Blepharoplasty

Upper & Lower Eyelid Surgery

Eyelid Surgery Info

Procedure
Price Range

$ 2,500-4,000

Length
of Surgery

1-3
Hours

Surgical
Anesthetic

General or Local Anesthesia

Bruising
Swelling

10
Days

Return
to Work

5
Days

Final
Results

3-5
Months

Suggested
Procedure Age

21-70
Years Old

What is Blepharoplasty?

Blepharoplasty or Eyelid Surgery as it is commonly referred is comprised of several different surgeries which are performed on the upper or lower eyelids. These surgeries are done for cosmetic as well as functional purposes in order to correct medical conditions.

Are you looking to correct the puffy and droopy look of your eyelids? Do you want to remove the ‘older than your age’ look from your eyes? Then it is time to consider cosmetic eyelid surgery.

The illustration is a very simplified depiction of the more common, stripped down, basic components of blepharoplasty surgery. The diagram shows the removal of excess skin and surplus fat from the upper and lower lids. It should be noted that very few real-world cases actually match the diagram. Every blepharoplasty surgery is different as a result of the fact that every patient is different in their needs and their anatomy.
The illustration is a very simplified depiction of the more common, stripped down, basic components of blepharoplasty surgery. The diagram shows the removal of excess skin and surplus fat from the upper and lower lids. It should be noted that very few real-world cases actually match the diagram. Every blepharoplasty surgery is different as a result of the fact that every patient is different in their needs and their anatomy.

Brief History of Blepharoplasty

While there are those who consider cosmetic eyelid to be a surgical procedure of the modern times it actually finds its roots back to as early as the first century AD, when Aulus Cornelius Celsus, a Roman, described in De Re Medica the removal of skin for ‘relaxed upper eyelids’. In the tenth century, Arabian surgeons are said to have devised techniques to eliminate excess skin folds in the upper eyelid that impaired vision.

Surgery for Aesthetics or Function

An upper eyelid surgery may be performed for functional or aesthetic reasons. While for those who need this surgery due to medical conditions such as trauma to the eyelid, inflammation, etc, it clears the line of vision; there are those who want cosmetic eyelid surgery for purely aesthetic reasons. For the latter the surgery helps remove the puffy and droopy look of the eyelids.

Puffy & Droopy eyes

Blepharoplasty is a great way to make for a more youthful appearance or attractive appearance. First we must make an exact diagnosis, just like any other medical condition. For example cosmetic eyelid surgery will not work well if the brow is too low and it’s not an eyelid problem at all. These considerations must all be noted as well to decide if the cosmetic eyelid surgery is for aging, beautification or to treat a visual problem.

Blepharoplasty in a Nutshell

To understand the various procedures available for eyelid surgery it is first important to understand what eyelid surgery entails. The eyelid surgery is performed in order to remove the excess skin, fat and muscle in the eyelids to result in a more youthful look. The puffiness of the eyelids is attributed to the fact that the skin has lost its elasticity and is unable to support the excess fat and muscle in the region. Incisions are made on the natural crease of the eyelids and the surgeon removes the skin, fat and muscle, as is required in the case. Thereafter the cuts are stitched up with fine sutures.

Conditions Treated with Cosmetic Eyelid Surgery

Our surgeons are experts in many conditions for corrective eyelid surgery and cosmetic improvements. These may be issues with excessive skin which blocks the vision, weak eye muscles, sagging, wrinkling or excess fat deposit which show a bulge. We also have the artistic sense to make the eye area more attractive. A surgeon which has experience in the face as a whole is important and oftentimes rare.

Conditions Treated With Eyelid Surgery

  • Excess skin
  • Droopy or sagging skin eyelids
  • Fat bags of lower eyelids
  • Hanging skin of upper lids
  • Correct uneven eyelids
  • Obscured vision as a result of upper eyelid hooding
  • Puffiness beneath eyelid

Conditions NOT Treated With Eyelid Surgery

  • Dark coloration and dark circles
  • Small fine wrinkles
  • Twitches
The diagram points out specific conditions attributed to aging around the eyes. A severely aged example was used to more easily show clear examples of these conditions.
The diagram points out specific conditions attributed to aging around the eyes. A severely aged example was used to more easily show clear examples of these conditions.

Cost Of Cosmetic Eyelid Surgery

While the cost of cosmetic eyelid surgery varies form place to place and also depends on the surgeon it usually costs about $2,500. It is important to understand that there may be additional costs such as pre and postoperative care, medication, laboratory costs, etc. While the most expensive may not always be the best option it is advisable not to base your decision simply on the cost of the procedure. You should be looking for a surgeon with experience and the proper qualifications such as Dr. Pasquale. If all the eyelids are worked upon then the price would go up by about 50%. The cost of the cosmetic eyelid surgery would not only include the surgeon’s fees but also that of the anesthetist, the pre and post operative care, medication, laboratory testing, etc. In some cases where your vision is impaired due to sagging skin, insurance companies may contribute to cosmetic eyelid surgery. Not all plastic surgeons are equipped or prepared to accommodate patients who wish to have their eyelid surgery paid for by an insurance company. In many cases a patient needing surgery paid for by an insurance company would need to have the surgery performed in a hospital which is best suited to meeting the requirements and administrative needs of the insurance companies.

Different Blepharoplasty Procedures

Each procedure attributed to the more general blepharoplasty family of surgical procedures has it’s own specific purpose towards the improvement of appearance, attractiveness or the correction of a specific medical condition. Often procedures are mixed, combined and customized slightly to meet the needs of patients. Blepharoplasty in general is a widely misunderstood term in that many people don’t realize it’s actually a large family of separate more specific surgical procedures.

