At Boston Eyelid Surgery in Wellesley, MA, Dr. Mitesh Kapadia treats eyelid position problems, including ptosis, where the upper eyelid sits too low, and eyelid retraction, where the upper eyelid sits too high. The goal of treatment is to improve eyelid height, symmetry, comfort, and overall balance while maintaining a natural appearance.

What Is Eyelid Retraction?

Eyelid retraction means the eyelid is pulled away from its normal resting position. In upper eyelid retraction, the upper eyelid sits higher than it should. This may expose more of the white part of the eye above the iris and can make the eyes look unusually open or asymmetric.

Upper eyelid retraction is different from ptosis. Ptosis occurs when the upper eyelid droops too low and may block vision. Eyelid retraction is the opposite problem: the eyelid is elevated too high.

Lower eyelid retraction can also occur, usually when the lower eyelid sits too low or pulls away from the eye. This article focuses mostly on upper eyelid retraction, because that is the type most closely related to ptosis repair and eyelid height correction.

What Causes Upper Eyelid Retraction?

There are several reasons the upper eyelid may sit too high. Common causes include:

• Prior eyelid surgery: Eyelid retraction can occur after previous eyelid or ptosis surgery if the eyelid heals in a higher position than intended.
• Thyroid eye disease: Thyroid eye disease can affect the muscles and tissues around the eyes, sometimes causing the eyes to appear prominent and the upper eyelids to retract.
• Scarring or trauma: Injury, inflammation, or scar tissue around the eyelid can change the eyelid’s position.
• Natural eyelid asymmetry: Some patients have one eyelid that has always rested higher than the other.
• Overcorrection after ptosis repair: Ptosis repair is designed to raise a drooping eyelid. In some cases, the eyelid may be raised too much and require adjustment.

An in-person evaluation is important because the right treatment depends on the cause of the retraction, the amount of eyelid elevation, the health of the eye surface, and whether other conditions are present.

Symptoms of Eyelid Retraction

Some patients are bothered mainly by the way eyelid retraction affects their appearance. Others also experience eye irritation because the eye is more exposed than usual.

Common symptoms may include:

• Eyes that look wide open, startled, or uneven
• More white showing above the colored part of the eye
• Dryness, burning, or scratchiness
• Excess tearing, especially when the eye surface is irritated
• Light sensitivity
• Difficulty fully closing the eye in more severe cases
• A change in appearance after prior eyelid surgery

Even mild eyelid retraction can be noticeable because small differences in eyelid height can significantly affect facial expression.

Why Eyelid Position Matters

The eyelids do more than shape the appearance of the eyes. They also protect the surface of the eye and help keep it lubricated. When the upper eyelid sits too high, more of the eye may be exposed to air. This can contribute to dryness, irritation, and discomfort.

From a cosmetic standpoint, eyelid retraction can make one eye look more open than the other. Patients may describe looking surprised, intense, or unlike themselves. In many cases, the goal of surgery is not to create a dramatic change, but to bring the eyelid to a more natural position so the eyes look balanced and relaxed.

How Eyelid Retraction Is Evaluated

During a consultation, Dr. Kapadia evaluates the eyelid position, eyelid movement, eye closure, facial symmetry, and the health of the eye surface. He will also ask about previous eyelid surgery, thyroid disease, trauma, dryness, and changes in appearance over time.

Important parts of the evaluation may include:

• Measuring the height of both upper eyelids
• Comparing eyelid symmetry between the two sides
• Looking for signs of thyroid eye disease or scarring
• Evaluating how well the eyelids close
• Determining whether ptosis, dermatochalasis, or brow position is also contributing to the overall appearance

This detailed evaluation helps determine whether eyelid retraction repair is appropriate and what type of approach is most likely to help.

Early 60s Woman – 3 Months Post-Surgery

Eyelid Retraction Repair Surgery

Upper eyelid retraction repair is designed to lower an eyelid that sits too high. The exact surgical plan depends on the cause and severity of the retraction.

In many cases, surgery involves adjusting the eyelid-lifting muscle so the eyelid can rest in a lower, more natural position. If scar tissue from prior surgery is contributing to the problem, that scar tissue may need to be released. The goal is to improve eyelid position and symmetry while preserving normal eyelid function.

Eyelid retraction repair is highly individualized. Perfect symmetry is not always possible, but a significant improvement in eyelid position and balance is often achievable.

Is Eyelid Retraction Repair the Same as Ptosis Repair?

No. Ptosis repair and eyelid retraction repair address opposite eyelid position problems.

Ptosis repair raises the upper eyelid that sits too low. Eyelid retraction repair lowers an upper eyelid that sits too high. Both procedures require careful attention to eyelid height, contour, and symmetry, which is why they are often performed by oculoplastic surgeons who specialize in eyelid surgery.

Some patients may have a combination of eyelid issues. For example, one eyelid may be droopy while the other is retracted, or a patient may have excess upper eyelid skin in addition to an eyelid height problem. A consultation helps clarify which procedure, or combination of procedures, is appropriate.

What About Lower Eyelid Retraction?

Lower eyelid retraction is a different problem. It occurs when the lower eyelid sits too low, sometimes showing more white beneath the iris or causing the eye to feel exposed. This can happen after lower blepharoplasty, trauma, facial nerve weakness, thyroid eye disease, or scarring.

Lower eyelid retraction repair often requires different surgical techniques than upper eyelid retraction repair. The lower eyelid may need support, tightening, scar release, or grafting, depending on the cause. Because the upper and lower eyelids are repaired differently, it is helpful to separate these conditions when discussing treatment options.

Recovery After Eyelid Retraction Surgery

Recovery varies depending on the exact procedure performed and whether other eyelid surgeries are done at the same time. Most patients should expect some bruising, swelling, and temporary tightness around the eyelids.

