The top reasons you shouldn’t have traditional cosmetic upper blepharoplasty

Upper eyelid lift or upper blepharoplasty is the #3 most popular cosmetic surgery in the United States, in part because your eyelids have very, very thin skin and are the first parts of your face to show your age.

For some, cosmetic upper eyelid tuck can be an easy way to make your entire face look brighter and more like a younger version of you.  But for others, it can be a mistake.

How do you know if an upper blepharoplasty makes sense for you?  Read below to find out…

1. If you never had an eyelid platform..

The eyelid platform is the shelf that sits between your eye lashes and your eyelid crease.  See image below:

dr. brett kotlus eyelid shelf

If you never had a great deal of eyelid platform showing when you were younger, a “simple” traditional upper blepharoplasty that simply removes skin (and maybe fat) could be a big mistake. By creating a platform where none existed before, your eye shape will change and you may look “done”.

See the example below.  This woman had beautiful eyes with a little bit of loose skin.  After a skin removal upper blepharoplasty (done elsewhere), she has more shelf exposed and it doesn’t look natural.

dr. brett kotlus upper blepharoplasty

In this case, it would have been preferable to have had a very conservative upper eyelid skin removal in combination with volume replacement (with fillers or microfat grafting) to restore her eye shape.

2. If your upper eyelids are hollow and deflated

In order to get the best possible and most natural-looking results, upper eyelid rejuvenation shouldn’t be approached in the same way for every person.  If your upper eyelids look to be sagging because they are actually sunken or hollow, traditional skin removal only can be a mistake.

Often, the best way to treat a hollow or sunken upper lid with secondary loose eyelid skin is to remove a very minimal amount of skin along with crease defining techniques, and then to re-inflate the sunken areas with microfat grafting or fillers.

See the examples below.  They maintained a natural look by having volume replaced but leaving the platform height alone.  This way, the eye shape doesn’t change.

dr. brett kotlus under eye bag remove nyc
Dr. brett kotlus cosmetic oculoplastic eyelid lift ny

3. If the real problem is your eyebrow

Most people who seek upper eyelid rejuvenation fail to notice that the eyebrows have aged along with the eyelids, and more specifically, the fullness below the eyebrows has depleted over the years (see reason #2 above).

If you have simultaneous under-brow or sub-brow deflation and sagging, the best and most natura-looking upper eyelid procedure will deal with the brows at the same time.  This could mean Botox, sub-brow fillers, microfat injections, or even a subtle brow lift.

See the image below.  She initially wanted just an upper blepharoplasty but realized (during her consultation with me) that the best way to look her best was to have a brow lift with a subtle upper eyelid lift.

dr. brett kotlus brow lift nyc

The new LFT approach to upper eyelids

I like to use a “multimodal” approach to upper eyelid rejuvenation by addressing the multiple reasons that the eyes look older.  I call this the LFT method because it can include 3 things (but some people only need 1 or 2):

L: laser resurfacing- this removes wrinkles, sun damage, and smoothes the upper eyelid skin.  In fact I published this technique in the Ophthalmic Plastic and Reconstructive Surgery Journal to share this concept with other eyelid surgery experts around the world.

F: fat grafting- this provides a long-term way to restore fullness that has been lost in the area below the eyebrow.

T: tuck- a small removal of skin and crease definition is done to “clean up” and sharpen the upper eyelid.

dr. brett kotlus eyelid surgery