Laser Eyelid Surgery

Eyelid surgery may be performed using a scalpel to make the required incisions on the eyelids and this is the conventional method of eyelid surgery. Lasers are also used for some blepharoplasty procedures to great benefit. Laser eyelid surgery uses laser beams to make the incisions in the eyelids and is found to be useful because the laser beams cauterize the blood vessels as it cuts the skin. Thus there is lesser amount of bleeding and this makes it easier for the surgeon to work. Also laser eyelid surgery is found to result in lesser scarring and swelling of the eyes; in turn influencing the post operative recovery and healing.

The illustration depicts one of the operative goals of lower blepharoplasty surgery. The image shows the postoperative result after having a lower blepharoplasty where excess skin and surplus fat were removed.
The illustration depicts one of the operative goals of upper blepharoplasty surgery. The image shows postoperative outcome from the removal of excess skin from the upper lid which had resulted in a condition called hooding where the excess skin begins to drop over from the top of the upper lid.
The illustration depicts one of the operative goals of upper blepharoplasty surgery. The image shows postoperative outcome from the removal of excess skin from the upper lid which had resulted in a condition called hooding where the excess skin begins to drop over from the top of the upper lid.

Upper blepharoplasty

Upper blepharoplasty is the procedure in which excess skin, fat and muscle are removed only from the upper eyelids. The surgeon will suggest upper blepharoplasty once he has examined the condition of the eyelids. This procedure is meant for upper eyelids that are puffy and droopy and removes excess skin, fat and muscle in the region leading to the tightening of the eyelid skin. This procedure may be done along with a brow lift, if the case requires one. Incisions are made in the upper eyelids at the natural crease and the required skin, fat and muscle are removed and thereafter tiny and fine incisions are placed.

Lower Blepharoplasty

Lower blepharoplasty is meant for the lower eyelids and the skin, fat and muscle are removed from the lower eyelids only. In some cases where there are eye bags under the lower eyelids and the eyes look puffy only lower eyelid surgery may be needed. The incisions are made just under the eyelids and after the surgeon has completed removal of the skin, fat and muscle, fine sutures are used to close the incisions. In cases where only fat needs to be removed from the lower eyelids, and no skin, a transconjunctival blepharoplasty can be performed. In this procedure, the incision is made inside the eyelid and thus leads to no visible scarring. Lower eyelid surgery may be done in conjunction with a mid-face lift.

Transcutaneous Blepharoplasty

Transcutaneous or subciliary blepharoplasty is a procedure for eyelid surgery that is meant for the lower eyelids. Transcutaneous means through the skin while subciliary means below the eyelashes. Thus the incision in this procedure is made through the skin just below the eyelashes of the lower eyelids. The incision may be made to remove or if necessary reposition fat.

Transconjunctival Blepharoplasty

Transconjunctival blepharoplasty refers to eyelid surgery done through the inside tissue of the eyelid. In cases of lower blepharoplasty where only fat and no skin is required to be removed the transconjunctival blepharoplasty is suggested. There is no visible scarring as the incision is made inside the eyelid.

Canthoplasty & Canthopexy

Canthoplasty and canthopexy is the procedure for eyelid surgery wherein the ligament or muscle that supports the outer corner of the eyelid is tightened. While a canthoplasty reshapes the eyelids a canthopexy supports it without changing the eye shape. This procedure (canthoplasty) is used to provide a ‘cat eye’ look.

Double Eyelids

Before and after photo of a patient who had double eyelids surgery by Dr. Michael A. Pasquale. Patient had no prominent upper eyelid crease preoperatively.

Double eyelids is also commonly referred to as asian eyelids or asian blepharoplasty. This unique surgery removes a small section of skin from the upper eyelids. The eyelid is then sutured in such a way so as to result in the appearance of having a natural upper crease. Many asians do not have a natural crease above their eye, which can be created surgically and is known as the Double Eyelids Procedure. A crease is created by either surgery or something known as the thread technique. The height created can vary and you will be given a choice of how much lid to show. Although controversy flares up from time to time in regards to this procedure, it is very common among many Asian countries. It should also be mentioned that double eyelid surgery isn’t always performed purely for cosmetic reasons. In some instances it is done to correct ptosis.

Lateral Canthoplasty

Photo shows the before & after photos of a caucasian surgical patient of Dr. Michael A. Pasquale who had successful lateral canthoplasty surgery.
Photo shows the before & after photos of an asian surgical patient of Dr. Michael A. Pasquale who had successful lateral canthoplasty surgery.

This procedure is not a blepharoplasty but an eye reshaping procedure. It creates an upward slope to the eye corners, from inner to outer. In caucasians and in asians it can improve their appearance dramatically. The lateral canthoplasty takes a rather lifeless appearing shape which doesn’t appear attractive to us and makes for a more vibrant appearing eye which reflects energy and youth. The problem is when it’s overdone, as is seen in many Hollywood cat eyes done by overzealous surgeons. Dr. Pasquale strives to create a more natural, less overdone beauty.

Blepharoplasty for Aged Eyelids

For aged eyes we typically remove only skin and some fat. One may reshape the eye in this type of blepharoplasty, but many patients do not want this, as was the case with this particular patient below. She only desired a small amount of skin removed and no reshaping, just in order to look a little more fresh. Very small changes to an area such as the eyes can result in the entire face appearing very different. This case is a great example of the patient needs being synergistic with the surgeon’s experience, knowledge and medical opinion.

Before & After Photo of a blepharoplasty patient. The surgery was customized and performed to address the effects of aging. The patient has clearly visible excess skin in the upper eyelids which has caused a hooding effect.
Photo shows the before & after photos of a surgical patient of Dr. Michael A. Pasquale who had blepharoplasty surgery for aging eyelids.

What Makes the Eyes Attractive or Beautiful?

What makes an eye appear attractive or pretty? Well, basically there are many components which communicate beautiful eyes. Size, shape of the eye, the color, ethnic characteristics and of course the subjective feelings of the person who is making the judgment.

