Eyelid Surgery

About Eyelid Surgery (Blepharoplasty)

Blepharoplasty is the medical term for a procedure designed to address age-related issues of the upper and/or lower eyelids. Dr. Sam Gershenbaum is a plastic and reconstructive surgeon in South Florida who frequently performs facial rejuvenation surgery at his center in Miami to assist individuals who would like to address the signs of aging.

Choosing An Experienced Blepharoplasty Surgeon in Miami

Choosing an experienced blepharoplasty surgeon is extremely important because eyelid surgery requires a surgeon who approaches the procedure in an ultra-conservative manner. An aggressive approach can lead to irreversible, unnatural-looking changes that could severely affect the function of the patient’s eye.

What Can Cosmetic Eyelid Surgery Address?

The bags beneath the lower eyelid

– the lower eyelid tends to age in one of two ways: Patients may inherit a condition that causes the lower eyelids’ ‘bags’ to appear during their late 20s or early 30s. However, for the majority of people, eyelid aging becomes apparent at some point in their early 40s.

Excessive skin redundancy of the upper eyelid

– the skin of the upper eyelid hides its crease and a small amount of fat may bulge out near the individual’s nose.

What Causes These Changes to the Eyelids and the Brow?

As an individual ages, the fibrous septum that houses the orbital fat surrounding the eye may become lax. Once lax, this orbital fat (that is intended to support the eye) begins to bulge and accumulate directly below the eye. This accumulation leads to the development of visible ‘bags.’ The skin itself also begins to age, developing lines and wrinkles. If the upper eyelid’s muscle descends, the eyelid will have a ‘droopy’ look.

Other factors that affect the appearance of the eye include:

  • Genetics
  • Sun exposure
  • Smoking
  • Weight fluctuations

Recognizing a Descending Brow

As time passes, the eyebrow itself begins to descend. Once it does, the skin of the brow begins adding fullness to the area and crowds the upper eyelid.

Unfortunately, cosmetic eyelid surgery cannot address a descending brow. When examining the upper eyelid area, it is crucial for the surgeon to determine whether the issue at hand is caused by aging of the upper eyelid or due to the descent of the patient’s brow. An experienced surgeon like Dr. Gershenbaum can differentiate between an aging eyelid and a descended brow. If the brow is descending, Dr. G may recommend the patient have a brow lift in conjunction with or instead of upper eyelid surgery.

How Does Eyelid Surgery Address These Issues?

During eyelid surgery, Dr. G addresses the tired, aged appearance of the eyes by removing or repositioning the pouches of orbital fat resting beneath them, by lifting the sagging eyelids as well as by eliminating the loose skin and excess folds that surround the eyes.

In the event that there is a hollowing below the eye that needs to be filled, instead of removing the excess orbital fat, Dr. Gershenbaum can reposition it over the bony rim to eliminate this hollowed appearance.

Once the fat pouches and skin folds are addressed, and the eyelid creases are improved, patients enjoy a more youthful-looking, rested appearance.

Who Should Consider a Blepharoplasty with Dr. G?

In Miami, men and women of all ages choose to have eyelid surgery as a means to eliminate the excess fat beneath the eyes and tighten loose skin. Although a Blepharoplasty is typically performed for cosmetic reasons, eyelid surgery is also used to treat impaired vision caused by drooping upper eyelids. If a Blepharoplasty is necessary to address impaired vision, the insurance company may reimburse the patient for the procedure. Dr. G recommends that his patients speak with their insurance company concerning this matter.

Reasons Men and Women in South Florida Choose Dr. G Cosmetic Surgery Center in Miami

At Dr. G Cosmetic Surgery Center, Dr. Sam Gershenbaum uses the most innovative techniques in conjunction with state-of-the-art technology to perform Blepharoplasty procedures. His advanced approach to improving the aesthetic appearance of the eye and addressing the inability of a drooping eyelid to function properly has made him one of the top Blepharoplasty surgeons in South Florida.

