Posted May 27, 2025 in Blepharoplasty
Blepharoplasty is one of the best “bang for the buck” facial rejuvenation surgeries turning back the hands of time.
Current trends in blepharoplasty revolve around skin removal, preservation and repositioning of fat, and creating rejuvenation at the cellular level with bioregenerative stimulation. Today’s blepharoplasty patient deserves a natural result. My personal aesthetic philosophy is “less is more”, and four words, “no one should know.”
Whereas lower blepharoplasty in the past involved removal of lower eyelid fat “bags”, today’s most refined lower eyelid blepharoplasty surgeons reposition lower eyelid fat from the eyelid bulge to fill the hollow circle below it , restoring a smooth transition between the lower eyelid and the cheek. Lower eyelid fat transposition blepharoplasty is approached through a small incision through the inside of the lower eyelid.
In the past, upper eyelid blepharoplasty involved removal of fat pads, muscle, and skin. This often resulted in a hollow sunken upper eyelid. Similar to lower blepharoplasty, fat is preserved and can be translocated if need be. Minimal or no muscle is removed, and an appropriate strip of upper eyelid skin is removed to ensure closure of the eyelids without excessive “hooding” skin. Many patients only need skin removal without fat removal, in these cases the septum which supports the fat compartment is tighted by heating it causing contraction of any minimal bulging.
Lower eyelid skin may be removed using a “skin pinch” technique. Both upper and lower eyelid skin may be tightened with ablative fractional CO2 laser.
Bioregenerative rejuvenation at the cellular level with platelet rich plasma or fibrin (prp,prf). Topical exosomes, and/or salmon sperm (pdrn) may also be used. EZ-Gel (prf) may be used in appropriately selected patients to fill lower eye hollows in patient who do not want surgery, and who wish to have a 100% natural injectable gel from their own blood.
Most patients are motivated to have blepharoplasty by their “tired” appearance, while some seek functional improvement of their visual fields. A 75 year old pilot with excessive skin hanging from his upper eyelids told me that he was tired of flying his plane with one hand on the controls, and the other holding up his eyelids so that he could avoid other planes. Patients share that before their blepharoplasty they could sleep for twelve hours and still look tired in the morning, and that after the surgery they could stay up all night and still look rested the next day.