Dr. Pasquale who performs blepharoplasty at his plastic surgery clinic in Hawaii can change many of the physical aspects of the eye to bring out a natural looking beauty. If we look at the eyelid pictures below, most would agree she has attractive eyes. The three lines are areas which blepharoplasty surgeons change often to improve the eyes. First is the line showing the crease of the eye. This is the upper lid crease which combined with the eyelash line (lower line) has a measurable distance between the two marks. This distance varies between for example Asians and Caucasians. Then there is the angle created by a line drawn through the inner corner and outer corner of the eye. There is also the amount of fat seen between the eyebrow and the upper lid crease as well as the angle of the eyebrow itself. These are all factors which Dr. Pasquale must consider in the blepharoplasty surgery. Of course this is a simplified consideration for blepharoplasty but, gives you some idea of the complexity of blepharoplasty considerations.

Diagram of basic surface anatomy of the eye and the surrounding area including the upper and lower eyelids. The anatomy is that of a young, healthy eye still unafflicted by age.
Diagram of basic surface anatomy of the eye and the surrounding area including the upper and lower eyelids. The anatomy is that of a young, healthy eye still unafflicted by age.

Eyelid Anatomy

Compare that to this these eyes. Most people would consider her eyes less attractive. Study each aspect and compare to see the difference. There is a downward slope from inner to outer corner of the eye. There is more fat and some white of the eye showing below the pupil. Typically these are not considered attractive features.

How each aspect can be changed can be found in our plastic surgery video gallery. Further down this page are a listing of the procedures performed at our Hawaii Blepharoplasty Clinic.

At our Honolulu Hawaii clinic we perform many eyelid and facelift procedures which can correct the individual issues you may have. Aged eyelids may only need slight amounts of excess skin removed. For severe cases, the patient may need a more complex procedure performed to reshape the eye. A listing of some of the Blepharoplasty procedures we perform with actual examples follows from our Hawaii blepharoplasty clinic.

Schedule a Consultation with Dr. Michael A. Pasquale

Consultations allow a plastic surgeon to evaluate you and answer all the important questions that are impossible to answer otherwise, such as surgery options and surgery prices etc, All consultations are complementary and by appointment only.

Schedule a Consultation for Cosmetic Eyelid Surgery

The staff at Infinity Life Center is friendly and courteous. We will educate you about eyelid wrinkles, skin care around the eyes, and removing the extra skin of the upper eyelids as well as fat removal for the lower bulges. We can suggest all the options and advanced cosmetic eyelid techniques available. Consultations can be conducted virtually across the internet or in person in our pleasant office in a non intimating atmosphere.

A physical examination of the eyelids will help Dr. Pasquale ascertain what kind of a procedure is ideal for you. Blepharoplasty surgery and virtually all facial procedures, the conditions that they seek to correct and the signs of aging they’re intended to improve are incredibly complex. The diagnosis and the surgical plans necessary to even begin to suggest specific surgeries are much too involved for anyone beyond an experienced board certified plastic surgeon.

To remove the excess skin, fat and muscle from the eyelid nearly invisible incisions are made in the eyelids. These incisions are virtually invisible since they are made on the natural crease of the eyelids. Once the removal is complete, fine sutures close the incisions. LASER can also be used for cosmetic eyelid surgery.

The recovery period for cosmetic eyelid surgery is 3-14 days depending on which cosmetic eyelid procedure is done. Don’t forget Honolulu, Hawaii is a terrific place to relax while you recover from the procedure.

Some possible effects of the cosmetic eyelid surgery is reduction in the puffiness of the eyelids or reshaping. These procedure can help define the eyes sharply and make the face and the person look much younger than they did before. It can fully alter facial features or only reshapes them in a subtle manner depending on the exact procedure chosen for cosmetic eyelid surgery. Also in many cases vision is improved by the eyelids being moved away from the line of eyesight. Your needs for cosmetic eyelid surgery will be determined at the time of consultation.

Cosmetic eyelid surgery typically cannot remove wrinkles or crow’s feet or rectify dark circles under the eyes (unless they are on the skin that is removed). Our Honolulu Hawaii clinic has other treatments for that condition. As example LASER resurfacing or the popular BOTOX can be used instead of or together with cosmetic eyelid surgery. The cost of cosmetic eyelid surgery can vary from region to region and is also dependent on the surgeon. While the most expensive may not always be the best option it is advisable not to base your decision simply on the cost of the procedure. You should be looking for a surgeon with experience and the proper qualifications such as Dr. Pasquale. Lower or upper eyelid surgery can cost $2000-$3000. If all the eyelids are worked upon then the price would go up by about 50%. The cost of the cosmetic eyelid surgery would not only include the surgeon’s fees but also that of the anesthetist, the pre and post operative care, medication, laboratory testing, etc.

Alternatives to Eyelid Surgery

At the Infinity Life Center we have a wide variety of eyelid surgical and nonsurgical techniques to create beautiful eyes for you and to treat aging. We may use one of the LASER Eyelid techniques, or other fat and skin removal techniques using traditional surgery. Some of the non surgical options for eyelid beautification such as Thermage for eyelids do not have any down time. This will all depend on your personal preference and need.

Although many times dynamic wrinkles around the eyelids can be treated simply with Botox or one of the other botulism toxins such as Dysport this only treats specific types of wrinkles.Yet for excess skin or aging in general, cosmetic eyelid surgery will be the best technique. Then there are procedures just for beautification that may be desired such as changing the angle of the lateral side of the eye. There are so many various procedures available that will depend on what you want to achieve. You and the cosmetic eyelid surgeons at Infinity Life Center will require careful study before a procedure is decided.

Cosmetic Laser Eyelid Procedures

A common problem in are the bulges under the eyes or fat pockets. These are commonly removed with the LASER and the patient is back to work in three days. There are no stitches in the eyelids to be taken out or seen. Additionally the crows feet or fine lines around the eyes can be treated with LASER as well to help smooth out the skin.

