Upper eyelid surgery

What’s the best way of treating hooded eyelids? Hooded eyelids are one of the most common problems that we see in aesthetic medicine. The good news is that we have a couple of options for treating them both surgically and non-surgically. Heavy upper eyelids are sometimes something we’re born with, it gets worse with age, and sometimes they just happen upon us as we get older. In the most extreme examples, the eyelid skin can eventually reach on top of the eyelashes and start to obstruct the vision. It becomes almost a functional problem as well as an aesthetic problem. If you are a little bit younger and you don’t have a huge amount of excess skin, then it is often possible to achieve a nice improvement just through using muscle-relaxing injections to give you a little bit of lift to the eyebrows. But when you’re doing that, you need to be careful. What you don’t want to do is over-elevate the eyebrows so that you look constantly surprised. So when I’m using toxins to try and lift the eyebrows, I always try and keep it really conservative, like literally a millimetre or two of elevation, and even if you need more than that, it’s enough to make a little bit of a difference, but without making you look like Captain Spock. When the excess gets a little bit more significant, however, then we really need to be thinking about surgical options, but the good news is that of all of the surgical procedures that we do in cosmetic surgery, this is among the least invasive. It’s the design of where to place the incisions and exactly how much skin to remove that ultimately determines how the final result will look. What we’re trying to do is take away some of the heaviness,  but what we don’t want to do is lose the fullness or softness of youth. So you’re kind of treading a fine balancing line here between doing enough to make enough of a difference, but without doing too much that you cure the problem with the hooded eyelids, but you make it look quite harsh, and that really is an art that varies from surgeon to surgeon. The procedure itself is actually relatively short. First of all, we inject some local anaesthetic to make the skin go numb. That stings a bit like when you go to the dentist, it’s the exact same numbing injection that we use. We then use the scalpel to remove the skin, and if we take any muscle or fat, we only take a small amount. So in the olden days, doctors, as a matter of routine, took away as much muscle and fat as they thought they could get away with. What that ended up doing was creating a lot of really hollow eyelids, which is something you used to see in the 90s and naughties. So any muscle excision or fat resection that we do is usually very conservative. See one that the heaviness is gone, but I also want you to pay attention to how soft the contour looks. This is down to the design skills of the surgeon performing the procedure. Again, you see the heaviness is gone, but it still looks soft, and that softness is absolutely critical to having a result that looks youthful and attractive and not just a sort of very crude result that amputates the skin but doesn’t look very nice. So, in a nutshell, if you are young and only have a little bit of excess skin, then injectables are going to be your number one go-to. If you have a little bit more loose skin but don’t want to have surgery,  you will get a bit of benefit from injectables, but if you want the best result, a minor surgical procedure called the upper blepharoplasty is the answer. Any questions or suggestions for our future content, please pop them in the comments section, and don’t forget to like and subscribe to our channel.

Upper eyelid surgery can fix hood of the eyes by removing excess skin and tissue that causes the eyelids to sag or droop. The surgery involves removing the extra skin and possibly some underlying fat and muscle that creates the hood of the appearance, making the eyes look more open and more youthful. When we decide how much skin to remove, we carefully design the excision to reshape the eyelid and enhance its natural contour, and create a more defined, lifted look, improving both eyelid appearance and the function of the eyelid. The incision is placed in the natural eyelid crease, ensuring that any resulting scar is hidden in the shape of the eyelid and remains natural. The procedure restores a more refreshed and awake appearance, helping people with hooded eyes to look less tired and more alert.

With a well-performed upper eyelid surgery, the goal is for results to be subtle and natural. So most people should not notice you’ve had surgery, but rather people would comment on how you’re looking well and refreshed. To achieve this sort of outcome, it all comes down to the design of the operation. Before your surgery, I painstakingly designed the amount of skin to remove and perhaps even more importantly, how much to leave behind. This, in my opinion, is what makes the difference between a good eyelid surgery and a great one. The key is removing just enough skin to make a worthwhile difference, whilst leaving behind enough skin so that the eyelid looks soft and natural.

