Eyelid surgery isn't all about vanity

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Eyelid surgery isn’t all about vanity

Okay, maybe it’s a little about vanity, but it’s also about health.


When I had plastic surgery to get rid of a neck that made me look like a walrus and bags under my eyes I could touch with my toes each morning, I also had one droopy eyelid “lifted.”

This wasn’t to make me look younger but just more “balanced.”

Turns out droopy eyelids are a common sign of aging and these sagging lids can even be harmful to your health. Like saggy uppers cause problems like loss of vision headaches, fatigue (particularly after prolonged reading), frequent blinking and eye twitching.

What’s the cause of all this?

“We have to look at the eyes in two forms – eyelids and eyebrows,” says Dr. Farbod Esmailian, a plastic surgeon. “Both problems are a result of aging and the loss of ligament support and the result is saggy eyes.”

Q: Does everyone get saggy eyes?

A: No, but it becomes more prominent as you age and the more you age, the more likely you are to get it. In part, it has to do with a person’s genetic makeup.

Q: Is surgery the only option?

A: Surgery is not the only thing if we are looking to raise the eyebrow, which can be sagging. To raise the eyebrow we can also use injections such as dermal fillers Restylane and Botox.

But, really, when we are talking about upper and lower eyelids, surgery is the ultimate thing. We can do a peel but what that really addresses is the wrinkling of the skin more than the underlying fat.

You see, a patient with aging eyes not only has wrinkling and loose skin, but also fat underneath that is pushing through and creating bags.

Q: Is this just a problem of age?

A: I’ve had patients as young as 35.

Q: Let’s talk first about a brow lift.

A: A brow lift opens your eyes by raising the lids. It addresses the upper not the lower eyelid.

In facial rejuvenation, a patient may need a brow lift in conjunction with the upper eyelid surgery. This is called blepharoplasty.

More often than not, when patients come to see me for eyelids, they really need a brow lift to pull the eyebrow back into position, lift some skin hanging in the lid and then removal of some skin of the eyelid.

Q: I would think sagging eyelids could be a medical problem.

A: Right. We call it dermatochalasis, the drooping of the skin of the upper eyelid. Some patients actually have vision problems and their peripheral vision is interfered with. They have a hard time driving a car because they can’t see out the side of their eyes.

Q: Is this procedure covered by insurance?

A: The upper eyelid could possibly be covered by insurance if you can prove a medical necessity – the peripheral vision is interfered with. This has to be documented by an eye exam. If insurance does cover the procedure, Medicare also will cover it. But the lower eyelid and a brow lift is not covered by insurance.

Q: What’s the average cost for these procedures?

A: A brow lift is about $5,000 and upper and lower eyelids are about $3,000 each.

Q: Does this require a long hospital stay?

A: Patients go home the same day. Each procedure (brow lift, upper and lower eyelids) takes about an hour. I counsel patients (to avoid) too much reading or television; no eye stress for two days. Then there is a follow-up exam. Sutures around the eyes are removed after five days and sutures or staples in the scalp from a brow lift are usually removed after seven days. All the incisions are well-hidden, of course.

Q: Are you seeing more patients asking for this surgery?

A: I think in general we are seeing more cosmetic surgery as a whole. Society is more and more accepting of these procedures. People are more open and talking about it themselves. More talk leads to more people seeking advice and, as a result, more surgeries.