Advanced Cosmetic Eyelid Surgery Techniques

Our doctors have lectured on lower lid blepharoplasty, upper lid blepharoplasty, and treating conditions to correct aging and simply for beautification of eyelids.Some of these techniques are very advanced and require great skill both in artistry and science. We may perform alterations on the skin only, the muscle or both as well as suggest other procedures around or near the eye. Some techniques require not only advanced technical skill and knowledge but years of experience. You can be assured that our doctors at our Hawaii clinic meet that requirement.

Cosmetic Surgery for Caucasian Eyelids

Dr. Pasquale’s clinic has become the favorite destination for people looking for cosmetic surgery for Caucasian eyelids who live in Hawaii or come from abroad. His experience with both the Asian and Caucasian eyelids is very significant. Experience is critical in eyelid surgery especially when dealing with the multiethnic population of Hawaii of Japanese, Korean, Pacific Islanders African Americans as well Filipino in addition to Caucasian eyelids. His training in New York provided ample experience with Caucasians as well as Asians and he has been well trained for the Hawaii melting pot.

The anatomical features of Caucasians and non-Caucasians eyelids are quite different and therefore the cosmetic surgery procedures for eyelids must also be distinct. The procedures for Caucasian eyelid surgery and that for Asian eyelid surgery requires knowledge and experience with both. As example cosmetic surgery for Caucasian eyelids usually involves getting rid of the droopy, puffy look of baggy eyelids that develops over time when the skin loses its elasticity. While that for Asians does not require as much fat removal and concentrates more on the skin folds and creases such as the double eyelid procedures. The placement of the eyelid crease is different and we do not wish to see Caucasian appearing eyelid on an Asian patient.

Cosmetic surgery for Caucasian eyelids is done at out clinic in Honolulu, Hawaii, where clients are made aware of the options before them. They are also informed all aspects of the cosmetic surgery and also the risks involved. We also ensure that clients have realistic expectations of the procedure. Our Staff is extremely well trained for eyelid cosmetic surgery.

The Procedure For Caucasian Eyelids

The procedure for removal of excess fat, skin and muscle is also called blepharoplasty. Cosmetic surgery for Caucasian eyelids may be done under local or general anesthesia and would take about 1-2 hours. The incisions in the upper eyelid are made at the natural lines or a predetermined point and in the lower eyelid they are made under the eyelashes. These areas are best for producing nearly invisible scars. Excess skin, fat and muscle is removed through these incisions and then it is stitched up with very fine sutures. Technique must be meticulous and care taken to create an excellent outcome for cosmetic surgery of the eyelid.

Transconjunctival Blepharoplasty

In the case where fat needs to be removed only from the lower eyelid it can be done by making an incision inside the lower part of eyelid on the inside near the eye. This is also referred to as transconjunctival blepharoplasty and does not leave any visible scars. It generally requires no stitches. The recovery time is excellent especially when performed with the CO2 Laser. Some patients return to work in three days with this technique.

Caucasian Eyelid Surgery Aftercare

The eyes may be bandaged with gauze pads and the patient would be asked to lie in an elevated position. The eyelids may feel swollen and medication may be prescribed to ease the pain. Cold compresses are applied to reduce swelling for the first evening after cosmetic eyelid surgery.

An ointment or eye drops may be recommended to take care of the dryness. Stitches would be removed in 3 days and one can go back to normal routine in about 7 days. Sensitivity to sunlight is common and sun glasses should be worn and a special sunscreen should be applied when going out. It is important to remember that healing is a gradual process and it will take a while for scars to fade away.

As in any surgery cosmetic surgery for Caucasian eyelids also carries risk of complications and these include blurred or double vision, partial or complete loss of sight, damage to eyeball and surrounding area, hematoma in the eye, etc. It is vital that you select a reputable and experienced cosmetic or plastic surgeon and have the surgery done in a regulated country such as in Honolulu, Hawaii. As with all of cosmetic surgery any complication is rare.

Am I a Good Candidate for Eyelid Surgery?

Blepharoplasty or cosmetic eyelid surgery is the surgical procedure by which eyelids are reshaped by removing excess skin, fat and muscle in order to provide the eyes a younger and nicer look. It may also called as an eyelid lift or blepharoplasty. This procedure is performed by a plastic or cosmetic surgeon under local or sedation type anesthesia and can be done on lower, upper or both sets of eyelids. The surgeon decides on the procedure once he has done a complete physical examination of the area. Cosmetic eyelid surgery may be performed in conjunction with other procedures such as a brow lift, skin resurfacing, etc.

  • This balance between your health and your desire will determine if you are a good candidate for any eyelid surgery. Not everyone is a good choice for eyelid surgery, some factors are considered below:
  • It is important that the person be in good physical and mental health. It is crucial that the candidate is psychologically balanced and does not see the procedure as a way of changing his/her personality. In fact at our clinic at Honolulu, Hawaii, clients are encouraged to speak about their expectations of the surgery so as to ensure that they have a realistic view of the outcome.
  • A good candidate for eyelid surgery understands that subtle changes caused by the procedure will provide the face a more attractive and youthful look and will not alter the facial features dramatically unless that is what is desired where more complex procedures can be done. Dr. Pasquale at his Honolulu Plastic Surgery clinic believes strongly that good plastic surgery does not look “done” or have a unnatural appearance.
  • The procedure can correct puffy and droopy eyelids but is not meant for elimination of fine line wrinkles or dark circles.
  • The procedure is open to members of both sexes and people of all cultures. Asian patients will typically require a different set of procedures than Caucasians or black individuals. Dr. Pasquale has trained and has experience in the multicultural environment of Hawaii.
  • It is crucial that you don’t have certain medical conditions that can affect the surgery. These include thyroid problems such as Grave’s disease, dry eyes, glaucoma, etc. Also it is vital that you don’t have a heart condition, high blood pressure, diabetes or other circulatory problems. If you do you must notify Dr. Pasquale and his cosmetic eyelid surgery team.
  • For patients who are suffering from flu the procedure should be postponed until the infection is taken care of. Coughing or sneezing can cause severe bruising after cosmetic eyelid surgery.
  • If the eyes and condition of the eyelids make you look older and it may be due to excess skin, fat and muscle that the eyelid skin is unable to support. However if the puffy look is caused by an underlying infection or allergy then Dr. Pasquale may suggest getting an opinion of an eye specialist.
  • A good candidate for eyelid surgery may be a man or a woman of any culture. Also, age of the candidate will not matter as very young Asians have double eyelid surgery for example. Of course there should not be any serious illness that could hamper the cosmetic eyelid surgery or its effects.
  • If you are considering cosmetic eyelid surgery you will definitely want to have a consultation with Dr. Pasquale to explore your options. His experience and easy style will make you comfortable and you will see the difference when you walk into our Honolulu Hawaii clinic to be evaluated for cosmetic eyelid surgery.

