Patients often ask me if blepharoplasty is a standard procedure or if there are variations to it. The truth is that there are tremendous numbers of individual variations that are performed during a cosmetic eyelid surgery. There are many reasons for this.
First, everyone’s eyelids are different and as a result the cosmetic problems of their eyelids vary tremendously. Some people have more puffiness of the lower eyelids. Others have more loose skin. Some people have eyelids that are low or the skin is crepey. As one can imagine, the technique to make the eyelids appear better in will vary as well. In some cases I have to remove more fat. Other cases I reposition more fat. In some cases, skin removal is more important and so on and so forth.
Second, what everyone wants after surgery is different. Some patients want their eyelid puffiness to be removed. Others don’t want too much puffiness removed. Others more. There are variable expectations from the patient.
At the end of the day we try to deliver as close to the expectations of the patient as possible. Limitations can be the basic anatomy of the patient and their individual aging. For example, if a patient has a deep eye socket and another has a shallow eye socket, both patients may not have the same appearance after cosmetic eyelid surgery. Similarly if a patient has crepey skin and one has softer smoother skin, the blepharoplasty results may be limited by these other factors. I often tell patients that “everyone can’t be turned into anyone”. I can reduce the puffiness and excess skin but if your bone structure, muscles and skin are not like Angelina Jolie’s, I can’t make your eyes like hers.
What are the variations that one does during cosmetic eyelid surgery? For example here are a list of some variations that I perform every day on these patients.
Removal of more, less or no skin on the lower eyelid
Transfer of fat in the lower eyelid
Removal of fat in the upper eyelid
Tightening the corners of the eyelid with a support stitch
Also performing a ptosis (eyelid raising) operation at the same time, if the patients has droopy eyelids
Removing more or less skin from upper eyelid
Releasing ligaments in the tear trough
These are just some of the variations that I perform during an cosmetic eyelid surgery. As one can see, these can really determine a difference in outcome for patients. As an oculoplastic surgeon or eyelid specialist, we try to tailor our surgery to each person’s problems, anatomy and expectations. Hopefully that also clarifies why an eyelid specialist is generally the best person for this complex procedure.