Dr. Steven Fagien & Dr. Elbert Vaca

Eyelid Surgery


Blepharoplasty, or cosmetic eyelid surgery (sometimes referred to as an “eye lift”), can be performed on both the upper and lower eyelids. This procedure is used to rejuvenate the eye region by restoring the volume and youthful contours that diminish with age. Blepharoplasty involves reducing excess eyelid skin and/or removing or repositioning fat around the eyes.

The eyelids are one of the first areas of the face to demonstrate noticeable aging changes – however, each patient’s aging changes are unique and require a thorough analysis and individualized treatment plan.  A “one size fits all” approach to eyelid surgery risks a noticeably “surgical” and poor aesthetic appearance. For this reason, it is extremely important that eyelid surgery be customized to your individual needs.

Dr. Fagien is arguably the world’s foremost authority on aesthetic eyelid surgery and his patients have traveled from all over the world to seek his expertise. Dr. Fagien has authored over 350 publications, has given more than 1,500 national and international presentations, and he has served on the editorial board of Plastic and Reconstructive Surgery.

Dr. Vaca has published extensively on the nuances of eyelid and facial aesthetics and has also presented his contributions to the advancement of plastic surgery both nationally and internationally.

Our practice offers eyelid plastic surgery procedures including:

Ptosis (Droopy Eyelid) Surgery

How and why do eyelid aging changes occur?

The delicate skin around the eyes is prone to visible sagging and volume loss, which detract from an otherwise youthful appearance. The natural aging process, genetics, facial expression, and environmental and lifestyle factors such as smoking, diet and sunlight exposure can all contribute aging of the eyelids.

Upper eyelid aging is complex. An aged appearance of the upper eyelids can be due to a combination of excess or loose appearing skin (i.e. dermatochalasis), droopy upper lids (i.e. ptosis), hollowing of the upper eyelid, bulging of upper lid fat, changes in the position and curvature of the brow, and thinning of the eyelid skin and appearance of wrinkles.

In the lower eyelid, aging can present as “puffy bags”, dark circles beneath the eyes, excess skin and wrinkles, loosening of the lower eyelid, and changes in the shape of lower eyelid and upper cheek.

Where are incisions made for eyelid surgery?

In the upper eyelid, an incision is placed and concealed along the upper eyelid crease – this incision heals extremely well and is mostly undetectable once healed.

In the lower eyelid, an incision is made inside the lower eyelid (i.e. no external visible incision). If you have excess skin of the lower eyelids, an additional incision may be made just below the lower eyelashes – over time, this incision is inconspicuous in the vast majority of patients. During your consultation, both you and your surgeon can help decide which is the best surgical approach to best address your concerns.

What causes lower eyelid bags and the “tear trough?”

As we age, the muscles and skin around the eyes naturally weaken, which allows the fat that surrounding the eyes to shift position. Fat commonly settles in the lower eyelid area and causes more prominent bags. In some cases, fat loss and atrophy will also cause lower eyelid hollows, also called “tear troughs.”

Prominence of the tear trough gives the eyes a sunken appearance, creates dark circles and makes the eyes look fatigued even when you are well-rested. With the appearance of “bags”, the tear trough may appear deeper or “worse.”

What is ptosis?

Ptosis (TOE-sis), or drooping, can occur in both the upper and lower eyelids. This condition can be caused by muscle weakness, nerve damage and loose or excess skin. In some cases, severe ptosis may be considered a medical condition and may impair vision. Ptosis can be surgically corrected.

What is “Double Eyelid Surgery” (Asian Blepharoplasty)?

Some people of Asian descent lack a pretarsal fold, which is the natural crease between the upper eyelid and the brow. Also referred to as a “single eyelid,” this can make the eyes appear puffy and tired, and can be easily corrected if needed with oculoplastic surgery.

What is “Canthoplasty?”

