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Blepharoplasty (Eyelid Surgery)

Eyelid Surgery In-depth

‘Toronto Blepharoplasty surgeon Dr. Lawrence Tong can help correct your eye bags, droopy eyelids, and dark shadows of the lower and upper eyelids’

Introduction to Toronto Blepharoplasty

No feature makes your face look older than aging of the eyes. Very popular for patients in Toronto, Blepharoplasty is a procedure that can reverse the signs of aging in the upper and/or the lower lids. Upper lid Blepharoplasty is straightforward, while lower lid Blepharoplasty is a technically demanding procedure. For that reason, you should choose an eyelid surgeon who is experienced, and very comfortable with all aspects of Blepharoplasty. Toronto Plastic surgeon, Dr. Lawrence Tong will guide you through the process of making your decision about eyelid surgery.

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Signs of Aging in the Upper Lids

Upper Lids: The Aesthetic Ideal

The upper lids should have a clean, crisp, and uniform crease height. There should be no hanging skin to touch the lashes, and the skin itself is ideally smooth and wrinkle free.

Upper Lids: Typical Signs of Aging

  • Excess lid skin that hangs down, making the patient look older
  • They describe themselves with ‘droopy eyelids’
  • The eyes often looking sad, tired, or appear angry
  • Patients typically lose the appearance of a well-defined lid crease, and the lid skin may be wrinkled
  • Female patients find it difficult to apply eye makeup due to the excess skin
  • In some cases, the excess skin causes upper visual field obstruction
  • The appearance of bulging fat in the upper lid is common
  • As patients continue to age, the upper areas of the eye tends to lose fat, resulting in a gaunt, aged appearance

Upper lid Blepharoplasty is a procedure that can reverse many signs of aging in the upper lids.

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Signs of Aging in the Lower Lids

The lower lids should have a smooth appearance. The lid should blend seamlessly with the cheek, free of bulges or fat bags. The skin is ideally tight, and the lid margin should sit at or slightly above the lower edge of the iris.

Lower Lid: Typical Signs of Aging

  • The main culprits of lower lid aging are the ‘eye bags’
  • The ‘bags’ are composed of protruding fat that makes a patient look tired, or worn out
  • Crepe-like lower lid skin and fine wrinkles on the lower lid
  • These changes stem from loss of elasticity from aging, and sun exposure
  • Finally, dark circles are very common with lower lid aging
  • Dark circles are caused by shadows cast by the bulging fat, or deeper pigmentation in the lower lid region

Lower lid Blepharoplasty is a procedure that can reverse many of the signs of aging in the lower lids.

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What does Blepharoplasty accomplish?

Blepharoplasty helps reverse the signs of aging of the upper and lower eyelids. Specifically, Blepharoplasty can:

  • get rid of fat pockets in upper and lower lids
  • remove excess lid skin
  • help smooth out wrinkles
  • improve dark circles in the lower lids
  • help to fix lid drooping (upper or lower lids) caused by old age

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Who is a candidate for Blepharoplasty?

Dr. Tong will make sure that you are a suitable candidate for surgery at the time of your consultation. Anyone with signs of aging in the upper or lower lids may benefit from Blepharoplasty. Patients should be generally healthy, and be relatively fit. Smokers should quit smoking at least 2 weeks prior to surgery, and not resume for at least 6 weeks. You should let Dr. Tong know if you have problems with dry eyes or thyroid problems as these medical issues may affect your procedure.

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Issues to Consider with Blepharoplasty

Upper Lid Blepharoplasty vs. Lower Lid Blepharoplasty

Upper and lower lid Blepharoplasty are distinct operations. The difference stems from the unique way in which they change with aging. In general, the main concern for the upper lid is excess skin, while the main concern for the lower lids are fat bags. Lower lid Blepharoplasty tends to be much more technically demanding than the upper lid Blepharoplasty.

Excess Skin Removal in Blepharoplasty

In the upper lid, skin removal will help to restore a clean consistent crease, and help eliminate wrinkling due to crepe-like skin.

In contrast, skin removal in the lower lids must be done cautiously; too much removal of lower lid skin can lead to functional and aesthetic problems. A patient may complain about dry eyes, a sad appearance, or the inability to fully close their eyes if too much lower lid skin is removed.

Excess Fat Removal in Blepharoplasty

In the lower lids, fat removal is acceptable and desirable when eye bags are present. However, over-removal can cause a hollow, unattractive appearance. Excess lower lid fat is frequently repositioned (instead of removed outright) to help contour of the lower lid/cheek junction.

For the upper lids, fat needs to be removed judiciously, and in the right areas; too much removal can lead to a ‘skeletonized’ look. In the upper lids, an important sign of aging is loss of fat; therefore the upper Blepharoplasty technique should not exacerbate the appearance of fat loss by removing too much of it.

Dr. Tong is very comfortable and experienced with all facets of upper and lower lid Blepharoplasty.

