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Surprised look after Blepharoplasty or Eyelid Lift: What really causes it?

Many patients looking for an eyelift surgeon in Denver come to my office for a consultation to determine what is the best procedure for them. The most common concern that eyelift patients have is that they don’t get a “surprised look” or “overdone” look. This short article is to let patients know how a surprised look is created and what we do to avoid it.

Fig: Photo above shows "surprised look" with elevated eyebrows and white of eyes visible. This surgically created is via eyebrow lifting and ptosis.

A blepharoplasty or eyelid lift is commonly when the skin of the eyelids are removed along with fat of the upper eyelids. This is one of the most common procedures that I perform as an oculoplastic surgeon in Denver. This procedure is done for not only cosmetic improvement but also for vision improvement if excess eyelid skin is hanging over the edge of the eyelids blocking the eyes from seeing.

When a patient gets surgery and skin is removed it is largely difficult to create a surprised look. That being said, it is possible to remove too much skin and cause a slew of problems such as dry eyes, trouble with eyelid closure and blurry vision. That however, will not cause a “surprised look”.

There are two procedures that are commonly done with blepharoplasty that can cause a “surprised look” from eyelid surgery. The first is eyebrow lifting. The second is ptosis repair. Eyebrow lifting is raising the physical height of the eyebrows. This can create a look of surprise if overcorrected. This is especially true for male patients who classically have low brows. Ptosis repair is raising the height of the eyelid so the eye is more open. It is done by tightening the eyelid muscle.

If you look at my eyelids in the pictures below you can see the surprised look is really from two components: The height of the eyebrows and how open the eyelid is. I explain to patients daily in my office in Denver that in eyelid lifting or blepharoplasty, it is impossible to raise the eyebrows or open the eyelid height by removing skin which is done during a blepharoplasty.

As a surgeon who performs all three procedures (eyebrow lifting, ptosis repair, and blepharoplasty) patient selection is critical to determine what the best procedure is for patients. Some patients do need eyebrow lifting or ptosis repair at the same time. It is in those procedures that overcorrection needs to be avoided as much as possible for optimal cosmetic outcomes.

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