The Aging Process
As part of the normal aging process, the appearance of the eyes changes in a predictable way.

UPPER EYELID

The skin of the upper eyelid becomes redundant and appears to sag. The upper eyelid crease, well demarcated in youth, becomes blunted and eventually is lost. The deeper tissue, firm in youth, becomes lax with age resulting in protrusion of fat which can appear lumpy or bulging. Descent of the brow with aging contributes to the diminished appearance of the upper eyelid.

LOWER EYELID

In the lower eyelid, the skin becomes thinner and can take on a finely-wrinkled appearance sometimes described as resembling the characteristically crinkled crepe paper. Dark circles can appear underneath the lower eyelid as cheek fat is displaced and eyelid fat begins to bulge. Together, these changes cause the eyes to appear tired and less bright.

Candidates for Blepharoplasty (Eyelid Plastic Surgery)
You may be a good candidate for eyelid surgery if you notice any age related changes that are of concern to you. These changes may include excessive or sagging upper eyelid skin, dark circles under the eyes, areas of bulges which may detract from the optimal appearance of the eyes. Dr. Pearson will assess your concerns along with the appearance of your eyes and surrounding tissues to help you to understand if eyelid surgery may be a good option for you.

Blepharoplasty Surgery (Eyelid Plastic Surgery)
Blepharoplasty involves the removal of excess skin and sculpting of eyelid fat by way of carefully placed and small incisions in the eyelid creases. Blepharoplasty can minimize the puffiness and bags which can contribute to the appearance of aged or tired eyes. In some cases, blepharoplasty can be performed in the office by Dr. Pearson.

Illustration of Lower Eyelid Blepharoplasty. Upper right image: yellow hightlighted area delineates protuberant lower eyelid fat pads, which cause a shadow to be cast in the relative hollow underneath. This protruding fat is thinned or repositioned during lower blepharoplasty. Lower right image: yellow arrowheads demonstrate rejuvenated and more smooth eyelid-cheek junction, with a minimized shadow. Blue arrowheads demonstrate inconspicuous scar from removal of excess lower eyelid skin. The scar is concealed just beneath the eyelash line. Click illustration for higher-resolution image.

Dr. Pearson's Philosophy Regarding Facial Rejuvenation
Dr. Pearson understands that people want to look like themselves, only better - that is, the best version of themselves. The goal of facial rejuvenation is to retain your unique facial features, while simultaneously minimizing those unfavorable characteristics which contribute to the appearance of perceived aging and loss of vitality. In Dr. Pearson's opinion, the ultimate goal of facial rejuvenation services should be to restore a refreshed and rested appearance, while maintaining a natural and appropriate look.

The goal of cosmetic Eyelid Surgery is not to look different, just better. In particular, one should never look 'done' or 'surgerized.' as a result of plastic surgery. In order to achieve that, the surgeon needs to avoid the tell-tale signs of surgery such as overly-tight or pulled appearance, poor incision site design and/or scars, or an overdone appearance in general.

A superior Blepharoplasty result is usually not even perceived as having resulted from surgery. Onlookers usually comment that our patients look refreshed, or especially well-rested as if having recently returned from a vacation without assuming that it involved surgery.

We are grateful to our many patients who have generously contributed their before and after photos so that others may learn. Please view our photo gallery to see samples of Dr. Pearson's work. Pictures may speak more clearly than words what we mean by 'the best version of yourself.'

Complementary Procedures
Blepharoplasty is often undertaken in conjunction with laser resurfacing of the skin surrounding the eyelids. When a heavy or malpositioned brow contributes to the appearance of upper eyelid fullness or hooding, a forehead lift or browlift can be beneficial. When the lower eyelid appearance is affected by age-related cheek descent, a midface lift may help to rejuvenate the entire lower lid-cheek complex.

Possible Non-surgical Alternative Treatments
Subtle signs of aging may be amenable to minimally invasive methods to rejuvenate the eyelids and surrounding tissues. Dr. Pearson offers a full range of nonsurgical procedures including facial skin resurfacing, Botox treatments, and volume replacement. In some cases, the hollows in the tissue surrounding the eyes may be improved using hyaluronic acid filler.

Recovery after Blepharoplasty (Eyelid Plastic Surgery)
Following blepharoplasty, you can expect a few days of swelling and bruising. Soreness is typically minimal. Sutures are typically removed between days 3 and 7. Makeup can be used at this point to camouflage any bruising or scars. Swelling and bruising generally subside by 7 days. You can resume most normal activities after a couple of days, except for intense exercise, which may be resumed at about 3 weeks. Most people are able to return to work in 1 week. Blepharoplasty scars are usually not noticeable after a short time.

