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  • Chris Thiagarajah MD

Blepharoplasty: One size fits all or customized?


Many patients think that blepharoplasty is the same for every patient. Nothing can be further from the truth. The blepharoplasty goal in most patients is the same but the actual procedure and technique involved varies on a patient to patient basis.


Blepharoplasty woman

Here are some differences that are individualized for patients with blepharoplasty. There are three situations specifically where blepharoplasty may have to adjusted for the specific individual. I describe them below.


Male versus Female – “The eyebrow position”


Male patients and Female patients differ for blepharoplasty in two main areas. First eyebrow position is critical for female patients. Women shape their eyebrows and raise them. In men low eyebrows are more masculine. In fact, if you look at male models you will find that they have lower eyebrows than female models.

In female patients who have loose skin because their eyebrows are low along with loose skin may need an eyebrow lift along with blepharoplasty. In male patients, unless the eyebrow drooping is severe, a blepharoplasty alone will suffice.

Remember, eyebrow raising also changes the appearance of the patient. Often when patients think of someone who has had severe plastic surgery, it is often an eyebrow lift that they are thinking of. Eyebrow raising can create the “surprised look” that is often feared by patients.

It is important for patients, male or female to discuss all these points with their surgeon. Do you want the eyebrows raised? How will this change my look? Remember in plastic surgery there is not 100% predictability of what will happen when you have surgery but it is better to discuss all the options and all the possibilities beforehand.


Asian versus Non-Asian Eyelid - “The eyelid crease”


In Asian patients, they commonly have a lower eyelid crease than non-asian patients. This is important to know because it is critical to keep a lower eyelid crease in Asian patients during blepharoplasty. Often Asian patients who have a westernized blepharoplasty will be unhappy after blepharoplasty. We try to keep the eyelid crease low in Asian patients.

In non-Asian patients the eyelid crease can vary. It is best to try and maintain the eyelid crease in non-Asian patients at the same position as best as possible. During blepharoplasty the eyelid crease can rise even in the best of hands. Often we try to suture it to deeper tissue to hold it in place. Eyelid crease position is important to analyze before surgery to see where it will be.


Older versus Young Patient – “How strong is the tissue”


Older patients have weaker tissue. With age, collagen levels decrease. Skin elasticity also goes down. The healing process is slower. Younger patients have generally more healthy tissue. Additionally, older patients also have a myriad of other issues at the time of blepharoplasty. These include eyebrow drooping, aging skin, drooping of the eyelid itself, and descent of the midface which causes the tear trough.


Additionally, the ability of an older patient to have their skin tightened without appearing “overtightened” is lower than a young patient. Often the eyelid can be “pulled down” after blepharoplasty in an older patient because the eyelid structure is looser and weaker than a younger patient. Another important consideration for older versus younger patients. How tight is reasonably tight?


When performing blepharoplasty on an older patient, it is important to recognize that simply tightening skin and removing fat alone will not “fix everything”. There are a myriad of other aging changes that are there that will be visible after surgery. Often in younger patients the fat or loose skin is the only issue. Older patients who undergo blepharoplasty may focus on other aging components that will come into focus after eyelid surgery.

As can be seen these are three simple things that as an oculoplastic surgeon we think about before eyelid surgery. This often analyzed by eyelid experts before performing surgery. For a consultation call our office. We can go over your options and your individualized blepharoplasty needs.

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