Many patients feel comfortable returning to light activities within several days, but bruising and swelling can take longer to improve. For many eyelid procedures, patients who work from home may be able to resume work sooner, while patients who need to appear in person may prefer to allow approximately two weeks.

As with any eyelid surgery, healing takes time. Eyelid height and symmetry can continue to settle as swelling improves. Dr. Kapadia will review recovery expectations during the consultation based on your specific surgical plan.

Why Choose Boston Eyelid Surgery?

Eyelid retraction is a subtle but complex eyelid position problem. Even a small adjustment can make a meaningful difference in how the eyes look and feel. Because of this, it is important to choose a surgeon with extensive experience in eyelid anatomy and eyelid position surgery.

Dr. Mitesh Kapadia focuses on cosmetic and reconstructive eyelid surgery and has extensive experience treating patients with ptosis, eyelid retraction, eyelid asymmetry, and revision eyelid concerns. At Boston Eyelid Surgery, the goal is to create a personalized treatment plan that improves function and appearance while keeping the result natural.

Schedule a Consultation in Wellesley, MA

If one or both of your upper eyelids sit too high, or if your eyes look uneven after previous eyelid surgery, eyelid retraction repair may help restore a more balanced appearance.

Contact Boston Eyelid Surgery in Wellesley, MA, to schedule a consultation with Dr. Kapadia and learn whether eyelid retraction repair is right for you.

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At Boston Eyelid Surgery in Wellesley, MA, we see highly satisfied patients across all age groups. Eyelid surgery, or blepharoplasty, can help you see better and look more rested by addressing your specific concerns. Ultimately, the right time for surgery is when your eyelids begin to bother you, whether cosmetically or functionally.

Why Age Is Just a Number for Eyelid Surgery

A common misconception is that eyelid surgery is exclusively for older adults. In reality, everyone’s face ages at its own pace, and genetics play a significant role in how your eyelids change over time. Some families pass down traits like heavy upper eyelids or prominent under-eye bags. If you have inherited these characteristics, you may choose to seek treatment earlier in life.

When determining if you are a candidate for surgery, your overall health matters much more than your age. As long as you are in good health, eyelid surgery can be a safe and effective procedure for adults at almost any stage of life.

When Younger People Need Eyelid Surgery

Many younger adults visit our Wellesley office seeking to refresh their appearance. In fact, we perform lower eyelid surgery on a lot of patients in their 20s and 30s. People in this age group often complain of looking constantly tired, even when they are fully rested. This is usually due to prominent, puffy bags under the eyes that they were born with. Because these bags are caused by excess orbital fat rather than a lack of sleep, no amount of rest or expensive eye creams will make them go away.

Lower eyelid surgery (lower blepharoplasty) is an excellent option for removing or repositioning this excess fat. Having this procedure done early can eliminate that perpetually exhausted look, helping you feel more confident and refreshed for years to come.

Why People in Their 40s and 50s Get Eyelid Surgery

The forties and fifties are the most common decades for patients to consider upper eyelid surgery. During this time, the skin around the eyes naturally begins to lose its elasticity. Muscles can weaken, and excess skin may begin to droop over the lashes, creating new folds and fine lines.

Getting eyelid surgery at this stage helps address these anatomical changes before they become more severe. It is a highly effective way to maintain a natural, youthful appearance. Most patients simply want the outside to reflect how energetic they feel on the inside, and a blepharoplasty can help restore that rested, alert expression.

Eyelid Surgery for People in Their 60s and Beyond

It is never too late to improve your quality of life. For older adults, the primary concern is often heavy, sagging skin that physically obstructs their peripheral vision. Advanced dermatochalasis (excess eyelid skin) can make daily tasks like reading, driving, and watching television difficult. It can also cause brow ache and fatigue from constantly having to lift the eyebrows to see clearly.

Upper eyelid surgery removes this excess skin, clearing the visual field. We have safely and successfully treated many patients in their sixties, seventies, and eighties. The main goal for these patients is functional improvement—making daily life easier, safer, and more comfortable.

Understanding Upper Eyelid Surgery

Upper blepharoplasty focuses on the top eyelid. Over time, excess skin and fat can accumulate, causing the eyes to feel heavy and look tired. During this precise outpatient procedure, Dr. Kapadia makes a hidden incision in the natural crease of the eye to carefully remove the excess tissue. Because the incision is placed in the natural fold, the resulting scar is usually barely visible once fully healed. This procedure opens up the eyes, giving them a brighter, more alert appearance.

Understanding Lower Eyelid Surgery

Lower blepharoplasty focuses on the area beneath the eyes and is the most effective way to eliminate puffy under-eye bags. Dr. Kapadia gently removes or repositions the fat pads causing the bulge. This is frequently done through a transconjunctival approach—meaning the tiny incision is hidden on the inside of the eyelid, leaving no visible scar on the skin. The result is a smooth, natural transition from the lower eyelid to the cheek.

This picture shows a patient in her early 50s. She is 9 months post op lower eyelid surgery with lower lid CO2 laser. No fillers were used in this case.

What is Ptosis and How Does it Affect Your Eyes?

Sometimes the issue is not just excess skin. A condition known as ptosis occurs when the muscle that elevates the eyelid (the levator muscle) weakens or stretches. This causes the actual margin of the eyelid to drop lower over the pupil.

Ptosis can affect one or both eyes and, if severe, can significantly block your vision. To compensate, patients often subconsciously raise their eyebrows, leading to forehead fatigue and tension headaches. During ptosis repair surgery, the surgeon tightens this weakened muscle to lift the eyelid back to a normal position. This is often performed concurrently with a standard blepharoplasty.