The eyes are one of the most important features of the face: Many consider the eyes ‘the windows to the soul.’ While the eye itself is essentially expressionless, the movements an individual makes to change the contour of the muscles, skin, fat, eyelashes and the brow is what allows for the creation of expression.

This changing contour around the eye can project a variety of emotions, including:

  • Happiness
  • Anger
  • Sorrow
  • Fear

At Dr. G Cosmetic Surgery Center in Miami, Patients Receive Individualized Treatment

Every patient is unique; therefore, Dr. Gershenbaum and his medical team take the time to create a custom treatment plan to meet each patient’s particular needs. By creating individualized cosmetic procedure and surgical treatment plans, patients receive the best results possible.

The Initial Consultation

During the patient’s initial consultation and examination, Dr. G will determine which procedure or combination of procedures will provide the patient with his or her desired results.

During an initial consultation, patients will be asked about their medical history.

Information Dr. G needs includes the following:

  • Surgical history
  • Previous/Current medical treatments
  • Health conditions, such as heart disease, chronic obstructive pulmonary disease (COPD), hypertension and diabetes, etc.
  • Current medications, including over-the-counter medications
  • Vitamin and herbal supplement usage
  • Tendency to smoke, drink alcohol or participate in recreational drug use

Patients should be prepared to discuss what they would like Dr. G to accomplish with eyelid surgery. In addition, Dr. Gershenbaum needs to know if the patient has had any ocular diseases, including dry eye. If applicable, he will also want to know if the eyelid has just recently started to droop, if the eyelid began to age early on or if it has been aging for some time.

The Examination

Dr. Gershenbaum will examine the patient’s face, including his or her eyelids and brow. He will examine the skin on the upper eyelid and determine whether or not the brow itself is descending. A descended brow can mimic upper eyelid redundancy. In the event that a surgeon neglects to recognize a descended brow and chooses to perform upper eyelid surgery, the patient may be left with an even lower brow. Patients who have a low brow should consider a brow lift.

The lower eyelid is examined to determine the strength of the lower lid itself as well as the amount of orbital fat that has escaped from the thin fibrous septum that previously encased it. Dr. G will also note the position of the patient’s eye in relation to the bony rim, which helps him determine the eyelid surgery technique that will best serve the patient.

Once the examination is complete, Dr. Gershenbaum will have a good idea as to what results he can achieve for the patient with eyelid surgery and/or a brow lift procedure. Dr. G and his medical team encourage all of their patients to ask questions during their initial consultation.

Blepharoplasty Can Be Performed in Combination with Other Procedures

Some patients choose to have additional procedures when they have upper and/or lower eyelid surgery with Dr. Gershenbaum at his cosmetic surgery center in Miami. These procedures include a brow lift and/or a chemical, or laser peel. The brow lift raises the eyebrows to a more youthful position: Chemical and laser peels are used to treat fine wrinkling, and/or dark circles.

Preparing for Eyelid Surgery

Dr. G requires that the majority of his patients visit their primary care physician to receive a release for surgery prior to their eyelid surgery. He may also order pre-operative labs, including blood tests.

For at least two weeks before their Blepharoplasty with Dr. Gershenbaum in Miami, patients must stop taking certain medications. These medications include anti-inflammatory medications (such as ibuprofen and aspirin). Dr. G provides a list of the medications that his patients need to avoid prior to their surgical procedures. It is essential that patients avoid these medications as they can affect the ability of the blood to clot. Therefore, if disregarded and taken anyway, they can cause the patient to experience excessive bleeding and bruising.

Patients who smoke need to avoid smoking and second-hand smoke for at least four weeks before and four weeks after their Blepharoplasty procedure. In addition, to reduce the incidence of swelling, alcohol needs to be avoided for five days before their procedure.

A Blepharoplasty at Dr. G Cosmetic Surgery Center in Miami

At Dr. Gershenbaum’s cosmetic surgery center in Miami, eyelid surgery is performed as an outpatient procedure. Upper and Lower Blepharoplasty can be performed at the same time. Moreover, either of these procedures can be performed independently as well.

