the Eye
What can you expect from eyelid surgery?
Most all upper eyelid and lower eyelid procedures are surgical. These procedures are highly specialized to their targeted concern and can create vast improvements in appearance and function.
- Entropion Procedure: This surgical procedure is used to restore the normal position of the eyelid by surgically repairing muscle and skin tissue. Entropion more commonly affects the lower eyelid.
- Eyelid Malposition Procedures: Surgical corrections to both the upper eyelid and lower eyelid are encompassed in malposition procedures. Blepharoplasty procedures are surgical procedures that repair, alter, and/or excise excess skin, muscle, and/or excess fat tissue to reposition and restore eyelid appearance.
- Eyelid Ptosis Surgery: These procedures target the musculature that connects the upper eyelid to the upper orbital bones to restore the appearance and function of the upper eyelid.
The majority of eyelid procedures are surgical procedures typically with a few weeks of recovery time. Common side effects include bruising, swelling, pain, and minimal bleeding. Most symptoms can be controlled with cold compresses or ice packs. Different techniques are less invasive than others, and consultation with a certified plastic surgeon can determine which is most appropriate for your unique concern.
When and why should you consider eyelid surgery? The nature of your concern will determine the most appropriate time for a surgical intervention. Of course, a good candidate should be in generally good health, have ruled out underlying medical illnesses that may be contributing to eyelid abnormalities, considered needed recovery time, and set realistic expectations of their cosmetic procedure.
In the case of genetically sagging or hooded lids, candidates may wish to pursue treatment earlier. For those experiencing age related skin changes, including loss of skin integrity and muscle tone, surgical procedures can be pursued once appearance has become dissatisfactory-the age at which this occurs is unique to every individual.
Blepharoplasty Procedures
Blepharoplasty procedures involve alterations to the skin, fat, and muscle tissue of, and around, the eyelids. These changes can restore upper eyelid and lower eyelid appearance while simultaneously correcting any abnormalities of eyelid function.
- Lower Eyelid Blepharoplasty Transconjunctival Approach
- Overview: Under anesthesia, small incisions are made in the lower eyelid to access and alter or remove fat tissue. No sutures are used. This is ideal for those who can achieve restored under eye fullness with a less invasive procedure.
- Cost: $2,000 - $7,000
- Recovery & Results: Pain, swelling, and discoloration for 10 to 14 days. All activities can be resumed after about one month. The results are permanent.
- Lower Eyelid Blepharoplasty Transcutaneous Approach
- Overview: Incisions are made under the eyelashes, and skin, fat, and muscle is altered or removed. Sutures are used to close the incision.
- Cost: $2,000 - $4,000
- Recovery & Results: Tenderness, discoloration, and swelling for about two weeks. All activities can be resumed after one month. The results are permanent.
- Upper Eyelid Blepharoplasty
- Overview: Excess skin and fat tissue is removed from the upper eyelid under anesthesia. This restores fullness and curvature to the upper lid.
- Cost: $800 - $5,000
- Recovery & Results: Swelling, pain, and discoloration typically lasts for about two to three weeks. The results are permanent.
- Asian Blepharoplasty
- Overview: One of two surgical approaches can be used to create a “double eyelid” with a natural appearing eyelid crease.
- Cost: $2,200 - $7,000
- Recovery & Results: Bruising, swelling, and discoloration will last for about two weeks. Full recovery occurs within a month usually. Results are permanent, although over time signs of aging will begin to appear again.
- Asian Blepharoplasty Open Incisional Approach
- Overview: Ideal for candidates who also need to address skin and muscle laxity in addition to creating an upper eyelid crease.
- Cost: $2,500 - $3,500
- Recovery & Results: Side effects will generally last two weeks, and full recovery occurs within about a month. Results are permanent.
- Asian Blepharoplasty Partial Incisional Suture Technique
- Overview: This is less invasive than the open approach. The process is similar and involves the creation of the upper lid with a natural crease, but there is less scarring.
