Direct Lower and Upper Blepharoplasty

Before and After


This patient in her 60s came for evaluation of her eyelids.  In her before photo it is quite easy to see how much extra skin she has, especially on her lower eyelids.  On her left eye (the eye on the right when looking straight on), she also has a little bit of droopiness to the eyelid (ptosis) that did not bother her.  For her lower eyelids the condition she has is called a festoon.  This is when the eyelid skin is so redundant that it begins to fold over itself.  When someone develops festoons the standard incisions used for an eyelid surgery (blepharoplasty) cannot be used.  The reason is she had almost two inches of excess eyelid skin.  If the standard incision was used below the eyelashes then the removed skin would lead to cheek skin replacing the eyelid skin.  The cheek skin is heavier and would cause the eyelid to begin to pull away from the eye ball (called ectropion).  Therefore, in this patient the incision to address her lower eyelids was made below the festoon, at the junction between the cheek and the eyelid.  Even those this incision is directly on the face, when you look closely it is very hard to find because we naturally have a transition shadow on the face there.   In the after photos you can see how much more open her eyes appear.  She still has the ptosis on the left eye, but both eyes have a more rested appearance.  This patient also told us she no longer feels so tired towards the end of the day because she is not wasting so much energy holding her eyelids up.  She is ecstatic about her results as they not only improved her look and feel, but also look completely natural.