How to Tell if You Need Eyelid Surgery

If you are wondering whether it is time to schedule a consultation, consider how your eyes look and feel throughout the day. You may be a good candidate for eyelid surgery if:

• Your upper eyelids feel heavy or physically block your line of sight.
• You have prominent, puffy bags under your eyes that never seem to go away.
• Friends or coworkers frequently ask if you are tired, sad, or stressed.
• You experience eye strain or headaches from constantly raising your eyebrows to see.

If these points resonate with you, an evaluation with an oculoplastic specialist is the best next step.

What to Expect During Your Recovery

Recovery from eyelid surgery is typically straightforward. It is an outpatient procedure, meaning you will go home the same day. While you will experience some swelling and bruising, most patients find the recovery very manageable.

To promote optimal healing, you will be advised to:

• Sleep with your head elevated on extra pillows for the first few nights.
• Apply cold compresses (like ice packs or frozen peas) to keep swelling down.
• Avoid heavy lifting, strenuous workouts, and bending over for about two weeks.

Most patients feel comfortable returning to work and normal social activities within 7 to 14 days, depending on the exact procedure performed.

How Eyelid Surgery Can Improve Your Vision

While the cosmetic benefits of eyelid surgery are well-known, the functional benefits are equally important. Excess skin hanging over your eyelashes acts like a visor, restricting your peripheral vision. By removing this obstruction, a functional blepharoplasty dramatically opens up your field of view. Patients frequently report that they no longer feel the need to strain their eyes or tilt their heads back to see clearly, making everyday activities safer and much more enjoyable.

Finding the Right Surgeon in Wellesley, MA

Choosing the right surgeon is the most important decision you will make regarding your procedure. You want a specialist who focuses exclusively on the delicate anatomy of the eyelids.

Dr. Mitesh Kapadia is a highly experienced oculoplastic surgeon who has been performing specialized eyelid procedures for nearly two decades. At Boston Eyelid Surgery in Wellesley, MA, our goal is to optimize both the functional and aesthetic outcomes for every patient. We take the time to listen to your concerns, answer your questions, and design a customized surgical plan that yields beautiful, natural-looking results.

Conclusion

There is no magic number or perfect age to address your eyelid concerns. Whether you are in your thirties or your eighties, the right time for eyelid surgery is when your eyelids begin to affect your confidence or your vision.

If you are tired of looking fatigued due to under-eye bags or struggling to see past heavy upper lids, we are here to help. Contact Boston Eyelid Surgery in Wellesley, MA, today to schedule a consultation. We look forward to helping you achieve the refreshed, clear-sighted, and vibrant appearance you deserve.

The post Is There a “Right” Age to Get Eyelid Surgery? appeared first on Boston Eyelid Surgery.

An Oculofacial Plastic Surgeon is a special doctor who works only on the eyelids and face. They start as eye doctors to learn everything about how the eye works inside and out. Then, they spend more years learning how to do plastic surgery around the eyes. This makes them the very best choice when you need an eyelid procedure. They know how to make your eyes look good and see well at the same time. If you want safe and beautiful results, you need this kind of doctor.

Years Of Extra Training For Your Eyes

Becoming this kind of eye doctor takes a very long time and hard work. First, the doctor finishes medical school and learns all about the whole body. Next, they spend up to four years learning just about the eyes and clear vision. After that, they train for two more years just to do plastic surgery on eyelids. This extra training teaches them how to fix tiny details around your delicate eyes. This long path gives them the amazing skills needed to protect their sight.

Why This Special Doctor Matters For You

Your eyes are very delicate and need the most careful touch possible. A tiny mistake near your eye can cause big problems for your vision. An Oculofacial Plastic Surgeon knows exactly how to protect your eyes during surgery. They always make sure your eye is safe before they think about how it looks. They also know how to hide the small cuts so you heal looking great. You will feel safe knowing your doctor understands exactly how your eye works.

General Plastic Surgeons Versus Eye Specialists

General plastic surgeons do good work on the tummy, legs, and the whole body. However, they do not spend all their time working on tiny eyelid details. An Oculofacial Plastic Surgeon focuses only on the face and the eyes every single day. They do hundreds of these special eye surgeries every year to stay very sharp. They know how to handle the special skin and muscles right next to your eyeball. When it comes to your face, having a true specialist makes a big difference.

Common Surgeries For The Upper Eyelids

Many people get surgery to fix heavy or droopy skin on their upper eyelids. This surgery is often called an upper blepharoplasty and it helps you look awake.

• The doctor removes extra skin that hangs down over your eyelashes.
• They carefully hide the tiny scar right in the natural fold of your eyelid.
• This helps your eyes open up wider and look much brighter every day. This simple surgery can even help you see better if the skin was blocking your view.

Fixing Bags Under The Lower Eyelids

Bags under the eyes can make you look very tired even when you sleep well. A lower blepharoplasty is the best way to get rid of these puffy bags forever. An Oculofacial Plastic Surgeon can do this surgery from the inside of the lower eyelid. This means there are no outside cuts and no scars on your face at all. They gently take out the extra fat that causes the puffy bag to show. You will look much younger and happier when those dark bags are completely gone.

Repairing Droopy Eyelids With Ptosis Surgery

Sometimes the muscle that lifts your eyelid gets weak as you get older. This makes the whole eyelid drop down low and block your clear sight. This problem is called ptosis and it is very different from just having extra skin. An Oculofacial Plastic Surgeon is the exact best doctor to tighten this weak muscle. They fix the muscle so your eyelid sits at the right height again. Doing this helps you see much better and makes your eyes look perfectly even.

Non-Surgical Choices Like Botox

You do not always need a big surgery to make your eyes look better. Many patients choose simple treatments like Botox to smooth out their whole face.

