Eyelid Surgery


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What is eyelid surgery?

Eyelid surgery (blepharoplasty) is a procedure that tightens and lifts sagging eyelid skin.

Why get eyelid surgery?

Eyelid surgery may be right for you if you have any of the following: excess skin on your eyelids, loose skin hanging down over your eyelashes, puffy eyes, dark circles or bags under your eyes, or your eyes look tired and aged.

Below are some of the benefits of eyelift surgery:

  • Eliminate puffiness on your upper lids or bags under your lower lids
  • Increase your visual fields if you have overhanging eyelids
  • Look more youthful and less tired
  • Improve your self-image and self-confidence

What should I consider before getting eyelid surgery?

Please consult with your aesthetic plastic surgeon for more information on what is unique to you.

  • You need to be in good general health.
  • You’ll likely experience bruising and swelling, and your eyes may be dry and itchy following the procedure.
  • It will take time to see the results after surgery.
  • If you have drooping eyebrows or creases in your forehead, you may want to pair your eyelid surgery with a brow lift.
  • The recovery time is typically around two weeks.
How is eyelid surgery performed?

Dr. James Rosing performs upper eyelid skin excess removal (blepharoplasty) in the office, under local anesthesia.

"Upper blepharoplasty is one of the most underutilized plastic surgery procedures by both women as well as men. I think for most people, contemplating any procedure performed near the eye is anxiety provoking. Though I can quite confidently say, patients who have undergone the procedure consistently report one thing; they wish they had done it sooner. The procedure is delicate, though straight forward, with subtle though notable results, and has a short recovery."

The aim of upper eyelid plastic surgery, blepharoplasty, is to remove all excess skin above the upper eyelid crease. I perform the marking for upper blepharoplasty by having the patient sit upright facing forward with eyes closed. I then mark the natural upper eyelid crease defined by the superior border of the tarsal plate, typically 9-10 millimeters above the lash-line. I then use forceps to gently grasp the excess skin that folds over the crease until it is taught without having the effect of opening the eyelid and mark the location.

The same technique of marking continues from the nasal portion of the upper eyelid to the temporal portion of the upper eyelid. This creates a segment of skin above the upper eyelid crease that is redundant and can be surgically removed and the edges approximated with a suture. In doing so, the person before was unable to see their upper eyelids when looking in the mirror, and after can fully see their upper eyelids.

The result is subtle though significant and successfully transforms one from looking tired to refreshed and vibrant. The eye seems to appear more open again, creating an energetic and youthful aesthetic. For the lower eyelids, often repositioning periorbital fat (fat transfer) into the groove at the tear trough is effective to smooth the lower eyelid contour eliminating shadowing. I find eyelid surgery to be among the most attractive types of surgery, as it is minimally invasive to patients, provides a consistently satisfying result, with very little downtime.


There are a few options for eyelid surgery.

Upper Eyelid Surgery
If you have excess skin covering your natural eyelid fold, loose skin hanging down over your eyelashes, or puffy eyelids, you’ll need surgery on your upper eyelids.
Your surgeon will apply a local anesthesia to numb the area, then make an incision hidden within the natural fold of the upper eyelid so he or she can remove excess skin, muscle, and fat.

Lower Eyelid Surgery
If you have bags, puffiness, or deep groves below your eyes, you may benefit from surgery on your lower eyelids.
There are multiple lower eyelid surgery approaches, and your surgeon may recommend a combination of these procedures:
• The traditional approach smooths and tightens lower eyelids. The surgeon places the incision just below your eyelashes, trimming and repositioning excess skin and fat, and tightening the lower eyelid muscle.
• The transconjunctival approach reduces lower eyelid bags and puffiness. The surgeon places the incision inside your eyelid and removes excess fat, but not excess skin. The surgeon may use a laser in conjunction with this approach to tighten the lower eyelid skin.
• The ‘skin pinch’ blepharoplasty removes only a bit of skin. This is effective if you have strong lower eyelid support and only a little extra skin. In some patients, laser resurfacing can both tighten excess skin and remove wrinkles.
• Sylfirm X RF Microneedling. Sylfirm X is FDA approved for the treatment of periorbital aging. In our practice, we apply the  use of Sylfirm X to the lower eyelids for patients with mild to moderate skin excess and age related contour changes. Sylfirm provides an excellent non-surgical option for treatment of lower eyelid aging.

