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  • The Cosmetic Eyelid Guide

    is designed and written by Dr. Brett Kotlus, an eyelid expert, (a NYC oculoplastic surgeon).  It will familiarize you with the wide range of available options, both surgical and non-surgical, to treat cosmetic eyelid conditions and concerns.

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Top 10 Frequently Asked Questions About Cosmetic Eyelid (Oculoplastic) Surgery

How do I know if I need cosmetic eyelid / oculoplastic surgery?

This is a personal decision. There are varied reasons why people undergo eyelid surgery. In some instances, the decision is easy. For example, if your upper eyelid skin is interfering with your peripheral vision, an upper blepharoplasty would most likely be beneficial.

If the primary reason for surgery is aesthetic, you must weight the benefits with the risks of undergoing a procedure. A one-on-one consultation with an oculoplastic surgeon is recommended to determine which procedure (or combination of procedures) is suited to your concerns and the likely degree of improvement.

Are there non-surgical options to improve the appearance of my eyelids?

Yes, although it depends on the type and severity of eyelid concerns you wish to address. Injectable treatments such as Botox or Dysport can help to temporarily reduce wrinkles of expression around the eyes and can lift the eyebrows. This usually lasts 3 to 6 months per treatment. Injectable fillers may be used to add volume to hollow and deflated areas, often lasting up to a year per treatment. Lasers or chemical peels can improve the texture of the skin around the eyes. Topical creams may prevent the progression of wrinkles and can rejuvenate skin and reduce dark areas. In most cases, surgical approaches allow for a more dramatic result, but surgery is not always necessary. And often, non-surgical treatments are recommended after surgery as a maintenance regimen.

How long does it take to recover from cosmetic eyelid surgery?

This varies, but in the majority of cases, 10 days to 3 weeks are required to feel comfortable in social situations. In the early recovery stage (1-3 weeks), there is often swelling and bruising. During this time, it is suggested that you avoid strenuous activity. In some cases, swelling can last longer than a few weeks, and this depends on the type of procedure that was performed and your body’s own healing response. Some people look great after a week while others need longer to recover.

The final result may not be evident until 6 months or even a year after surgery. Again, everyone is different and healing takes time.

What can I do to help with recovery after cosmetic eyelid surgery?

You can reduce the chance of bruising by eliminating certain medications and supplements before surgery. This can include blood thinning medications (such as aspirin and ibuprofen), vitamin E, and fish oil. You doctor will discuss this with you. Sometimes you will need to consult with the doctor that originally prescribed your medication to see if it is safe to discontinue it for a period of time.

In the first 48 hours after surgery, cool compresses are helpful in preventing swelling. A bag of crushed ice or frozen peas can be applied on top of a piece of gauze for a few minutes at a time, intermittently. After the first 48 hours, warm compresses can help to resolve swelling. Care should be taken to avoid burning your skin with a compress that is too hot. Initially it may also help to sleep with your head elevated; perhaps with 2 or 3 pillows.

What kind of anesthesia is used for cosmetic eyelid surgery?

Local anesthesia consisting of an injection of a numbing fluid under the skin is always used. Another common approach includes local anesthetic with the addition of an oral or intravenous medication to aid in relaxation. These two types of anesthesia are often preferred for safety reasons.

In some cases, but less commonly, general anesthesia is administered so that you are completely asleep during surgery.

Are eyelid bags hereditary?

Yes and no. The way we look and the medical conditions we develop are influenced by both our environment and our genetic makeup. In some families, it appears that bulging lower eyelid pouches or heavy eyebrows are passed down from generation to generation. But smoking and excessive sun exposure can accentuate our predispositions for the worse. You may blame your ancestors for a trait you don’t like, but you can control some of the factors that influence the expression of those traits.

How do I choose a cosmetic eyelid surgeon?

You should consider several factors, including your doctor’s experience and training, your rapport and comfort level, and recommendations. The most obvious choice is a fellowship-trained oculofacial plastic surgeon that focuses on cosmetic surgery. In the United States, the majority of excellent oculoplastic surgeons are members of ASOPRS, an organization that oversees fellowships and certification in oculofacial plastic surgery.

You may wish to pursue multiple consultations before deciding on a surgeon that is right for you. You should inquire if there is an opportunity to talk with other patients who underwent surgery with each doctor. Ultimately, the decision to undergo cosmetic surgery is a personal one, and so is your choice in a surgeon.

Will I have visible scars after cosmetic blepharoplasty?

Usually, there are hidden scars.

On the upper eyelid, the scar is most often planned to coincide with the natural, preexisting upper eyelid crease. As the incision heals, the scar tends tends to be unnoticeable.

For the lower eyelid, the scar may be hidden behind the eyelid so that it is not seen at all, or it may be hidden beneath the eyelash line.

The eyelid skin has a remarkable ability to heal well, partially due to its rich blood supply.

Will I need to repeat the blepharoplasty?

Most people will undergo blepharoplasty once, possibly twice in their lifetime. There are exceptions to this statement. Some conditions are more complicated than others, requiring more than one procedure. There may be factors (such as allergy, eye-rubbing, heavy smoking, etc) that lead to recurrence of the original problem. There may be post-surgical issues that require corrective surgery. A new cosmetic issue may arise at a later date due to the natural aging process. Thankfully, cosmetic blepharoplasty has an overall high rate of satisfaction leaving most people a reasonably long duration of benefit.

Is cosmetic eyelid surgery painful?

The procedure itself is not painful, due to anesthetics. The recovery is generally well-tolerated, but this is subjective and can depend on your tolerance for discomfort. Most people experience little or no pain after surgery, and often Tylenol is sufficient for any soreness felt in the first week.

dr. brett kotlus eyelid surgery guide

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