• Botox helps relax the tiny muscles that cause deep lines around your eyes.
• It works great on the small wrinkles that people call crow’s feet.
• The smooth look usually lasts for three to six happy months at a time. Our special doctor knows exactly where to put the medicine so you stay safe.

This photo shows a patient in her early 60s. She is 8 months post op upper and lower eyelid surgery with canthopexy. No fillers were used in this case.

Protecting Your Vision During Surgery

The main job of an Oculofacial Plastic Surgeon is to keep your eyes totally safe. They know how to check your eyes for dry spots before they start anything. If a doctor takes away too much skin, the eye might not close the right way. This mistake can make your eye very dry, hurt a lot, and blur your vision. Our expert doctor knows exactly how much skin is safe to take off. Your eye health is always the most important thing during any eyelid procedure.

Making Sure You Look Like Yourself

Nobody wants to look fake or surprised after they have work done on their face. The true goal of a great Boston Eyelid doctor is to keep your natural beauty. They look very closely at the shape of your face and the way your eyes sit. Then, they make a special plan just for you and your unique face shape. They use a very light touch so your soft changes look completely normal. You will just look like a younger, brighter, and happier version of yourself.

Planning Your Surgery Step By Step

Getting ready for your procedure is very easy when you have a good medical team. First, you will meet with the doctor to talk about what you want to fix. The doctor will look closely at your eyes and take some simple pictures. They will tell you all about the surgery and answer every single question you have. You will learn exactly what to do before the surgery to stay safe and healthy. This clear plan helps you feel very calm and ready for your big day.

How To Prepare For Your Procedure

There are a few easy things you must do before your surgery day comes. You need to stop taking medicines that can make you bleed too much. Your doctor will give you a clear list of what common pills are safe to take. You should also buy some soft gauze pads and gentle soap for your clean face. You will need a friend or family member to drive you safely home after the surgery. Being ready early makes the whole process smooth and keeps away any extra stress.

What Happens On The Day Of Surgery

When you come to the office on your surgery day, the sweet team will greet you. You will sit in a very comfortable chair and they will gently clean your face. They will give you medicine so you do not feel any pain during the careful work. The doctor takes their time to do the surgery safely and with great care. Most of these procedures only take about one or two calm hours to finish up. After a short rest, your friend can drive you right back to your cozy home.

Simple Tips For A Fast Recovery

Taking care of your eyes after surgery is very simple if you follow the rules. Your doctor will give you easy written steps to help your body heal up fast.

• You must rest with your head propped up on extra pillows for a few days.
• Use your cold ice packs to keep the swelling and dark bruises far away.
• Put the special soothing ointment on your small cuts exactly like the doctor said. Following these easy tips makes sure your eyes heal up perfectly and look great.

Why Patients Trust Our Boston Eyelid Expert

Dr. Kapadia has worked on eyes for over nineteen years with totally amazing results. He is a top Boston Eyelid doctor who truly cares about all his patients. People fly from very far away just to have him fix their delicate eyelids. He gives every single person high-quality customer service and a very warm smile. His deep knowledge makes him a highly trusted Oculofacial Plastic Surgeon in our area. You will love how you look and feel when you trust a true expert.

Conclusion: Take The Next Step For Your Eyes

Now you know what an Oculofacial Plastic Surgeon is and why their skills matter. They have the very special training needed to keep your eyes safe and looking great. Whether you need surgery for droopy skin or just want to look less tired, they help. Reach out to our Boston Eyelid team today to set up your very first visit. We are very excited to meet you and help you see and look your best. Call us right now to start your journey to brighter and happier eyes.

The post What Is an Oculofacial Plastic Surgeon — and Why It Matters appeared first on Boston Eyelid Surgery.

Understanding Regular Eye Bags

As we get older, the skin around our eyes gets very weak. The fat that protects our eyeball starts to slip forward over time. When this fat pushes out, it makes a puffy bump right under the eyelashes. This puffiness is what we call a normal eye bag. They are mostly made of fat, not extra water or fluid. These bags can make you look very sleepy even when you feel great. Many people visit Boston Eyelid to make these tired bumps go away forever.

Learning About Festoons

festoons are a totally different problem from regular fat bags. They do not sit high up against your eyeball like a fat bag does. Instead, they sit much lower down where your cheek meets your eyelid. They look like little hammocks of swollen skin and trapped water. If you poke them very gently, they feel quite squishy and very soft. These puffy spots can look much worse in the morning when you wake up. They can also look worse if you eat lots of salty foods for dinner.

What Are Malar Bags?

You might hear the term malar bags used by your face doctor. This is just another medical name for the exact same cheek swelling. The tricky word “malar” simply means cheek bone in doctor language. So, these are puffy fluid bags that sit right over your hard cheek bones. They are the exact same annoying problem as a festoon. Some doctors use both words to talk about the very same puffy spot. No matter what name you use, they can be very hard to treat without a true expert.

Where Exactly Do They Show Up?

It is very easy to tell them apart if you look closely in your mirror. You just need to see where the big swelling rests on your face.

• Regular eye bags sit very high up on your face.
• They start right under your lower eyelashes and stop before your cheek.
• Swollen malar bags start way down below the normal eye bag area.
• They sit heavily right on top of your hard cheek bone. Paying close attention to this exact spot helps us know how to help you.

Why Do We Get Eye Bags?

There are a few big reasons why people get regular bags under their eyes. The biggest reason is just getting older and having lots of birthdays. Over many years, the thin wall that holds our eye fat back gets very weak. When that thin wall stretches out, the fat slips right through it. Another big reason is your family tree and your special genes. If your parents had under eye bumps, you will probably get them too. Sometimes bad plant allergies can also make this top area look a little bit more puffy.

Why Do We Get Festoons?