Both (Upper and Lower Eyelid Surgery)
If you have issues with both your upper and lower eyelids, your surgeon may recommend a combined approach.
In some cases, your surgeon may recommend pairing your eyelid surgery with a brow lift or a facelift to achieve optimal results.

Generally, because of the in-depth nature of the consultation, there is usually a cost associated with the initial visit.
During your initial consultation, you will have the opportunity to discuss your aesthetic goals. Your surgeon will evaluate whether you are a good candidate for eyelid surgery and clarify what blepharoplasty can do for you. Your surgeon may also ask you to look in a mirror and point out exactly what you would like to see improved. Dr. James Rosing may evaluate the elasticity of your skin and take photos of your face. Once your surgeon understands your goals and medical condition, both alternative and additional treatments may be considered (see related procedures).
You should come to the consultation prepared to discuss your complete medical history, such as your:
• Previous surgeries
• Past and present medical conditions
• Allergies and current medications

It’s important that you take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.
• Am I a good candidate for eyelid surgery or blepharoplasty?
• Are the results I am seeking reasonable and realistic?
• Do you have eyelid surgery before-and-after photos I can look at?
• How many eyelid surgeries have you performed?
• Where do you plan to make the incision, and will the scars be visible?
• Where will you perform my surgery and how long will it take?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my eyelid surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the outcome of my eyelid surgery does not meet the goals we agreed on?
See Questions To Ask Your Aesthetic Plastic Surgeon

Based on your goals, physical characteristics, and your surgeon’s training and experience, your aesthetic plastic surgeon will share recommendations and information with you, including:
• An approach to your surgery, including the type of procedure or combination of procedures
• The outcomes you can anticipate
• The financial investment required for the procedure
• Associated risks and complications
• Options for anesthesia and surgery location
• What you need to prepare for your surgery
• What you can expect to experience during and after surgery
• Before and after photos of cases similar to yours
• Answers to any of your questions
Once you’ve done your research and completed your consultation, you should be able to make an educated decision on whether surgery is right for you and whether a surgeon is a good fit. If you still aren’t sure how to proceed, you should feel empowered to ask follow-up questions or set up a consultation with a different surgeon. 

How do I prepare for eyelid surgery?

Your surgeon will provide thorough preoperative instructions and answer any questions you may have before your surgery. Prior to getting eyelid surgery, your surgeon will also:
• Ask you detailed questions related to dry eyes, glaucoma, eye-related allergies, and other eye problems. Tell your surgeon if you have circulatory problems, thyroid problems, diabetes, or other serious medical conditions. He or she will ask you about your current medications, including over-the-counter medicines. Make sure to tell your surgeon about any herbal supplements you take, as some of them may cause bleeding problems.
• Conduct a physical exam, which may include testing your tear production. Your surgeon may use special tools to measure parts of your eyelids.
• Photograph your eyes from different angles. These photos help with planning the surgery and assessing its immediate and long-term effects.
• Discuss expectations with you. An honest discussion will help determine a satisfactory outcome. Be prepared to talk about your motivation for seeking blepharoplasty and what you hope the results will be. Your surgeon can tell you whether your expectations are in line with typical results.
In advance of your procedure, your surgeon will ask you to:
• Stop smoking before undergoing surgery to promote better healing.
• Avoid taking aspirin, certain anti-inflammatory drugs (NSAIDs: Advil, Motrin, Aleve), and some herbal medications that can cause increased bleeding.
• Hydrate before and after surgery for safe recovery.
Eyelid surgery is usually an outpatient procedure. Be sure to arrange for someone to drive you home after surgery, and you should have someone stay with you at least for the first night following surgery.

Below is what you can generally expect, but be sure to consult with your surgeon before your surgery so you have the most accurate expectations.
• You may have your eyelid surgery in an accredited hospital, free-standing ambulatory facility, or office-based surgical suite.
• Most eyelid procedures take at least one to two hours to complete.
• The surgeon will administer medications for your comfort during the surgical procedure.
• Local anesthesia combined with sedation is commonly used during eyelid surgery, though general anesthesia can be used instead.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your surgeon will follow the surgical plan discussed with you before surgery.
• After your procedure, you will go to a recovery area for continued monitoring.
• The surgeon will apply a lubricating ointment to your eyes to protect them and prevent dryness. The ointment may cause temporary blurred vision.
• You may choose to go home on the day of surgery unless you and your aesthetic plastic surgeon have made other plans. Under no circumstance will you be permitted to go home alone.