Patients do receive medications throughout their procedure that keep them comfortable (anesthesia).

On the day of their eyelid surgery, patients need to arrive at Dr. G Cosmetic Surgery Center in Miami with a driver. A Blepharoplasty usually lasts anywhere from one to two hours. Patients who are having multiple procedures should expect a lengthened procedure time.

Upper Eyelid Surgery – The Procedure Steps

1. Marking the Skin

Prior to the procedure, the patient’s skin on the upper eyelid is marked to ensure the exact amount of skin is removed during the surgery.

2. Anesthesia

Anesthesia is administered, the type of anesthesia used will be discussed with the patient prior to the procedure.

3. Creating the Incision

The upper eyelid incision is created within the natural crease of the patient’s eyelid and extends a short distance laterally to the side.

4. Removing Excess Skin and Fat

The excess skin and the fat in the medial area (next to the patient’s nose) is carefully removed.

5. Closing the Incisions

Dr. G closes the incisions with delicate stitches. These stitches are placed in such a way as to allow the incision to heal into a virtually invisible scar.

Lower Eyelid Surgery – The Procedure Steps

There are two kinds of incisions that can be used during lower eyelid surgery:

1. The transconjunctival Blepharoplasty incision, which is created along the inside of the patient’s lower eyelid (the majority of patients will receive this incision).

2. The other incision used during a Lower Blepharoplasty is an incision that is placed externally, directly beneath the lower lashes.

What Determines Which Incision a Patient Receives During Lower Eyelid Surgery?

The transconjunctival Blepharoplasty incision is used when a patient has baggy lower eyelids with just a small amount of extra skin. Individuals who are eligible for the transconjunctival incision will not receive an external incision.

The incision directly beneath the lower eyelashes is used when a patient has an excessive amount of skin and fat that needs to be removed. Although this incision is made externally, once healed, it is typically virtually invisible.

Lower Eyelid Surgery to Remove Excess Skin – The Procedure

This procedure is performed as an outpatient procedure. Patients need to bring a driver with them to Dr. G Cosmetic Surgery Center in Miami on the day of their lower eyelid surgery.

1. Anesthesia

Patients receive medications so they remain comfortable throughout their Blepharoplasty procedure.

2. Creating the Incision

During this procedure, the incision is typically made below the lower eyelashes of each eye. These incisions extend for a short distance, laterally.

3. Removing or Repositioning Excess Fat

Dr. G may remove fat or reposition and secure the fat in place.

4. Removing Excess Skin

Excess skin is removed.

5. The Incision is Closed

Dr. G closes the incisions beneath the lower lashes of each eye using stitches.

Lower Eyelid Surgery Without Excess Skin – The Transconjunctival Approach

Again, this is an outpatient procedure and patients do receive anesthesia. When arriving at Dr. G Cosmetic Surgery Center in Miami on the day of their surgery, patients need to bring a driver with them.

1. The Transconjunctival Incision is Created

To avoid an extended scar, the transconjunctival approach involves an incision being created inside the lower eyelid.

2. Removal or Repositioning of Fat

Depending on the patient’s specific needs, the excess fat is either removed or repositioned and then secured.

3. Closing the Incision

For this eyelid surgery, self-dissolving sutures are used.

Lower Eyelid Surgery – When an Advanced Approach is Recommended

During youth, there is typically a smooth contour between the transition from the eyelid to the cheek. As an individual ages, it is not uncommon for the eyelid-cheek junction to appear hollow. This hollow area sits below the fat bags that are located beneath the lower eyelids. Dr. Gershenbaum performs this advanced Blepharoplasty approach to restore that youthful contour. By blending this eyelid-cheek junction, patients enjoy a more youthful appearance.

The Advanced Blepharoplasty Approach

An outpatient procedure, anesthesia is administered and the patient will need to bring a driver with them on the day of their surgery.