The reasons for cheek swelling are a little bit different than for fat bags. Sun damage is one of the biggest reasons why people get festoons. When you get too much bright sun, it hurts the stretchy parts of your skin. The sun makes the thin skin and muscle on your cheek very loose and weak. When the skin gets loose, normal body fluid gets stuck in that spot. Smoking cigarettes can also make this bad cheek swelling happen much faster. Having very fair skin can also mean you might get them more easily.

How Does Aging Change Our Eyes?

Getting older changes our face in many different ways over time. Our skin stops making the special glue that keeps it tight and bouncy. Without this bouncy glue, our face skin starts to droop down toward the floor. The muscles around our eyes also get tired and very thin. When everything gets loose, it leaves space for fat and fluid to bulge out. This is perfectly normal, but it can make us look sad or mad. We can help you fix these normal changes at Boston Eyelid.

Can The Sun Make Things Worse?

The bright sun is not a good friend to your soft face skin. Hot sun rays break down the strong walls inside your lower cheeks. This damage is a huge reason why these puffy bags start to grow big. People who spend years in the sun without a hat see more damage. The skin becomes like a loose old sweater that has lost its nice shape. Wearing dark sunglasses and strong sun cream every single day is super important. Good habits can stop the sun from making your cheeks look even puffier.

Do Salty Foods Cause Face Swelling?

What you eat and drink can change how your face looks every day. Eating too much salty food makes your whole body hold onto extra water. This extra water loves to hide in the loose skin of your cheeks.

• Eating salty chips makes cheek swelling look much bigger very fast.
• Drinking lots of pure water helps flush the bad salt away.
• Getting a good night of sleep also helps the water drain away. Changing what you eat can help your puffy cheeks look a tiny bit better.

Can Fancy Creams Fix Eye Bags?

Many people buy very expensive creams to try and fix their tired eyes. Sadly, no magic cream can push the loose fat back behind your eye. Creams can only help make the very top layer of your skin feel soft. They cannot tighten the weak wall that is letting the fat bulge out. If you have real fat bags, you need a doctor to help move the fat. Do not spend all your money on tiny jars that make big promises. Surgery is usually the only real way to fix the bulging fat for good.

Can Fancy Creams Fix Malar Bags?

Creams are also not very good at fixing big cheek swelling. Loose malar bags are caused by broken muscle and trapped water deep inside. Lotion cannot reach deep enough to fix the broken muscle or drain the water. Some cool gels might make the puffiness go down for just a few minutes. But the heavy swelling will always come right back later in the day. You need a deeper treatment to make the loose cheek skin tight again. Your doctor can tell you what treatments will actually work for your cheeks.

What Is The Best Fix For Eye Bags?

The best and longest lasting fix for fat bags is a small surgery. This tiny surgery is called a lower eyelid blepharoplasty. During this quick fix, the doctor hides a tiny cut inside your pink eyelid. Then, they gently remove or move the extra fat that is bulging out. Because the cut is hidden inside, you do not see any scary scars later. This makes the area right under your eyelashes look very smooth and flat again. Most people heal very fast and look wonderfully awake after this gentle fix.

What Is The Best Fix For Cheek Swelling?

Treating cheek swelling takes a completely different plan than treating fat bags. Surgery does not always work well for fluid trapped in the loose cheeks. Sometimes, doctors use strong heat lasers to peel and tighten the cheek skin. Lasers help build brand new, tight skin that holds the fluid back better. Other times, special medicines can be used to help the swollen area shrink down. Every single face is different, so we always make a special plan just for you. We know exactly how to treat these tricky spots with very safe tools.

Why Choose Us For Your Face?

You always want to pick a doctor who knows all about the eyes. I have spent nineteen long years helping people fix their puffy eyes and cheeks. I know exactly how to tell the difference between fat and extra fluid. We treat every single person like they are our own dear family members. Our office provides the best customer service to make you feel very safe. We want you to be totally happy with your fresh new look. You can trust Boston Eyelid to take great care of your beautiful face.

How To Get Ready For Your Visit

Getting ready for your first visit with us is very easy and fun. You should write down any big questions you have on a piece of paper. Bring a list of all the pills or vitamins you take every single day. We will sit down and look very closely at your eyes and your cheeks. We will talk about what bothers you the most when you look in the mirror. Then, we will make a safe plan to help you reach your goals. We always make sure you understand everything before you leave our friendly office.

What To Expect After Your Treatment

Healing after an eye or cheek treatment takes a little bit of time. You will need to rest at home and use cool ice packs on your face.

• Your face might look a little bit black and blue for a few days.
• You might feel a tiny bit sore, but it does not hurt very much.
• We will give you simple rules to follow to help you heal fast.
• Most people can go back to reading and watching TV very quickly. Soon, you will look in the mirror and see a bright, happy face looking back!

Conclusion

Now you know the big difference between puffy eye bags and swollen cheek festoons. Fat bags happen right under the lashes, and fluid bags happen lower on the cheek. They both make you look sleepy, but they need totally different types of fixes. Using the wrong fix will not make your tired face look any better. That is why seeing an eyelid expert is the smartest choice you can make. We would love to help you find the perfect treatment for your unique face. Call us today to start your journey to a brighter, younger looking you!

The post All About Festoons vs Eye Bags: The Key Differences appeared first on Boston Eyelid Surgery.

Understanding Why Eyelids Become Droopy

Droopy eyelids are very common as people age. Skin slowly loses its strength and can stretch over the eyelid. In other cases, the muscle that lifts the eyelid becomes weak. The brow can also drop lower on the forehead, pushing extra weight on the eyelid. Many patients have more than one of these issues at the same time. A detailed exam helps determine which treatment will provide the best result.

