Eyelid Surgery

The Eyelids

The eyelids are extremely complex and delicate structures that are vital to the preservation of sight. The eyelids protect the eye and spread tears across the surface of the eye. The position and contours of the eyelids are important features of a normal facial appearance. Abnormalities in the eyelid’s position, function, and appearance can arise from a variety of causes including birth defects, aging, tumors, injury, or medical diseases such as thyroid disorders. Depending on the cause of the eyelid abnormality and the purpose of its surgical repair, eyelid operations may be either reconstructive (functional) or cosmetic (for appearance only). As a general rule, insurance companies will cover part of the cost of functional eyelid surgery but not of cosmetic surgery.

What is Eyelid Surgery?

Eyelid surgery, or blepharoplasty, is a procedure designed to create a more youthful, rested, and open appearance around the eyes. Generally, there are two groups of patients who come see Dr. Vanek for eyelid surgery consultation: patients with mechanical issues and patients with cosmetic issues.

“Some patients have mechanical issues that cause visual field obstructions, and if so, we can do an assessment that enables me to have their eyelid surgery covered by their insurance,” explains Dr. Vanek, a Fellow of the American College of Surgeons. “The patient who is aesthetically dismayed with their upper or lower lids can be comfortable knowing that their surgery will be expertly performed and that the risk of mechanical problems after surgery is low.”

Eyelid surgery can be performed on either the lower lids or upper lids, or both at the same time. During your consultation with Dr. Vanek, your needs will be individually assessed. “I do not take a cookie-cutter approach to surgery,” says Dr. Vanek.

For more information from The American Society of Plastic Surgeons, please click here

What is the difference between Upper and Lower Blepharoplasty?

For eyelid surgery, there are distinct techniques for the upper and lower lids. “Particularly with lower lid surgery, I can often offer my patients ligament tightening, which is something that a lot of surgeons don’t undertake because of the complexity of the procedure,” says Dr. Vanek, who studied the art and science of blepharoplasty at the Kellogg Eye Center at the University of Michigan. “A good ‘bleph’ is not just tightening the skin – it’s a matter of three-dimensionally assessing the eyelid: its muscle layer, its skin layer, and its supportive tissue layer. And then those layers need to be rejuvenated in a single procedure for a natural-looking result.”

“The upper eyelid blepharoplasty technique sometimes simply involves extra skin removal. Sometimes it involves skin and extra fat removal that is tastefully done and not over-resected. Sometimes it also involves removing the minimum amount of skin and muscle. It all just depends on the individual person’s needs. If they have problems with their levator muscle, I have enough oculoplastic experience to make their levator muscles more functional and create a more awake and alert appearance, as long as the healing process goes as we hope.”

This patient is an 88 year-old Black woman with an ectropion that’s very severe. She has exposure of her conjunctiva and chronic drainage from having her eyelid rolled out so extensively. The patient and I have spoken about her situation, and she said it’s intolerable. Even though she’s an aged woman, she’s an excellent candidate for remediative reconstructive surgery. This procedure was performed in about an hour as an outpatient surgery, and you can see her in her other views side-by-side that’s solved the problem. Her eyelid is in excellent position. It co-apps and abuts the eye properly. The corner of the eye is properly reconstructed. The excess lid that’s so loose, as well as the retractor muscles that have become disinserted with her age are now reinserted in the right position surgically. I know she’s very happy. They front view and side views definitely show the restoration of the normal eyelid shape, and she has a long-term prognosis for an excellent outcome. She’s very happy as you can see by her happy smile. She’s a very darling lady.

What are some other sorts of Eyelid Rejuvenation?

In some cases, Dr. Vanek may suggest volume enhancement rather than surgery. “Sometimes the rejuvenation of the upper face can be facilitated without eyelid surgery. Patients who are lacking volume in their upper face can see tremendous improvement from a liquid lift,” says Dr. Vanek, named one of ‘America’s Top Physicians’ by the Consumer’s Research Council of America. “For patients who had eyelid surgery performed elsewhere and feel dissatisfied, improvements can be made in a revision involving fat transfer and volume-enhancing injectables that give them a less ‘operated-on’ appearance.”