- Cost: $2,500 - $3,500
- Recovery & Results: Healing will begin within the first two weeks and continue for about one month. The results are permanent.
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Entropion Procedures
This procedure specifically targets an entropion abnormality (inward turning of the eyelid), which more commonly affects the lower eyelid.
- Corner Sutures for Entropion
- Overview: Two or three strategically placed sutures are used to turn the eyelid into the correct position and improve structural integrity.
- Cost: $500 - $2,000
- Recovery & Results: Swelling, pain, and bruising will resolve within two weeks. The results are permanent.
Eyelid Malposition Procedures
These procedures are typically used as correctives for previous eyelid procedures or to enhance structure prior to a blepharoplasty.
- Eyelid Malposition - Scar Excision and Spacer
- Overview: Ideal for individuals with scarring that necessitates artificial structural support to completely close the eyelids.
- Cost: $2,000 - $5,000
- Recovery & Results: Tenderness and swelling lasts for a few days. Full resumption of activities after one month. The results are permanent.
- Lower Eyelid Malposition - Lateral Canthal Suspension Canthopexy
- Overview: This procedure is specific to the lower eyelid. It is used to augment structural support to the lower lid.
- Cost: $1,500 - $5,000
- Recovery & Results: Bruising and swelling will diminish over two weeks. Limit strenuous activities for three weeks. The results are permanent.
- Lower Eyelid Malposition - Lateral Tarsal Strip Canthoplasty
- Overview: A wide ranging intervention to correct ectropion, retractions, and create a more toned lid.
- Cost: $1,000 - $1,500
- Recovery & Results: The sutures are removed within 10 days. Limit strenuous activity for three weeks. Results will loosen and diminish over time.
- [Lower Eyelid Malposition - Massage and Steroid Injection](https://aedit.com/procedure/lower-eyelid-malposition-massage-and-steroid-injection "Lower Eyelid Malposition: Massage and Steroid Injections)
- Overview: This procedure is designed to correct issues arising from previous blepharoplasties and enhance recovery.
- Cost: $25 - $300
- Recovery & Results: Patients perform the massages themselves at home for one hour daily. Results are gradual and temporary.
Eyelid Ptosis Surgery
These procedures alter the underlying structural support of the upper eyelid to move it into a more elevated position correcting drooping/sagging.
- Eyelid Ptosis Surgery External Approach
- Overview: This approach alters the orientation of the tissues that correlate to upper eyelid positioning to create an elevated upper lid position.
- Cost: $2,000 - $5,500
- Recovery & Results: Bruising and swelling resolves within one week. The results are permanent.
- Eyelid Ptosis Surgery Internal Approach
- Overview: A slightly different approach than the external technique, which allows access to different structures. The goal is to lift the upper lid into the desired position.
- Cost: $2,000 - $5,500
- Recovery & Results: Tenderness, discoloration, and swelling resolves within one to two weeks. The results are permanent.
- Eyelid Ptosis Frontalis Sling Fixation
- Overview: This procedure attaches the upper eyelid to forehead muscles allowing those muscles to assist eyelid movement and improve the appearance of the lid.
- Cost: $2,000 - $5,500
- Recovery & Results: Swelling and discoloration resolves within two weeks. The results are permanent.
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Source List
- American Society of Plastic Surgeons 2018 Plastic Surgery Statistics Report plasticsurgery.org; 2019-01-01
- Bhupendra C. Patel; Michael J. Lopez; Zachary P. Joos. Anatomy, Head and Neck, Eyelash PubMed.gov; 2020-07-27
- Dailey RA, Wobig JL. Eyelid Anatomy PubMed; 1982-12-01
- Harry S Hwang The effect of "single" vs "double" eyelids on the perceived attractiveness of Chinese women PubMed.gov; 2014-03-03
- Kun Hwang Eyebrow Shapes Over the Last Century PubMed.gov; 2016-11-01
- MJ Elder Anatomy and Physiology of Eyelash Follicles: Relevance to Lash Ablation Procedures PubMed.gov; 1997-03-01