Blepharoplasty for Excess Eyelid Skin

Blepharoplasty is a surgical procedure that removes extra skin and sometimes fat from the eyelids. This surgery can help open the eyes and reduce the heavy or tired appearance. It is one of the most common treatments performed at Boston Eyelid. Upper eyelid blepharoplasty focuses on loose skin that hangs over the lashes. Lower eyelid blepharoplasty treats puffiness and bags under the eyes. When performed carefully, the surgery creates a natural and refreshed look.

Some benefits of blepharoplasty may include:

• Reduced hooding over the upper eyelid
• A brighter and more alert appearance
• Improvement in upper side vision for some patients
• Smoother contour around the eyes

Learn more about Blepharoplasty.

Ptosis Repair for Weak Eyelid Muscles

Ptosis is different from extra eyelid skin. In this condition, the eyelid itself sits too low because the lifting muscle does not work properly. Ptosis repair surgery tightens or adjusts the eyelid muscle so the eyelid lifts to a better position. This procedure can improve both appearance and vision. It also helps restore balance between the eyes. A careful exam helps determine the best surgical method for each patient.

Brow Lift for Low Brows

Sometimes droopy eyelids are caused by the eyebrows moving downward. When the brow drops, it pushes extra skin over the eyelids and creates a tired appearance. A brow lift gently raises the brow to a more natural position. This can reduce heaviness above the eyes and improve the overall look of the upper face. Some patients benefit from a brow lift combined with blepharoplasty. Treating both areas can produce a more balanced result.

How Surgeons Decide the Best Treatment

Choosing the right procedure starts with a full eyelid evaluation. The surgeon examines the eyelid skin, muscle strength, and brow position. Each part of the upper face plays a role in how the eyelids look. A personalized treatment plan is created for every patient. In some cases, one surgery is enough. In other cases, combining procedures provides the best outcome.

Important factors considered during evaluation include:

• Amount of excess eyelid skin
• Strength of the eyelid lifting muscle
• Position of the eyebrows
• Vision changes caused by eyelid drooping

What to Expect During Recovery

Recovery after eyelid surgery is usually straightforward. Most procedures are performed as outpatient surgery. Patients return home the same day to rest and heal. Swelling and bruising are normal during the first week. Many people return to normal daily activities within about two weeks. Final results continue to improve as swelling slowly resolves.

Helpful recovery tips include:

• Use cold compresses to reduce swelling
• Sleep with the head elevated
• Follow all post surgery instructions carefully
• Attend scheduled follow up visits

Why Patients Choose Boston Eyelid

Patients trust Boston Eyelid for specialized care focused on eyelid surgery. The practice concentrates on procedures around the eyes, which require precision and experience. A detailed consultation helps patients understand their options. The goal is always to create natural results that fit the patient’s facial features. Careful surgical planning can improve both appearance and comfort.

Conclusion

Droopy eyelids can affect both appearance and vision. Several procedures can correct this issue depending on the cause. Blepharoplasty removes extra skin, ptosis repair lifts a weak eyelid muscle, and a brow lift raises low eyebrows. Many patients benefit from a customized approach that combines treatments. A consultation with Boston Eyelid can determine which solution is best for your needs.

The post Surgery for Droopy Eyelids: Blepharoplasty, Brow Lift, and Ptosis Repair appeared first on Boston Eyelid Surgery.

Scheduling a Consultation

The process starts by calling, texting, or emailing the office to schedule a consultation. Our office staff will help get an appointment scheduled and can help answer any questions about the process. You can call or text the office at 978-393-5437 or send an email to office@bostoneyelids.com.

We have a busy office and usually schedule consultations 2-3 months from your initial call. That being said, we have a very active waiting list and can often get patients in sooner if they are flexible on times. Another trick is to call the office on Monday morning at around 8:00 AM – Monday cancellations are common, and we might be able to fit you in on short notice.

The Initial Office Visit

During this visit to our Wellesley office, you will meet Dr. Kapadia and our office staff.

What to Expect During Your Consultation

• The Initial Consultation: This is where Dr. Kapadia will discuss your aesthetic goals and concerns. We want to understand what bothers you most and what you hope to achieve.
• Discussing Your Goals: Be open and honest about your expectations. We’ll help you set realistic goals and explain what blepharoplasty can and cannot do.
• Medical History Review: We’ll go over your complete medical history, including any eye conditions, allergies, and current medications (prescription, over-the-counter, and herbal supplements).
• Physical Examination: We will assess your specific anatomy to plan the most effective and safest procedure for you.
• Procedure and Anesthesia Recommendations: If you are a candidate for surgery, we will discuss what we hope to accomplish as well as what types of anesthesia options are available.
• Surgical Quote: If you are a candidate for surgery, we will provide you with a written quote which details the costs of surgery as well as any treatments that we recommend before and after surgery.
• What to Expect: We will provide you with detailed information about what to do before surgery, what to expect on your surgery day, and what you need to do after surgery. Knowledge is power. We want you to be as prepared as possible with no surprises.

Eyelid Surgery: The Procedure, Recovery, and Longevity

Our aim is to make your surgical experience as comfortable and efficient as possible.

Fast Facts on the Procedure and Recovery

• Outpatient Procedure: Eyelid surgery is performed on an outpatient basis, allowing you to recover in the comfort of your own home.
• Anesthesia Options: Upper eyelid surgery can be performed awake with local anesthesia (numbing injections) or with intravenous sedation. Lower blepharoplasty is generally performed under general anesthesia.
• Typical Surgery Duration (30-75 mins): The procedure itself usually takes between a half hour and 75 minutes, depending on whether you’re having upper, lower, combination surgery, and/or laser resurfacing.
• Post-Surgery Swelling and Bruising: It’s normal to experience swelling and bruising around your eyes after surgery. This typically lessens significantly within 14 days, though individual healing times vary. The vast majority of patients can return to in-person work in 14 days, though makeup is sometimes needed.
• Working From Home: Most patients can return to working on a computer the day after upper eyelid surgery and within 3-4 days after lower eyelid surgery. You are probably going to need your camera off during video calls for about 2 weeks.
• Post-Op Care: We will provide detailed instructions for post-operative care. This typically includes applying ice packs to your eyes, sleeping with your head elevated to reduce swelling, and using prescribed medication. You’ll need to avoid strenuous activity and rubbing your eyes. Pain is usually minimal – patients are surprised at how little it hurts.