Facts You Should Know Before Committing To Cosmetic Eyelid Surgery

Cosmetic surgery has come a long way from its start. Not only have the techniques and methods been refined but also the scope of change that can be brought about by cosmetic surgery. Cosmetic eyelid surgery probably creates the most noticeable difference, as it seems to take off years from the face. This surgical procedure is effective in cases where the eyelids are droopy and puffy and lead to eye bags under the eyes. The basic reason for puffy and droopy eyes is the fact that the skin has lost its elasticity and is no longer able to effectively support the fat and muscle in the region. It is important that you understand the facts and basic information about cosmetic eyelid surgery before you consider having it done.

Upper Eyelid Surgery

This procedure is meant for upper eyelids that are puffy and droopy and removes excess skin, fat and muscle in the region leading to the tightening of the eyelid skin. This procedure may be done along with a brow lift, if the case requires one. Incisions are made in the upper eyelids at the natural crease and the required skin, fat and muscle are removed and thereafter tiny and fine incisions are placed.

Lower Eyelid Surgery

In some cases where there are eye bags under the lower eyelids and the eyes look puffy only lower eyelid surgery may be needed. The incisions are made just under the eyelids and after the surgeon has completed removal of the skin, fat and muscle fine sutures are used to close the incisions. In case only fat needs to be removed from the lower eyelids, and no skin, a transconjunctival blepharoplasty can be performed. In this the incision is made inside the eyelid and thus leads to no visible scarring. Lower eyelid surgery may be done in conjunction with a mid-face lift.

Blepharoplasty Risks & Complications

As in all other types of surgery cosmetic eyelid surgery also carries certain risks and it is important that you be informed about these. Risk of complications include asymmetry in eyelids, loss of visions, damage to eyeball and related muscle, etc.

Ectropian, Eyelid Retraction And Other Over Done Eyelid Surgery Problems.

Cosmetic eyelid surgery generally turns out just fine and people are happy with their eyelid surgery. Unfortunately, there are problems with eyelid surgery that can happen at any time during and after the procedure. The factors leading to an unsatisfactory surgical outcome include poor quality of the tissues that just don’t heal right, smoking, variations in your anatomy, too aggressive of a surgery, unexplained reactions to surgery that was otherwise technically correct, an untrained surgeon, and choosing a surgeon who disagrees with your aesthetics.

Eyelid Surgery Specialist

Even good surgeons that know what they’re doing can have problems with eyelid surgery. You may need to get a second opinion from another surgeon so that you can be sure the surgeon has done the right thing. Most cosmetic surgeries can be repaired to look better if the outcome isn’t what you were expecting.

Infection Risks

Infection is one of the unexpected problems with eyelid surgery that can occur in anyone. It can occur on the eyelids or around the eyelids. Usually antibiotics take care of it and the outcome is good. Bleeding that is excessive after eyelid surgery can result in a hematoma or blood clot within the eyelid. You can get bleeding in the fat pads and in the orbicularis oculi muscles. The wound can separate in eyelid surgery. This can happen in the few days following stitch removal. If it is small, it will close on its own. A larger split in the surgical area may need re-suturing. It usually doesn’t affect the appearance of the surgery but it may widen the suture site.

Tiny milia or white cysts can develop along the suture line. Most go away without treatment but some may need to be lanced or scraped out if they are large and stubborn.

Asymmetrical Appearance

The eyelids can look different from one another, giving an asymmetrical appearance of the eyelids. One eyelid may look more or less wrinkled from another after the surgery or the brows can look different from one another. There can be more fat left in one eyelid from another. If it looks as though the asymmetry is going to persist, then the doctor needs to correct the problem by fixing at least one eye so it looks like the other.

Under-correction

Not enough skin may be removed in the eyelid surgery. This is called under-correction of the eyelid, which is a problem but is better than over-correction of the eyelids. There may be mild hooding left over from having the eyelid surgery done and there may be drooping of the eyebrow from under-correction. There can be excess skin occurring in the medial aspect of the eye, which is usually related to a droop of the forehead that was not treated at the time of the surgery. An eyebrow surgery is then needed to correct the problem.

Over-correction

Too much skin removed may result in problems with eyelid surgery that are hard to correct. The eyes might not close properly after this kind of surgery or there can be excessive blinking of the eyelid during sleep. It can look like the palpebral fissure is too wide so the person has eyelid retraction. The lower lid can pull away from the eyelid in a condition known as ectropion. This is difficult to treat but there are solutions which can help.

Blepharoplasty Revision Surgery

We at the Infinity Life Center have experienced plastic surgeons which can deal with problems you may have had with your eyelid surgery. This may include many issues ranging from dry eye to ectropian. If you are unhappy with your eyelid surgery you may want a second opinion. Our surgeons are happy to evaluate your condition.