Baggy Eyelids

Baggy eyelids usually develop as a result of hereditary tendencies and aging. Allergies and smoking may accelerate the aging of the eyelids and cause the bags to appear at a relatively young age. The bags in the eyelids are composed of loose skin and muscle, bulging fat, and in some cases fluid. Blepharoplasty is the operation designed to correct these deformities. This surgery may be either reconstructive or cosmetic, depending upon the severity of the problem and upon whether vision is impaired. Dr. Vanek and his staff can give advice regarding payment for surgery and possible insurance coverage if it is indicated.

Drooping Brows

As all facial structures may sag and droop with age, so too may the brows. Drooping brows (brow ptosis) may be so severe that they prevent the upper lids from opening fully. An eyebrow lift is the surgery that positions the brow back to a normal location. It is frequently performed in conjunction with an upper lid blepharoplasty or lower lid blepharoplasty and is most likely not covered by your health care insurance.

Droopy Eyelids (Eyelid Ptosis)

Droopy eyelids occur when the edge of the upper eyelid that contains the lashes falls too low. When the edge of the eyelid falls and covers part of the pupil, it blocks the upper part of your vision. In severe cases, it is necessary to tilt one’s head back or lift the eyelid with a finger in order to see out from under the drooping lid. A drooping eyelid can occur as a congenital defect in which the muscle that lifts the eyelid fails to develop properly.

In most cases, a drooping upper eyelid results from aging of previously normal structures. Typically the tendon that attaches the “lifting muscle” to the eyelid stretches and the eyelid falls too low. Since the muscle that lifts the eyelid has normal strength, surgical correction of a drooping upper eyelid that was once normal involves repairing the stretched tendon. It may also involve advancing the stretched tendon to its normal insertion on the cartilage of the upper lid. It is not uncommon for one to develop a droopy upper eyelid following cataract surgery. The cataract surgery is apparently the last straw that causes a weak tendon to finally give way.

Eyelids That Turn Outward

When a lower eyelid turns outward and no longer touches the eye (ectropion), it cannot properly spread the tear film across it. The exposed inner lining of the eyelid becomes dry and inflamed. Tearing often occurs and the eye may become damaged. Surgery is usually indicated to restore the eyelid to a normal position. This surgery is called canthopexy or sometimes lateral tarsal strip or sometimes Kount-Szymenowski procedure. Dr. Vanek will explain to you what procedure is indicated based on your eyelid anatomy.

Eyelids That Turn Inward

Scars in the eyelids and face can often be made less objectionable. Dr. Vanek is trained to choose the most appropriate scar revision technique for each patient. Sometimes multiple laser wavelengths are indicated to improve scars in their shape and their color problems so that they blend better with the overall face. Laser treatments are typically not a covered service by any health care insurance.


An eyelid can turn inward (entropion) so that the skin of the eyelid and its lashes constantly rub against the eye. Constant eye irritation and discomfort usually result. An eye so irritated is at risk of developing severe infections and scarring that may result in permanent visual loss. Surgical correction of an entropion is strongly recommended to help avoid these sometimes irreversible complications of the condition.

What to expect during your Blepharoplasty Consultation

In Dr. Vanek’s experience, great outcomes begin with the consultation. During your consult, Dr. Vanek will educate you on the risks and benefits of any procedure and empower you to make an informed, medically sound decision. Your individual anatomy and your aesthetic goals will create a series of surgical options for Dr. Vanek to review with you.

Your outcome will be based on sound principles of anatomy and surgery. “Give us a call,” says Dr. Vanek. “ I’d love to talk with you and help you celebrate your beauty.” Contact us to schedule your consultation today.

To contact Dr. Paul Vanek, please click here.