Understanding the Results and Longevity

The results of eyelid surgery can be truly transformative, offering a refreshed, more youthful appearance that can significantly boost self-confidence.

• A More Rested and Youthful Appearance: Many of our patients tell us they feel more self-confident and that friends and family remark on how rested and refreshed they look, often without realizing surgery was involved. This aligns perfectly with our philosophy of natural, subtle improvements.
• Increased Self-Confidence: When your outer appearance reflects how you feel on the inside, it naturally leads to greater self-assurance.
• Results Are Long-Lasting: For most patients, results usually last about 10-15 years. Surgery doesn’t stop the aging process – it just moves it backwards.
• Scars Are Hidden in Natural Creases and Fade Over Months: Our expert eyelid plastic surgeons carefully place incisions in the natural creases of your eyelids, minimizing their visibility. Scars usually fade to a barely visible, faint line over time.
• Protecting Skin From Sun Exposure is Key: After surgery and throughout your life, protecting your delicate eyelid skin from sun exposure with sunglasses and sunscreen is crucial to maintaining your results and preventing further signs of aging.

Navigating the Costs and Potential Risks of Eyelid Surgery

Making an informed decision about eyelid surgery involves understanding both the financial investment and the potential risks involved. We believe in complete transparency to help you feel confident in your choices.

A Breakdown of Eyelid Surgery Costs

The cost of eyelid surgery can vary, and it’s important to understand what contributes to the total fee:

• Factors Influencing Cost (Surgeon’s Fee, Facility Fee, Anesthesia Fee): The total costs for surgery can include the surgeon’s professional fee, the cost for the surgical facility where the procedure is performed, and the anesthesiologist’s fee. In our office, we will give you a total fee which includes all these costs. We believe in full transparency so there are no financial surprises in our office.
• Geographic Location: Costs can vary by region. In metropolitan areas like Boston, fees may be higher due to the cost of living and operating expenses compared to the Midwest.
• Complexity of the Procedure: Revision surgeries are often more complicated than primary surgeries and may have a higher cost.

Is Eyelid Surgery Covered by Medical Insurance?

Cosmetic surgery is never covered by medical insurance in the United States. In some cases, upper eyelid surgery may be covered by insurance if it is severe enough to cause a significant loss of peripheral vision. Lower eyelid surgery is not typically covered by insurance.

Our office, Boston Eyelids, does not accept any medical insurance.

Why don’t we accept medical insurance? Our goal is to provide our patients with the highest level of care and a world-class experience. Medical insurance typically pays less than 20% of the full cost of upper eyelid surgery. We are unable to provide quality of care at that price. You get what you pay for. If your goal is an optimal cosmetic result, you should consider paying out-of-pocket for surgery. If your goal is to improve your peripheral vision with less concern about how it looks, you can consider seeing a doctor that accepts medical insurance.

Scheduling Surgery

After your consultation with Dr. Kapadia, you will meet with our office staff. As mentioned above, we will provide you with a detailed quote for your surgery. We will also ask you to sign a financial agreement at that time. The financial agreement provides a breakdown of cancellation and rescheduling fees and is not an obligation to proceed with surgery.

If you are ready to schedule surgery, we will give you a list of available dates. If you are not ready to schedule, that’s totally fine as well. There is no sales pressure in our office. Feel free to go home and think about it more. You will potentially need to make arrangements with taking time off work and having a family member drive you on surgery day, so it’s important to pick a day that works.

Once you are ready to schedule a date, we will collect a booking fee of $1,000. This confirms your spot in our schedule. Note that there is a rescheduling fee of $500 if you need to change your date after booking. Full payment is due one month prior to surgery, and there are hefty fees to reschedule after that time. We need to pay our staff for a full day of work even if you cancel your surgery, and the fees are designed to cover these costs. If you have an urgent medical issue which requires you to reschedule surgery, we can usually waive some of these fees with a doctor’s note.

Surgery Day and Post-Op Care

Arriving for Surgery

If you are having surgery under local anesthesia only, we will ask you to arrive in our office about 30 minutes before your scheduled surgery time. You will be able to leave right after your procedure (typically around 60 minutes), though you will need a ride home. Because you will be awake and not drowsy, an Uber or taxi is totally fine – you just can’t drive yourself.

If you are having surgery under systemic anesthesia, we will ask you to arrive at least an hour before your surgery. You won’t be able to eat or drink anything after midnight. Our nursing team will help get you changed into a surgical gown and get you prepared for surgery. After surgery, you will need to be in our recovery room until you are awake enough to be discharged. A family member or friend will need to drive you home that day and be with you for several hours until the anesthesia is out of your system and you are fully awake.

Post-Op Appointments

A full list of post-op appointments will be provided to you along with detailed postoperative instructions. Your first post-op visit is typically one week after surgery.

The post The Patient Journey: From Scheduling a Consultation to Final Results appeared first on Boston Eyelid Surgery.