Epidemic of Post-Blepharoplasty Hollowness

While hollowness under the eyes may naturally occur with age, it is also a result of adverse blepharoplasty. The process of blepharoplasty or cosmetic eyelid surgery removes excess skin, fat and muscle from the eyelids. However if a competent and skilled surgeon does not perform this surgery it can result in post-blepharoplasty hollowness. There are various reasons for post-blepharoplasty hollowness, these include;

  • Excessive removal of fat: The fat from the eyelids needs to removed judiciously and excessive removal does not translate into a good surgery but in fact causes hollowness in the area.
  • Excessive removal of skin: A lot of people think that a higher crease in the eyelid will make them look younger, but this is not the case. The amount of skin that needs to be removed has to be decided from case to case and should be done in accordance to the natural facial features of the individual. A good surgeon such as Honolulu, Hawaii based Dr. Michael Pasquale ensures that the patient understands all aspects of the eyelid surgery and the techniques and methods used. A common mistake is the removal of upper eyelid that is caused due to the absorption of orbital fat.
  • Un-required removal of muscle from the eyelids is another reason for post-blepharoplasty hollowness. In fact in most cases removal of muscle may not be essential and it allows the eyelid to maintain a more natural look. Furthermore this will help prevent any closure problems in the future.
  • In cases where the fat in the upper eyelids is already lacking a brow lift will only accentuate this point and give an appearance of hollowness.

How to avoid post-blepharoplasty hollowness

One of the best ways to avoid post-blepharoplasty hollowness is by selecting a good plastic or cosmetic surgeon for the procedure. There may be many surgeons who offer cosmetic eyelid surgery but you want to choose a surgeon who is not only qualified and competent but is experienced, talented and skillful. Cosmetic surgery is more than a science it is also an art and the result is going to stare back at you every day. Unfortunately many surgeons are going in for aggressive blepharoplasty when it is not required. Honolulu, Hawaii is considered the No. 1 choice of people who want to have cosmetic eyelid surgery done. This is mainly due to the superb surgical and medical care available here and also as it provides a wonderful location to relax and recover in. At the hands of a skillful and experienced surgeon such as Dr. Michael Pasquale, who has completed his residency in plastic surgery and earned a 2-year training certificate from NYU Downtown, Manhattan, the cosmetic eyelid surgery will show remarkable changes in the manner in which the person appears.

Traditional Blepharoplasty

The anterior approach or transcutaneous blepharoplasty involves removal of orbicularis oris muscle, fat and excess skin through an incision that is done through the skin. It can be combined with lateral canthus reinforcement for a maximally youthful appearance.It is done under local or general anesthesia. The skin incision is made just below the margin of the eyelid and into the lateral canthus. The orbicularis oris muscle is tightened up and fat is removed through the incision. The surgeon checks to make sure enough fat is removed and so that there isn’t too much fat removed. Any other excess tissue can be removed through the incision. The skin is pulled up and trimmed off, allowing the lid to be smooth and wrinkle free. Sutures are used to close the incision.

The biggest advantage for this procedure includes the removal of excess skin that can’t be done with the transconjunctival approach. Muscle can be removed as well. The disadvantage is that it can show a scar after the procedure is over with.

At the Infinity Life Center we will be happy to explain more of the differences to you in our caring educational atmosphere. We can help you decide which procedure if any is best for you. Allow the opportunity and give us a call or contact us through our form.

Transconjunctival Blepharoplasty

The goal of transconjunctival lower blepharoplasty is to remove bulging fat from the lower eyelids. The incision is made underneath the lid in the conjunctiva, the part of the eyelid that comes in contact with the eyeball. The eyeball itself is protected with a plastic plate. The incision is made close to where the eyelid conjunctiva connects to the eyeball itself. There are three fat pockets inside the lower lid that can be teased out of the capsules they are nested within. Some fat is left behind for a natural look. Then the incision is closed with absorbable sutures or is left open to heal naturally. As no one can see the area, it doesn’t really matter if the incision is closed or not. It heals very fast under either circumsatances.

In some cases, the orbicularis oris muscle and canthal tendon is tightened up through a small “skin pinch” incision that is sometimes done. Fat can be repositioned to balance out the fat deposition of the eye. The advantages of doing a transconjunctival blepharoplasty vs. traditional blepharoplasty is that the scar is nonexistent, the procedure is less invasive, there is a decreased chance of lower eyelid ectropion, and fat sculpting is very precise. Bruising and postoperative swelling is decreased.

The problem with a transconjunctival blepharoplasty is that the skin cannot be tightened up and it only works if you have tighter skin to begin with. There can be no significant skin wrinkling and the only skin that can be removed includes a small pinch incision just beneath the eyelashes. You can use a chemical peel or skin laser resurfacing in order to make the skin smoother and tighter. The procedure is also more technically difficult than a regular transcutaneous lower eyelid surgery.

Transconjunctival Blepharoplasty vs. Traditional Blepharoplasty

There are two main types of blepharoplasty. There is the transconjunctival approach and the traditional approach. Both are designed to rid the eyelids of excess fat or skin that has lost its elasticity, so they basically serve the same purpose generally. Both can be done under local anesthesia and IV sedation or general anesthesia, depending on doctor and patient preference. The transconjunctival approach is less invasive surgically with some lessened risk of scarring. The surgery is only suitable for certain patients though and the surgery is a bit more technical than the traditional blepharoplasty.

A Sound Approach to Upper Eyelid Surgery

It is important to understand the basic upper eyelid surgery process in order to comprehend the manner in which it will effect the relation of the upper eyelid to the eyebrow. Upper eyelid surgery requires incisions to be made to appears as the natural crease of the eyelids. The incision placement will vary based on many factors which must be understood by the surgeon. Then the surgeon works out the design to remove excess skin, fat and muscle. The incisions are closed with very tiny and fine sutures. The surgery aims to improve the functionality and appearance of the eyelids.

