Eyelid surgery: not just an aesthetic procedure

According to a 2024 worldwide survey, eyelid surgery, also known as blepharoplasty,  was the most popular surgical procedure globally. The procedure is quickly rising in popularity among both men and women, however it may not always be for aesthetic reasons. Dr. Marcello Carminati, plastic surgeon and responsible for the plastic surgery wing of the Papa Giovanni di Bergamo Hospital, has been dealing with plastic constructive and reconstructive surgery for many years, specialising in everything from skin and breast cancers to issues related to eyelids. 

Eyelid surgery is extremely beneficial to patients of a certain age. «When talking about blepharoplasty, we mainly focus on upper blepharoplasty – Dr. Carminati comment- which is indicated when there is an excess of skin that clearly makes the gaze look somewhat heavier, a bit more tired, and therefore has an aesthetic relevance».

However, Dr. Carminati explains how eyelid surgery isn’t only undergone by those wishing to obtain a more “refreshed” look: «Very often, especially with age but also constitutionally, this excess skin becomes redundant on the upper eyelid, meaning it becomes so abundant that it not only slightly slows the opening of the eyelid, giving a tired look (especially in the evening or after a particularly exhausting day), but it also narrows the visual field, especially in the outer quadrants». Because of this, there is also a functional reason for the procedure. 

Two main situations to consider when opting for eyelid surgery

There are three types of blepharoplasty: upper, lower and combined. When deciding which kind of procedure to undertake, surgeon’s look at two main factors.

When the patient wishes to get the surgery for functional reasons, ergo the skin on the upper eyelid has begun to limit their vision, then a simple upper eyelid surgery is recommended, which Dr. Carminati explains is minimally invasive and requires local anaesthetic. 

On the other hand, when the issue is of an aesthetic nature, the problem mostly stems from below the lower eyelid, as the Doctor puts it: «It becomes surgical when those unaesthetic bags appear, which we call fat bags. These are swellings that, in general, may also have a constitutional origin and therefore be present even in young people, but they certainly become more evident with age. In this case, the procedure is specifically aimed at removing these blemishes, which are also a particular concern for men, since under-eye bags contribute to making the gaze look tired and aged, even when the person does not actually feel that way». In this case lower eyelid surgery is the best direction to go in.

However, some patients may have both an excess of skin on their upper eyelid and unaesthetic bags, requiring a combined surgery aimed at resolving both a functional and aesthetic issue. 

Does the effect last?

One of the main appeals of eyelid surgery is its rejuvenating effect. Luckily, the procedure has proved to be relatively long lasting. According to Dr. Carminati «It has happened to me only very rarely to have to intervene again, and usually after fifteen or twenty years. I also have cases with excellent follow-up results even after many years. Of course, if the procedure is performed, for example, at the age of fifty, it’s understandable that by seventy-five the patient may show some minor signs of recurrence. However, the improvement is still permanent, in the sense that someone who was operated on twenty years earlier will never be as if they had never undergone the procedure». 

Furthermore, compared to other plastic surgeries, eyelid surgery seldom results in complications. With more than thirty years of experience performing the procedure, Dr. Carminati affirms that the few complications which could arise have a very low incidence rate and are often related to the surgeon’s experience. 

Pairing eyelid surgery with other procedures

«There are many other procedures that help improve the appearance of the eyes – the Doctor explains – brow lift, canthopexy (which means slightly lifting the corner of the eyelid), or a midface lift, which serves to elevate the cheekbone and rejuvenate the entire orbital area. But, of course, the indication is subjective and depends on each individual case. It is essential to have a thorough consultation with the patient to understand their specific aesthetic needs».

Eyelid surgery is but one of the many procedures patients can access.

Dr. Carminati concludes by saying: «Generally, those who experience some aging in the lower third of the face also tend to have eyelids that are not perfect. In this case, combining procedures is more than reasonable. Of course, the combination of multiple interventions must be based on the patient’s clinical condition, but above all on the patient’s wishes».