GENERAL CONSIDERATIONS

What is Eyelid Plastic Surgery or Blepharoplasty ?

Blepharoplasty describes surgical treatment of eyes to improve their appearance.

Upper Blepharoplasty entails removal of excess skin and sometimes protruding fat to impart a more rested, youthful and alert appearance.

Lower Blepharoplasty entails removal of excess skin and often protruding fat which may contribute to the appearance of 'dark circles' under the eyes leading to a tired appearance.

Similar terms for Eyelid Plastic Surgery include: 'Eyelid Lift', 'Blepharoplasty.'

Where is the Blepharoplasty performed?

In some cases, especially for the upper eyelids, the procedure may be performed using local anesthesia alone in the office.

When IV sedation is used, Dr. Pearson performs Blepharoplasty in an accredited Ambulatory Surgery Center (ASC). Compared with a hospital setting, an ASC offers the advantages of lower cost, improved privacy and personalized attention.

What type of Anesthesia is used for a Blepharoplasty?

Several options are available for anesthesia during your Blepharoplasty. For procedures performed in the OR, most patients choose to have deep sedation (twilight). However, options including local anesthesia alone and light sedation are available.

Where are surgical incisions placed?

For Upper Blepharoplasty, the surgical incision is placed within the natural upper eyelid crease.

For Lower Blepharoplasty, the incision planning depends on the goals of the procedure.

For fat removal alone, the incision is placed on the inside of the lower eyelid, behind the lower lid lashes. This is called a 'transconjunctival' incision. No skin incision is used for this approach.

For lower eyelid skin removal, the incision is placed just below the lower eyelid lashes, enabling the scar to be well concealed by the natural transition zone between the lashes and the lower eyelid skin.

What type of surgical scar may I expect?

When surgical incision sites are carefully planned, meticulously performed, and appropriately cared for, Dr. Pearson's Blepharoplasty scarring is typically inconspicuous.

How much skin is removed during an upper Blepharoplasty?

Only the excess upper eyelid skin which contributes to heaviness or obscures the upper eyelid crease is removed.

Are there risks involved with Blepharoplasty surgery?

Yes. During your consultation, Dr. Pearson will discuss with you the potential risks of surgery. Precautions are taken to minimize risks. Most patients do not experience complications. As a Board-Certified Facial Plastic Surgeon, Dr. Pearson's surgical practice is limited to the Face and Neck. We believe that our high level of sub-specialization and practice focus enables us to minimize risks associated with Facial Plastic Surgery.

Associated potential risks involved with facial plastic surgical procedures include but are not limited to infection, bleeding, hematoma, neurovascular injury, scarring, asymmetry, hair loss, unfavourable cosmetic result. Prior to any surgical procedure, Dr. Pearson will personally discuss with you any specific or additional risks that may apply in your particular case.

Am I a candidate for Blepharoplasty?

If you are concerned with the appearance of your eyes or the associated appearance of chronic fatigue and/or disinterest you may be a candidate for Blepharoplasty. Several factors are considered as to an individual's candidacy for Blepharoplasty.

Ideal candidates for facial plastic surgery demonstrate the following characteristics:

• Are generally healthy
• Do not smoke or use tobacco
• Have a positive outlook
• Have reasonable expectations about what can be accomplished with surgery
• Understand and accept the risks and limitations of surgery

For the upper Eyelids, can I achieve a similar result with a Browlift instead of a Blepharoplasty?

No. Most people of a certain age demonstrate both brow heaviness and excess upper eyelid skin. In some cases, the brow contribution is more prominent and in other cases, the eyelid skin contribution is more significant.

During your consultation, Dr. Pearson will evaluate your brow and eyelids to determine the relative contribution of each.

A Browlift is better able to improve the appearance of 'etched in' crows feet visible at rest, and 'lateral hooding' which appears like extra skin extending beyond the outer corner of the eye.

If my brows contribute to the appearance of my upper facial aging, can a Browlift be performed at the same time as a Blepharoplasty?

Yes. Alternatively, a Browlift may be performed later without any detrimental effect.

RESULTS

How will I look after my Blepharoplasty? How much of an improvement may I reasonably expect?

During your consultation, Dr. Pearson will demonstrate to you in the mirror what you can expect from Blepharoplasty.