Non-surgery options cannot fully fix hooded or sagging upper eyelids as they can’t remove the excess skin or reposition the tissue. However, there are a couple of non-invasive treatments that can improve the appearance of upper eyelids to a certain extent. The main one is Botox injections, which help by lifting the eyebrow a little. The other options are to use makeup or skin adhesive tapes to provide a temporary camouflage. However, if you have a significant hooding or excess skin, surgery remains the most effective solution for long-term results.

Upper eyelid surgery is generally very safe and low-risk. Like all procedures, however, there are some risks. This includes over- or undercorrection. Removing too much skin or too little skin can affect eyelid function and appearance. We prevent this by carefully designing the incision lines before surgery and tailoring the procedure to each person’s unique anatomy. Dry eyes or irritation may occur after surgery. We minimise this by preserving natural eyelid function, advising patients to use lubricating eye ointment, and avoiding excessive tissue removal. Finally, visible scarring is possible. Although scars typically fade well, improper healing can leave noticeable marks. We minimise this risk by placing incisions in the natural eyelid crease using very fine suture techniques and providing aftercare tips like avoiding sun exposure. With skilled technique and proper post-up care, these risks are significantly reduced, ensuring a safe and effective eyelid rejuvenation.

Immediately after upper eyelid surgery, you should expect swelling, bruising, and tightness, which peak in the first two or three days. During this time, the swelling can really distort the appearance of your eyelids. Please don’t panic. This is normal and expected and will resolve sooner than you probably think. Most of the swelling and bruising has usually faded by the end of the first week, which is when we remove the stitches. Most patients were comfortable getting back to work after a week to 10 days, although the results will look much better and more natural in more like three or four weeks’ time. Fall healing with resolution of the last swelling and the scars fading typically happens around six months, although most patients will be really happy with the results much sooner than this.

Hi, I’m Russell Bramwell. I’m a plastic surgeon with a particular interest in facial rejuvenation surgery. Upper eyelid surgery is one of the most popular procedures that I do in my facial cosmetic practice. Heavy upper eyelids are one of the most common signs of aging that our patients complain of. Sometimes heavy lids are not even the result of aging. It’s simply a natural feature of the face that can make someone look tired, even when they feel youthful and anything but tired. The procedure itself is relatively straightforward. In essence, it’s a minor operation to remove skin, and sometimes a little muscle and fat too. But it’s a superficial procedure, normally done on the local anaesthetic as an outpatient. The key to the whole procedure, though, and the bit that varies from surgeon to surgeon, is the design of the skin excision. The design on how much skin to remove and how much to leave behind, that’s the important bit. If you look at a youthful eyelid, and one that’s considered attractive, it’s not hollow. It’s normally full and has a fold of skin present naturally. So what we don’t want to do is take away too much skin that makes the eye look hollow. Sure, simply removing skin makes the eyelid less heavy, which might be enough for some people, but most of our patients want to try and achieve an eyelid shape that’s youthful and attractive. And that’s where the unique skill set of your surgeon becomes pivotal. If you have a look at this before and after, you can see that the eyelid shape afterwards has a youthful softness to it. We could have taken a few more millimetres of skin, sure, but that would have given her a lid that would look more hollow and even less attractive. Or we could have taken some more fat or more muscle, but then we would have lost some of the youthful softness that, for me, is really important in creating an attractive result. If we look at this example on a more mature patient, again, we see that I’ve not taken away all of the skin that I could have. I’ve deliberately left behind some of the skin so that the contour of the lid looks soft and more attractive. And another example, this time on a younger patient of mine who was still in her 30s. This is the sort of patient who naturally had a full lid her whole life. So it was predisposed to it becoming excessively heavy at an early stage, making her look more tired than she felt. In this sort of patient, it’s really important that we conserve the natural fullness of her lid so that we maintain the character of her face. Had we taken too much skin from her, it would have changed the appearance of our eyes. And I don’t think she would have been happy with her. I guess eyelid surgery looks pretty straightforward. And from a surgical point of view, it is. But that doesn’t mean it’s easy. Getting the aesthetic judgment just right is the most challenging part. So we can achieve a result that’s both natural and attractive for our patients. Thank you.