Canthoplasty surgical technique used to reinforce or lift the outer corners of the eyes after lower blepharoplasty. The goal of this procedure is to reconstruct the weakened or stretched canthal tendon that anchors the lower eyelid. Canthoplasty is ideal for improving a tired or sad expression, revising the unwanted effects of previous eyelids surgery, and restoring a more youthful look to the eye area.  Dr. Fagien pioneered and developed his technique for canthal support or canthoplasty that has proven to be both effective and utilized by surgeons around the world.  The technique utilizes existing incisions during surgery that are undetectable and preserve the natural shape of the lower eyelid when necessary tightening of loose tissue is performed during lower blepharoplasty.

Eyelid surgery in men differs in several ways. Many men are looking for more conservative or subtle results, as they may not want others to know they had anything done. In addition, it is important to consider key differences in male eyelid proportions and male anatomy (such as thicker skin and stronger muscles). This is why it is imperative to consult with a highly specialized surgeon who has a great deal of experience with male patients.

Am I a good candidate for eyelid surgery?

The best candidates for surgery are those with aging changes of their eyelids who are in good health and have realistic aging concerns and expectations. During your consultation, Dr. Fagien or Dr. Vaca will discuss the details of your concerns and determine if you are a good candidate for surgery.

What is the typical age of patients seeking eyelid surgery?

While most patients seeking eyelid surgery are in their 40’s or older, there is no set age range for eyelid surgery as long as patients are healthy enough to undergo surgery. Patients in their 20’s can have lower eyelid bags or dark circles and can be excellent surgical candidates.

Can eyelid surgery be combined with other procedures?

Yes. Depending on your individual goals and needs, other surgical and non-surgical procedures can be performed at the same time as eyelid surgery. It is relatively common for patients with eyelid aging concerns to also have aging changes that affect the position of the eyebrow (known as brow ptosis – this may be improved by brow lift surgery).

What type of anesthesia is used during eyelid surgery?

Most eyelid surgery is performed in the operating room under “twilight” anesthesia under the care of an anesthesiologist or nurse anesthetist. “Twilight” anesthesia means that you are still able to breathe on your own without a breathing tube and numbing medication and sedation are used to make you comfortable. If your eyelid surgery is move involved and/or if you are having other aesthetic procedures at the same time as eyelid surgery, your surgery may be performed under a deeper form of IV anesthesia.

What are the risks of eyelid surgery?

The risk of any major complication with eyelid surgery is rare – nonetheless, all surgical procedures carry a degree of risk.

Eyelid scars are not visible or barely visible (on close inspection) in the vast majority of patients. However, scars may rarely be more visible in some patients.

Infection and bleeding are rare but can occur.

Eyelid surgery results in temporary numbness of the eyelashes, but this recovers over time.

Irritation and inflammation around the white part of the eye (sclera and conjunctiva) can occur after surgery. This is known as chemosis and can occur mostly after lower eyelid surgery. It manifests as swelling around the eye that can sometimes look like conjunctivitis (“pink eye”) and can be a normal and expected response to surgery in this area. If this occurs, it typically presents 5 – 14 days after surgery and gradually improves over time with either medicated or lubricating eye drops or both.

We all have natural asymmetries between each side of our face and eyelids – some people more than others. While one of the goals of surgery is minimize any pre-existing asymmetry between the eyelids, it is important to know that some asymmetry will still exist. After surgery, patients tend to scrutinize their face more intently and may notice some pre-existing asymmetries for the first time.

Meet Dr. Fagien

Dr. Fagien

Dr. Steven Fagien is one of the foremost oculoplastic surgeons in the United States and the world. He completed his medical training at the University of Florida and a fellowship in oculoplastic surgery at the University of Illinois Eye and Ear Infirmary.
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Meet Dr. Vaca

Dr. Vaca

Dr. Elbert E. Vaca is a Plastic & Reconstructive Surgeon who completed his medical training at The Johns Hopkins University School of Medicine and Northwestern Memorial Hospital.
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