For a sounder approach to upper eyelid surgery it has to be understood and accepted that the upper eyelid and the eyebrow are one entity and not two independent ones. This is vital as the relation between the two is close and is evident in any upper eyelid surgery. This key is the understanding of upper eyelid design.

This approach to upper eyelid surgery the features and abnormalities of the eyebrow need to be considered and dealt with. A brow lift may be required to be done in conjunction with the upper eyelid surgery to arrive at the best effect. This is especially true of cases where the eyebrows are below the orbital rim. However in cases where the fat in the upper eyelid is less a brow lift may make the eyelid look hollow, as also would removal of excessive fat from the region. One must consider more then eyelids in cosmetic surgery and thus a sounder approach is needed. We consider all aspects of a patients appearance before agreeing to cosmetic eyelid surgery at our Honolulu Hawaii clinic.

Every Eyelid Case is Different

Remember Every case of upper eyelid surgery needs to be dealt with individually and there is no specific formula that can be used to ensure the best effects. Thus it is crucial that you select a surgeon who is competent and experienced not only in cosmetic eyelid surgery. Also you want to select a surgeon who lets you know all aspects of the surgery and also decides on the extent of the surgery based on a physical examination of the facial features and your desires.

Our eyelid design is unique to each patient. We take our time and really try to understand what the patient wants. There are no standard eyelid operations and each one is designed for you.

Preparing for Eyelid Surgery

Eyelid surgery is becoming more and more popular as people are discovering the subtle yet dramatic change it brings to one’s face. With age the skin around the eyes tends to lose its elasticity and leads to droopy and puffy eyelids that make you look older than your years. Eyelid surgery is a great option at remedying such a situation. While it is performed in various places across the country Honolulu, Hawaii is the top choice amongst individuals seeking to have eyelid surgery. It is not just the scenic beauty of this tropical paradise that calls out to people but the excellent surgical and medical care available here. Honolulu, Hawaii is home to many world class surgeons such as Dr. Michael Pasquale who has completed his residency in plastic surgery and has also done a 2-year training certificate from NYU Downtown, Manhattan. He is also an osteopathic physician and surgeon (D.O.).

Time Off For Blepharoplasty

Eyelid Surgery Blepharoplasty Honolulu Hawaii can be done many times with only local anesthesia and is usually less than a week off of work though it may be even shorter time off, as little as 3 days. This will of course depend on what exact eyelid procedure is done. The more complicated procedures may require 2 weeks.

Honolulu Hawaii is an excellent location for recovery for eyelid surgery. Many of our patients fly in have the procedure done and enjoy the scenery, even sitting on the nice beaches within a day or so. Our concierge service can make the arrangement. So consider enjoying Hawaii while you recover.

Fear of Surgery

It is natural to be nervous about an upcoming surgery and it is important to ensure that you speak to your surgeon about your concerns and expectations of the eyelid surgery. Usually, as is done at Dr. Pasquale’s clinic at Honolulu, Hawaii the patient is briefed about various aspects of the surgery including preparing for eyelid surgery. Each patient undergoes a physical examination to ascertain the type of surgery required and if any particular aspects need to be given special attention. It is vital that you make the surgeon aware of any medical condition that you may have, food and other allergies, medication that you are taking regularly, etc. Also if you drink and smoke you would be required to make a mention of the same. Usually the cosmetic or plastic surgeon will provide you written instructions about preparing for eyelid surgery. In case these instructions are given verbally ensure that you write them down so that you don’t forget anything. Yet at Dr. Pasquale’s clinic no need to worry as we will provide you with all material in a written booklet form for eyelid surgery.

  • Medication – If you are taking any blood thinning medication such as Aspirin, Advil, etc your surgeon will ask you to stop a day or two before the surgery. Since these drugs thin blood they would lead to excessive bleeding and interfere in blood clotting; this in turn will influence the healing process.
    Even cold remedies with some amount of Aspirin need to be avoided and thus one has to be careful of any drugs being taken before the eyelid surgery.
  • For diabetics the daily dose of medication would need to be adjusted for the day of the surgery and it is advisable to consult with your general practitioner also.
  • Vitamin E supplements over 200 mg per day need to be stopped about two weeks prior to the eyelid surgery.
  • Any over the counter supplements such as gingko biloba and ginseng that may prolong bleeding also need to be stopped. If you are taking herbal teas or herbs in any other form it needs to be mentioned to the surgeon.
  • Dr. Pasquale will provide you with and extensive written detailed list of things to avoid at the preop visit and prepare you completely for eyelid surgery.
  • Lifestyle – Smoking and drinking should be stopped for a while before the eyelid surgery.
    Transportation after the surgery would need should be organized.
  • Ice cubes, clean wash cloths, a clean bowl for cold water and Ziploc bags to be used as ice packs should be kept ready at home.
  • It is a good idea to have someone stay with you for the initial days after surgery or post-surgery nursing may be organized.
  • A few meals should be pre cooked, frozen and stored in the refrigerator.

Sterile gauze pads, a bottle of antiseptic solution and any other medication suggested by the surgeon needs to be purchased and kept handy. At Dr. Pasquale’s clinic you will be provided with a complete post op care package.As with all the cosmetic surgery at Dr. Pasquale’s Honolulu Hawaii clinic the knowledgeable staff will provide you with information to prepare for eyelid surgery. All risk of the procedure for eyelid surgery will be discussed as well the pitfalls of post operative care. You can rest assured that your preoperative teaching will be complete, written out and questions answered. At Dr. Pasquale’s Hawaii clinic you will indeed be prepared for eyelid surgery.