How long does it take to recover from eyelid surgery?

It typically takes about two weeks to recover from eyelid surgery. Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-operative care, including information about:
• Incision care
• Typical symptoms you will experience
• Potential signs of complications
It is vital that you follow all the patient care instructions your surgeon provides. It is also important to know that the amount of time it takes for recovery varies greatly among individuals.

• Although you will not have to rest in bed following surgery, you should plan to relax and stay home.
• For the first 48 hours, you should apply cold packs to your eyelids to reduce any swelling.
• Use small gauze pads to stop any bleeding.
• Apply eye drops or artificial tears to help keep eyes from drying (ask your surgeon for a recommendation).
• Clean your wounds with clean washcloths and towels.
• After upper and lower blepharoplasty surgery, your eyelids will typically feel tight. You can take over-the-counter painkillers to help with any pain, which your surgeon can recommend. Avoid Advil, Motrin, Naproxen, Aleve, and aspirin due to the increased risk of bleeding.
• Sleep with your head raised higher than your chest. You can use regular pillows, wedge pillows, or sleep on a recliner. Minimize swelling and bruising by keeping your head elevated as much as possible during the first few days of recovery. Significant bruising can occur, but will resolve within two weeks.

• Avoid straining, heavy lifting, swimming, and strenuous activities, such as aerobics and jogging, for ten to fourteen days. Specifically, you should avoid activities in which you move your head abruptly or movement that increases the blood pressure in your head. This restriction includes, but is not limited to, bending over, which causes your head to be lower than your heart, and lifting objects heavy enough to cause you to strain. This restriction may apply for three to four weeks depending on your specific type of procedure.
• You may notice that your eyes tire easily for the first several weeks of your blepharoplasty recovery period. Take frequent naps. Avoid activities that may dry the eyes, including reading, watching television, wearing contacts, and using a computer.
• For the first two weeks after your surgery, wear dark sunglasses to protect the eyes from irritation caused by sun and wind.
• Your aesthetic plastic surgeon will remove the stitches between two and seven days after your eyelid surgery.
• You should feel well enough to resume normal activities around the tenth day of recovery.
• Seek medical attention immediately if you experience new pain, bleeding, or visual disturbance.

How long will my eyelid surgery results last?

Blepharoplasty results should be long-lasting. Upper and lower eyelid surgery are typically procedures you only get once. However, after your procedure, the natural aging process will continue and can gradually affect your results. Continued aging after an upper eyelid surgery can cause the brow to drop or descend and cause excess skin to reappear on the upper eyelid. In this case, most surgeons will recommend a brow lift procedure and not a second eyelid surgery.
While results are individual to each patient, eyelid surgery before and after photos can help you assess what a successful eyelid surgery result will look like.

To achieve the most beautiful and safe outcome, it’s important you return to your aesthetic plastic surgeon's office for follow-up evaluation at prescribed times and whenever you notice any changes. Do not hesitate to contact your surgeon when you have any questions or concerns.

What type of eyelid surgery incisions are there?

Your surgeon will provide a recommendation for what incisions to make during your eyelid procedure. There are a few options for eyelid surgery.

Your surgeon will mark the natural lines and creases of your lids and keep your scars as hidden as possible along these natural folds. Fine sutures will be used to close the incisions, thereby minimizing scar visibility.

In traditional blepharoplasty, your surgeon will make the incision in an inconspicuous site along the lash line and smile creases of the lower lid.
In a transconjunctival approach, your surgeon corrects eyelid puffiness caused by excess fat by making an incision inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin.

If you have issues with both your upper and lower eyelids, your surgeon may recommend a combined approach.

Any scars from your eye lift will be hidden in your natural eyelid creases, making them almost indiscernible.

What risks are there with getting eyelid surgery?

Fortunately, significant complications from eyelid surgery are infrequent. Every year, thousands of people undergo successful eyelid surgery and are pleased with the results. You should discuss the risks and potential complications of eyelid surgery with your aesthetic plastic surgeon during your consultation and after your procedure to ensure you are on the right track to recovery.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures
You can help minimize eyelid surgery risks by following the advice and instructions of your board-certified aesthetic plastic surgeon, both before and after your surgery.