Will I look like I had cosmetic surgery?

This is a common concern among individuals considering cosmetic surgery.

In short, once any early swelling and bruising have resolved, onlookers typically cannot tell that our patients underwent cosmetic surgery. Dr. Pearson is sought after specifically for his ability to achieve natural results.

How Blepharoplasty is performed makes a world of difference as to the results achieved. Careful incision site planning, meticulous surgical technique and avoidance of tell-tale signs of surgery are crucial.

A natural-appearing Blepharoplasty:

• Should not be overdone
• Should not remove too much skin
• Should have well-concealed surgical scars
• Should not attempt to compensate for the contribution of the brows

View our Photo Gallery to see a sampling of Dr. Pearson's Blepharoplasty results.

How long will my Blepharoplasty last?

Dr. Pearson will discuss this with you at the time of your consultation. The results of your Blepharoplasty are permanent. However, no surgical procedure can stop the aging process.

PREPARATION

How can I prepare for my Blepharoplasty?

During your pre-operative visit, detailed instructions for pre-operative preparation are provided and discussed. Prescriptions and supplies are also provided at that time.

What type of pre-operative testing is requested?

For procedures performed under local anesthesia alone, no particular pre operative testing is usually needed for otherwise healthy people.

For procedures performed in the OR, pre-operative testing is performed within about 30 days of one's surgery date. Depending on one's age and medical history, such testing may include blood work, EKG and medical clearance by your doctor. If your doctor is unavailable, we have a trusted team of doctors and cardiologists who are available for medical and/or cardiac clearance.

How far out should I plan to schedule surgery?

In general, we schedule Blepharoplasty surgery 6 or more weeks in advance. During certain times of the year, more advance notice is needed. If you know your preferred time and availability, we can schedule months in advance to reserve your appointment.

RECOVERY AND HEALING

What may I expect following my Blepharoplasty? (First 24 hours)

During your pre-operative visit, detailed instructions for aftercare are provided and discussed. Patients are instructed to apply cool compresses to the eyes and to keep the head elevated and avoid exertion for the early post-operative period. If you receive IV sedation, on the day and evening of surgery, a caretaker should be available to assist with home care. This person does not need medical training.

Recovery (after 24 hours)

• No surgical dressing is used for Blepharoplasty.
• Most patients use prescription pain medications for only the first night.
• Resume light activity at home the day after surgery. That includes caring for oneself, preparing food, etc.
• You are advised to avoid exertion and straining activities during the early recovery period.
• Most patients resume driving after a few days once they have discontinued prescription pain medications.
• Sutures are removed within 5-7 days.
• By 1 week, there is significant improvement in the expected peri-operative bruising and swelling.
• By 1 week, most patients feel that their appearance is acceptable to return to social appearances and work. Any residual swelling and/or bruising or pink discoloration of the scar may be concealed using eye glasses and concealer makeup.
• By 3 weeks, full exertion including exercise is resumed.
• By 3-4 weeks, most patients are pleased with the improvement in their appearance.

When can I return to work / Resume social appearances?

Most patients feel ready to return to work once they feel that their appearance is socially acceptable by day 7 (see above).

When can I resume exercise?

Intense exercise is typically resumed by 3 weeks. Depending on your swelling and healing progress, Dr. Pearson will advise you when exercise may be resumed in your case.

FINANCIAL CONSIDERATIONS

How much does a Blepharoplasty cost?

This is an individualized question. Contributing cost factors include: Whether surgery involving the upper eyelids, lower eyelids, or both as well as Location of surgery in the office or the OR

Each Blepharoplasty procedure is customized by Dr. Pearson to the individual's needs and preferences. Some cases require additional work and/or time to achieve optimal results. Consequently, the cost estimate varies accordingly. Following your consultation with Dr. Pearson, a customized quote will be provided.

The cost of a Blepharoplasty is not insignificant. However, people concerned with a diminished appearance related to their eyes consider the cost to be worthwhile. Dr. Pearson's patients report a very high rate of satisfaction with their results and the positive impact on their lives. See some of our patient's reviews on our website.

How do the finances work for cosmetic facial surgery?

If you choose to proceed with surgery, we will work with you to find an acceptable date for your procedure. A deposit is requested at that time to hold your date. Our office begins the pre-operative planning at that time, including pre operative testing, pre operative meeting with Dr. Pearson to discuss specifics and logistics of your procedure, etc. Final payment is due a few weeks prior to surgery.