1. The Incisions are Created, Excess Fat and Skin are Removed

Once the anesthesia takes effect, Dr. G creates a transconjunctival incision from which he removes excess fat. He reduces the excess skin on the upper eyelid using the standard external incision.

2. Canthopexy is Performed

Dr. Gershenbaum performs canthopexy, which is a procedure that involves gently tightening the upper eyelid.

3. The Lower Eyelid is Addressed

The thin muscle that supports the lower eyelid is lifted and secured.

Addressing Excess Laxity in the Lower Eyelid

Many patients have excess laxity in their lower eyelids. This can cause irritation and/or dryness of the eye. In addition, too much of the white of the patient’s eye is visible. The correct treatment for this condition is not removing the skin, but tightening the eyelid itself.

Recovering from a Blepharoplasty

  • External incisions will leave scars; however, these scars remain well hidden within the natural folds and lines around the eye.
  • Dr. Gershenbaum will gently remove the stitches in the upper eyelids over a five to seven-day period.
  • The stitches used during lower eyelid surgery may be self-dissolving; however, if they are not, Dr. Gershenbaum will remove them at some point around five to seven days.
  • Following a Blepharoplasty, patients usually only experience mild bruising and swelling. The majority of Dr. G’s patients return to their regular activities and exercise routines within seven days of their eyelid surgery.

Dr. Sam Gershenbaum and his team of medical professionals are dedicated to providing individuals in and around Miami with the highest quality of care available in South Florida. If you are considering a cosmetic procedure, plastic or reconstructive surgery, contact Dr. G Cosmetic Surgery Center today at (305) 933-1838 or with our online contact form. We look forward to helping you turn back the hands of time!


Eyelid Surgery (Blepharoplasty) in Miami, Florida

At the Brickell Riverfront Surgery Center, eyelid surgery is one of our most highly requested, and most satisfying procedures. Dr. Sam Gershenbaum uses an advanced approach to this life-changing procedure, and has become known as a leader for eyelid surgery – blepharoplasty in the Miami region.

Eyelid surgery or blepharoplasty at our center is performed only with the latest techniques and technology, because we understand that the eyes are responsible for an important part of facial expression; they project the feelings and emotions of happiness, sorrow, anger and fear. Many feel the eyes are the “windows to our soul.” Yet, the eyes themselves are essentially expressionless structures.

In actuality, it is the contour of the skin, muscle, fat, brow and lashes around the eyes that produce expression. Wrinkles, lines, loose skin and fatty bulges slowly develop and become more prominent as time goes on. Sun exposure, genetic predisposition, weight fluctuations and smoking can also be contributing factors that together produce a tired and older appearance.

Eyelid surgery, technically known as blepharoplasty, can correct conditions that produce an eyelid lift (blepharoplasty) picturesaged, tired appearance by removing pouches or “fat bags,” sagging eyelids, and excess folds of loose skin around the eyes. With skin folds, fat bulges removed, and eyelid creases improved, a more youthful and rested appearance can be achieved through eyelid surgery.

The fat in the eyelids is positioned behind a thin fibrous septum that, for various reasons, may become lax and allow bulging of orbital fat (the fat that surrounds and supports the eye). This is often seen as “bags” under the eyes that give that tired appearance. This fatty tissue can be removed or at times repositioned through eyelid surgery – blepharoplasty, which tightens of the lax fibrous septum. In other instances, the fibrous septum is opened and the fat is repositioned down and over the bony rim below the eye to conceal hollowness if present.

Our Miami eyelid surgery center understands that every patient has individual requirements. We formulate a procedure specific to each patient to ensure the best possible results. A comprehensive consultation and examination is needed to decide which procedure or combination of procedures is required to obtain the desired results.

For blepharoplasty Miami Florida contact Dr Gershenbaum today.

Eyelid Surgery Procedures in Miami, Florida


Upper Eyelid Surgery (Upper Blepharoplasty)

The incision for upper eyelid surgery is generally made in the natural crease of the upper eyelid and extended laterally to the side for a short distance. The excess skin and fat is then removed, and the incision is closed with sutures (stitches), which are removed over a five to seven day period.