Recovery from Eyelid Surgery

Eyelid surgery is performed under anesthesia and may take between 1-3 hours. It may be done on upper, lower or both sets of eyelids. Incisions are made in the natural crease of the upper eyelids and just below the eyelashes in the lower eyelids. Thereafter excess skin, fat and muscle are removed and fine sutures used to close the incisions. The eyes are bandaged. In case only fat needs to be removed from the lower eyelids then a transconjunctival blepharoplasty could be performed. In this case the incision is made inside the eyelid. The procedure can also be performed with lasers and would reduce the bleeding, swelling and bruising involved. Some of the temporary side effects include discomfort, sensitivity to light, dry itchy eyes, etc.

The eyes would feel bruised and swollen and discomfort may be eased with cold compressions and prescription medications. The eyes would remain bandaged for a day or two. Once the bandages and gauge padding are removed the eyes can be washed gently with a mild antiseptic solution prescribed by the surgeon. In case the eyes feel dry and itchy eye drops may be recommended. It is important to keep the head raised when lying down. Sensitivity to light is common and the eyes must be protected especially when going out in the day time. Sun glasses should be worn and a special sun screen for eyelids applied. The sutures will be removed in about 3 days.

Patient satisfaction is typically very high and incidence of complications are very low with blepharoplasty surgery. It is a safe and very straight forward surgical procedure when performed by an experienced plastic surgeon.

While rare cases of complications include hematoma in the eye, damage to eyeball and associated muscle, loss of vision, asymmetrical eyelids and risk of infection. These again are rarely seen. Dr. Pasquale and his team at the Honolulu Clinic for their cosmetic eyelid surgery are experienced well trained and therefore minimize the chance of any complication.

In 3-10 days you can go out in public and return to your normal routine but strenuous activities and exercise need to be avoided for another 2 weeks or as recommended by your surgeon. Alcohol intake needs to be restricted as it may lead to fluid retention. In about 3 months the scars from the surgery will fade and eventually become virtually invisible over the next 6 months. Recovery from eyelid surgery is easy as long as you follow the directions as given to you by Dr. Pasquale and his staff. The relaxing environment is perfect in Hawaii to recover from eyelid surgery. So make sure you call Dr. Pasquale’s office to set up a consult for your cosmetic eyelid surgery. Our friendly easy to talk to staff will make your experience pleasant and ease your fears.

How to Choose a Surgeon for Eyelid Surgery

Cosmetic eyelid surgery provides a chance for individuals to change the way their eyes and thus their face looks. It gives the eyes a more younger and youthful look by removing the puffiness and droopiness caused by the eyelids. While some people may be born with such eyelids most often they are caused with the effects of time. The skin loses its elasticity and is unable to support the fat and muscle in the area. The removal of excess skin, fat and muscle from the eyelids is what eyelid surgery does. It is also called Blepharoplasty. When you are considering cosmetic eyelid surgery one of crucial questions that arises is where to have the surgery done and how to choose a surgeon for eyelid surgery. While a lot of people are guided by the cost of the surgery the fact of the matter is that the surgeon who is performing the cosmetic eyelid surgery is far important than the cost of the procedure. This means that that surgeon charging the most fees may not be the obvious choice nor is the one who charges the least.

Experience:

Nothing can take the place of experience when you are considering a surgeon for cosmetic eyelid surgery. So feel free to ask about the surgeon’s background and experience. Any kind of surgical procedure carries with it a certain amount of risk and this is lowered considerably when you are in the trusted hands of an experienced cosmetic eyelid surgeon. Also experience translates to the fact that the surgeon has performed cosmetic eyelid surgery and similar procedures and understands all its nuances. Make sure he has performed cosmetic eyelid surgery on people with similar eyelids as yours such as Asian Eyelids or Caucasian eyelids. This is very important in cosmetic eyelid surgery.

The risks and complications of a cosmetic eyelid surgical procedure are reduced tremendously when you have an experienced surgeon because he knows exactly what all may go wrong and is in a comfortable place to handle all kinds of emergencies.

Reputation:

The more skillful and knowledgeable the surgeon the higher the chances of the cosmetic eyelid surgery going through flawlessly. It is a good idea to read up about a few surgeons and speak to people before you make your final decision. There will be some surgeons who are more qualified for eyelid surgery than others. Dr. Pasquale has experience and has performed the procedure for Asians, Caucasian’s including a significant experience with African Americans. He has a an international reputation and locally an excellent reputation for cosmetic surgery including cosmetic eyelid surgery.

Open to Discussion:

The surgeon and patient relationship is based on trust and you would like to choose a surgeon who is open about all aspects of the cosmetic eyelid procedure rather than trying to convince you to have the procedure done. In fact a good surgeon will ensure that the client has practical expectations of the surgery and doesn’t expect a total change in appearance or personality after the eyelid surgery.

Options Offered:

As with most cosmetic surgery there may be more than one way to skin the proverbial cat. Blepharoplasty may be one options but there may be others such as LASER eyelid surgery which may have certain benefits for your individual case. Dr. Pasquale will offer you a range of options from surgical to non-surgical ways to improve your eyelids. Dr. Pasquale at our Honolulu Hawaii clinic has all the options and technology in his state of the art facility not only to make your cosmetic eyelid surgery go well but safely.

Know the difference:

Cosmetic eyelid surgeons are as different as the various peoples eyelid problems that we seek to correct. At our Hawaii clinic you will be treated very special and by a staff that is well trained and understands cosmetic eyelid surgery. You should know who is a board certified plastic surgeon verses who may not be as qualified. Dr. Pasquale is a board certified plastic surgeon and will be happy to review his credentials and training for cosmetic eyelid surgery.

We welcome your questions regarding eyelid surgery and we hope you will contact us for a consultation today. When you are looking for a cosmetic eyelid surgeon you should seek the opinion of Dr. Pasquale.

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Honolulu Hawaii Plastic Surgeon

500 Ala Moana Blvd #4-470 Honolulu Hawaii 96813