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Incisions for Upper and Lower Lid Blepharoplasty

Incisions in the eyelids typically heal to a point where they are almost imperceptible. This is due to the thinness of the skin. Additionally, the incisions are placed in areas where they hide, in natural folds, curves, and lines.

Upper lid Blepharoplasty Incisions

  • placed in the natural lid crease
  • This location will hide the scar when your eyes are open
  • Even with your eyes closed, the scar will be almost invisible

Lower lids Blepharoplasty Incisions
The incision of the lower lids can be made in two ways:

  • Under the lash line: this incision heals remarkably well, and is easily hidden with any type of eye make up.
  • On the inside of the lower lid: this is call a Transconjunctival Approach; the inicion is made on the inside of the lid, and therefore there is no external scar whatsoever. This incision is used when there is no skin removal.

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Blepharoplasty Procedure Details

Dr. Tong performs Blepahroplasty in the private CAAASF accredited operating suites, located on the 3rd floor of our building in Yorkville, Toronto. In select patients, Blepharoplasty of the upper lids may be done with local anesthetic only. Otherwise, IV sedation (or general anesthesia) is preferred for upper and lower lid Blepharoplasty.

Upper Lid Blepharoplasty Procedure Details

Dr. Tong carefully designs skin markings on the upper lids prior to surgery. After anesthesia is given, Dr. Tong makes the incision in the upper lid crease, and removes the skin. When appropriate, he removes fat in the upper lid, and does so in a conservative manner. If the upper lid is drooping due to the effects of age, Dr. Tong corrects the drooping with specially placed stitches in the eyelid muscles. Finally, the incision is meticulously sewn together to obtain a fine scar.

Lower Lid Lift Blepharoplasty Procedure Details

Dr. Tong makes the incision just beneath the eyelashes, and the fat in the lower lid is exposed. He performs fat removal and fat sculpting to eliminate ‘bags’, and to achieve a smooth contour. Dr. Tong removes a small amount of skin if required to smooth out wrinkles and tighten the skin. Care must be taken to avoid excessive skin removal, which can cause aesthetic and functional complications. The incision is then sewn together for a beautiful closure.

Transconjunctival Lower Lid Blepharoplasty Procedure Details

In cases where no skin removal is anticipated or desired, the lower lid Blepharoplasty can be performed through and incision on the inside of the lower lid. No external incisions are made. This technique is called a ‘transconjunctival lower lid Blepharoplasty’. After Dr. Tong makes the internal incision, he carefully removes excess bulging fat in the lower lid. The procedure is complete when the bags are eliminated and a smooth contour is established. Stitches are generally not required with this technique.

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Recovery after Blepharoplasty

Blepharoplasty Recovery Immediately after Surgery

After your Blepharoplasty, the staff transfers you to the anesthesia recovery area. As you gently awake from anesthesia, our nursing staff monitors your progress. Once the anesthetic effects wear off, Dr. Tong allows you to go home, accompanied by friends/family.

Blepharoplasty Recovery at Home

At home, you should try to rest and relax as much as possible. You may do non-strenuous activities, but should avoid watching television, reading or otherwise straining your eyes. To help decrease swelling and bruising around the eyes, sleep in a reclining chair, or use multiple pillows to keep your head elevated. Pain is typically mild, but your eyes may be sensitive to bright light over the first few days. Dr. Tong prescribes pain medication, which you can use during this time. You will have some bruising that lasts 1-2 weeks.

Follow up Appointments after Blepharoplasty

Your first appointment with Dr. Tong will occur one week after surgery. The majority of patients return work (non-strenuous) at 7-10 days. Dr. Tong will likely allow you to start light exercise (e.g. waking) at 1-2 weeks after surgery. Avoid strenuous activity until 4-6 weeks after surgery. After the initial post-operative visit, you will follow up with Dr. Tong at 6 weeks, 6 months, and one year after surgery. Post-operative photos will also be taken at these visits.

Like any procedure, Blepharoplasty has risks and complications associated with it. The risks are low, but do exist. At your consultation, Dr. Tong will go over the pertinent potential risks and complications associated with Blepharoplasty.

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Become Educated about Blepharoplasty in Toronto

It is very important that you do your research about your surgery and surgeon. During your Blepharoplasty consultation, you will have Dr. Tong’s undivided attention to discuss concerns, and ask questions. You will have the opportunity to view many before and after photos of his Blepharoplasty work, as well. There is a great deal information to digest during your initial consultation, and our goal is to have you become an educated patient. We know that the educated patient will make better decisions about their surgery and their surgeon.

To learn more about how Dr. Tong can help you with Blepharoplasty and facial rejuvenation, set up a Blepharoplasty consultation by giving us a call at (416) 972-0999. You can also let us give you a call; just fill out our contact form and we will call you on the same or the next business day. No doctor’s referral is needed.

See Dr. Tong’s work in our Blepharoplasty before and after photos.

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We practise The Art of Beauty.