When considering eyelid surgery, it is important to note that “heaviness” or excessive sagging skin of the upper eyelids can also be caused in part or even solely by a sagging forehead or brow. In this care, a brow lift may be recommended, in addition to the eyelid surgery to be performed at our Florida facility.

Lower Eyelid Surgery (Lower Blepharoplasty)

For lower eyelid surgery, there are three principle approaches:

Lower eyelids with excess skin:
The incision is generally made just below the eyelash margin and extended laterally to the side for a short distance. Depending on individual requirements fat may be removed or repositioned and secured in place. The excess skin is then removed and the incision closed with sutures (stitches), which are removed over a five to seven day period. At times, self-dissolving sutures are used.

Lower eyelids without excess skin:

This eyelid surgery approach is called a transconjunctival approach in which the incision is made inside the eyelid so as to avoid an extended scar. The fat is removed or repositioned and secured in placed. In this procedure, sutures are self-dissolving and no sutures need be removed.

In certain instances, Miami eyelid surgery expert Dr. Gershenbaum may recommend laser skin resurfacing or a skin peel concurrent with transconjunctival blepharoplasty, or at a later date, to reduce fine lines or creases, which would not be addressed by this blepharoplasty procedure.

Lower eyelids (advanced approach):

This approach is aimed at blending the eyelid-cheek junction, allowing a more youthful appearance. In youth, there is generally a smooth contour/transition between the eyelid and the cheek. As aging progresses, the eyelid-cheek junction often appears as a trough or hollow below the eyelid fat bags.

This eyelid surgery approach reduces fat from a transconjunctival approach (incision inside the eyelid) and reduces excess skin from the more standard external incision. An eyelid tightening procedure called canthopexy is performed and the thin muscle supporting the lower eyelid is elevated and secured.

Many eyelid surgery patients have excess laxity in the lower eyelid itself, which reveals too much white of the eye and can cause dryness or irritation. At times laxity of the eyelid can resemble skin laxity. However, the correct treatment is tightening the eyelid and not removing skin, which can cause postoperative malposition (pulling down of the eyelid). Either canthopexy or canthoplasty eyelid-tightening procedures may be recommended and can be performed through the same eyelid surgery incisions.

Where external incisions are made, scars always occur, but generally are easily hidden in the natural lines and folds around the eye. Both upper and lower eyelids can be operated upon at the same time or independently as well.

Healing After Surgery

Eyelid surgery is frequently performed with facelift and brow lift procedures at our Florida practice. Bandages are generally not applied over the eyelid area. Cold compresses are applied to the surgical areas as tolerated for a 48-hour period.

Procedure time for the upper eyelid is approximately one hour. Time for the lower eyelids, depending, on which technique is used, will range from one to two hours.

Eyelid surgery is generally performed in our state-of-the-art outpatient surgical facility located between Fort Lauderdale and Miami, Florida. Eyelid surgery can be performed using local anesthesia with intravenous sedation or general anesthesia.

After surgery varying degrees of swelling and bruising of the operated eyelids will occur and at times extend down to the cheek area. It generally takes one to two weeks from the day of eyelid surgery for most of the bruising and discoloration to subside. This condition generally subsides more rapidly in the upper eyelid area than in the lower eyelid area. Irregularities along the suture line may be present for several weeks. You may experience swelling, tingling, itching, numbness, and irritation with a feeling of tightness and dryness as you heal. This will last for a variable length of time.

Sutures are removed in five to seven days after eyelid surgery. At times, dissolvable sutures are used at our practice in Miami, Florida. Eyelid surgery patients do not generally complain of pain after this procedure. Any discomfort is easily controlled with medication. Light exercise can generally be started three to four weeks after surgery.

To learn more, or to schedule an eyelid surgery consultation, please contact us in Brickell, Florida today