How much does eyelid surgery cost?

The cost of eyelid surgery (blepharoplasty) varies by surgeon, geographic area, and the technique used for your procedure. Be sure to ask your surgeon what the approximate cost will be for your specific eyelid surgery during your consultation.
The average cost for upper eyelid surgery is: $3,387*.
*The above statistic comes from the 2022 Aesthetic Plastic Surgery National Databank Statistics. This number only reflects standard procedure costs (surgeon and facility fees) and may not include other fees for anesthesia, medical tests, prescriptions, surgical garments, or other miscellaneous costs related to your procedure.

Unless you have significant visual field obstruction due to upper lid "hooding," eyelid surgery is elective cosmetic surgery and insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.

Choose your surgeon based on quality, training, and experience—not cost. At The Aesthetic Society, patient safety and your satisfaction come first. Members of The Aesthetic Society go beyond when it comes to education, certifications, credentials, and ethical standards so they can safely deliver results that are beyond your expectations. Learn more about how our members go beyond for you

Look Like Yourself, Only Better.

It’s hard to feel like yourself when you don’t look like yourself anymore. Don’t recognize that face in the mirror? When your appearance no longer reflects the way you feel on the inside, it’s easy to become uncomfortable in your own skin. It’s never too late to love the way you look again

Dr. Rosing answer's all your questions and explains his approach in great detail. His education and background of credentials is amazing which he provides in the patient packet. He really listens and is kind and caring. He ensures you are both on the same page so that he can fulfill your expectations. I had the same cosmetic procedures 15 years ago (breast implants and tummy tuck) and he amazed me when he explained his techniques of surgery and the recovery process for his patients. It made me feel that recovery will be much smoother, put me at easy, took away any concerns and calmed my anxiety. His office staff are professional and courteous. His office manager Rachell, goes further in depth with you on procedure and what to expect both pre-op and post-op. She is extremely knowledgeable and answers all of your questions.
I honestly cannot say enough wonderful things about Dr. Rosing!!!! Not only is his bedside manner caring and thoughtful, but he is meticulous and has a great amount of integrity that you cannot find in many doctors these days. In August 2018, my fiance had a suspicious mole removed from his head but instead of the dermatologist closing it up or referring him to someone who could close the hole, she sent him home. She said he would most likely have a scar, even a divot but that he should consider it a badge of honor. (Basically, be thankful that you don't have cancer and a suspicious mole is now gone!) I have to say that had Dr Rosing not squeezed us in the very next day, he would have had a very high chance of getting an infection. So we went to Dr. Rosing who was confident he could close the hole in a way that there would be minimal scarring and more importantly, the hair could grow over the scar so you wouldn't see it. He called it the "O" to "Z" procedure. Not only did he get us in the day after surgery, he stayed after business hours to get the procedure done. All I can say is these pictures speak a thousand words!! We are so happy with the results provided by Dr. Rosing and his staff!! You would never know that my fiance had anything done to his head! Thank you all so very much. We are forever grateful and would recommend every one of our family members to Dr. Rosing for any procedure. He is absolutely a God Send!!
From the moment Dr. Rosing introduced himself, I knew I had found my plastic surgeon. During my consultation, he was able to spend as much time as I needed answering my questions, while teaching me along the way. My expectations were beyond exceeded and my procedure has dramatically changed my life for the better! All the staff at Allure MD are so lovely and welcoming. From helping with coordinating my surgery date, to my weekly check-in appointments, and everything else in between, I was always comfortable and well taken care of. I can assure you, when in the care of Dr. Rosing and staff, all of your needs will be met and exceeded. Dr. Rosing is more than just my surgeon; he is a mentor and an inspiration. I cannot thank Dr. Rosing and his team enough for making my dream become a reality. I am without a doubt recommending Dr. Rosing and his staff at Allure MD to anyone and everyone I know!
Dr. Rosing is a masterful surgeon who’s technique is refined and subtle. The results are stunning, yet very natural. His eye for detail and his thoughtfulness make for results that exceed expectations. I don’t know how he does it, but post-surgery downtime and healing is very minimal. Dr. Rosing truly cares about his patients and works closely with you to ensure an optimal outcome. The staff is caring and available before and after surgery for any questions or concerns. I highly recommend him as I am a repeat patient…he’s just that good.

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