• Extensive, specialized training in eyelid plastic surgery – preferably an ASOPRS-certified oculoplastic surgeon, see discussion below 
• Experience and expertise in cosmetic eyelid surgery – a surgeon who performs hundreds of cosmetic eyelid surgeries annually and has done thousands in their career. Most plastic surgeons focus on reconstructive surgery – its not the same thing. There are only a small subset of surgeons who devote their careers to cosmetic procedures.
• Referrals. If a friend or family member had a good experience with a particular doctor, that’s obviously a great sign. If you don’t know anyone who has had eyelid surgery, your primary care doctor, hairdresser or aesthetician are also great resources for recommendations. 
• Before and after photos of the surgeon’s own patients. You want to make sure your aesthetic goals and what the surgeon can do are aligned. If you don’t like the before and after photos you are probably not a good match with that surgeon’s sense of aesthetics and should keep looking. We have such an extensive collection of photos in our office that most local patients in the Boston area can find someone they know in our photo library!
• Online reviews. While all surgeons have occasional unhappy patients, it’s worth taking the time to look through online reviews to see if there are common themes. What is the ratio of good reviews to bad reviews? Were there a lot of people unhappy with surgery, or were most of the bad reviews from patients the doctor turned away?

After making contact with the surgeon’s office and scheduling a consultation, there are a number of additional factors to consider. 

• • Surgeon personality. Were you and the surgeon on the same page during the consultation? Does the surgeon feel like someone you can trust? Does the surgeon seem as experienced as your online research suggests? Even if a surgeon has a great reputation, they may not be a good fit for you from a personality perspective. This is the start of a relationship that continues after surgery – you need to trust the surgeon and feel comfortable approaching them if you have concerns about the healing process.
  • Office staff. What was your experience like when you called to make an appointment or when you went to the office? Does the office staff know how to answer your basic questions? Are they friendly and patient or in a rush to get to the next person. Remember, the same people will be answering the phones when you have a question or concern after surgery.
• Trust your instincts. If your gut is telling you to run away you probably should. 

Why choose an oculoplastic surgeon to perform your eyelid surgery?

Your eyes are irreplaceable. The skin around them is delicate, and the muscles that control eyelid movement are intricate. One wrong move during surgery can affect your vision, your ability to close your eyes comfortably, or leave you with an unnatural “surprised” look that screams “I had work done.”

This is why choosing the right surgeon isn’t just important, it’s everything.

Oculoplastic surgeons (aka oculofacial plastic surgeons) are fully trained board-certified eye surgeons who have completed 4-5 years of training focusing on surgery of the eyes and eyelids. 

The difference matters. When you’re looking for subtle improvements—a refreshed look that makes you appear more rested, not radically different—you need someone who understands that less is often more. You need a surgeon who won’t remove too much skin and won’t change the shape of your eyes. The goal is to help you look younger and more refreshed without looking overdone.

This guide will help you understand what sets top eyelid specialists apart, what questions to ask during consultations, and how to find a surgeon whose philosophy aligns with your goals for natural, lasting results.

The Oculoplastic Surgeon: An Expert in Eyes and Eyelids

What truly sets a specialized oculoplastic surgeon apart and makes them ideally suited to perform eyelid plastic surgery? It’s their profound, almost obsessive, understanding of eye anatomy and function.

• Specialized training in both eye anatomy and plastic surgery techniques: This dual expertise is critical. Oculoplastic surgeons spend three years learning about the intricate structures of the eye itself before dedicating additional years of training to plastic surgery techniques of the eyelids and face. This means they understand how surgical changes will impact not just aesthetics, but also vision, tear production, and eye health.
• Deep understanding of delicate eye anatomy: The eyelids are incredibly thin and complex, containing numerous muscles, nerves, and glands crucial for eye protection and function. A specialist knows precisely where to make incisions, how much tissue to remove, and how to preserve these vital structures.
• Focus on preserving eye function and health: For an oculoplastic surgeon, aesthetics are never prioritized over the health and function of your eyes. They aim to maximize aesthetic results while ensuring the health and safety of your eyes. This is a crucial distinction.
• Expertise in micro-surgery for natural results: The precision required for eyelid surgery is immense. Oculoplastic surgeons are trained in micro-surgical techniques, allowing them to make minute, precise adjustments that yield natural-looking results without an “operated” look. Their goal is to restore and refresh, allowing you to retain the unique character of your face.

Training and Certification for Oculoplastic Surgeons

In cosmetic surgery, board certification is your gold standard for quality and safety. But know what kind of board certification truly matters, and there are different types of board certifications and training. The training to become an oculoplastic surgeon is quite extensive. The path to become an oculoplastic surgeon is outlined below.

• College and Medical School: Oculoplastic surgeons, like all physicians typically complete four years of college after high school and then go through another four years of medical school.  Medical school involves training in general topics such as anatomy and pharmacology as well as an introduction to different specialties. Medical school culminates with earning an “M.D.” degree.
• Internship. The next step after medical school is to do an internship year in medicine, surgery or a combination of the two. This involves general training on how to be a practicing doctor and allows licensure to most state medical boards.
• Residency. After internship, oculoplastic surgeons complete a three year residency in ophthalmology where they study all aspects of eye health and disease. Surgery on and inside the eye is an important part of this training. Doctors can become board-certified in ophthalmology after completing this training and passing both written and oral exams.
• Fellowship. After training in ophthalmology and eye surgery, oculoplastic surgeons then go through another 1-2 years of subspecialty training in oculoplastic surgery. This involves extensive training in all things around the eyes including eyelid plastic surgery, orbital tumors, fractures and tear duct surgery. This training involves performing hundreds of surgeries under supervision.
• After fellowship. After fellowship training, ASOPRS candidates must pass a rigorous written and oral exam. In addition, a scientific thesis advancing the field must be reviewed and approved by peers before becoming ASOPRS certified. 
• Certifications: Look for board certification by the American Board of Ophthalmology (ABO) followed by fellowship training and certification by the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). 

In the entire United States, only about 30 surgeons complete this type of specialized certification each year! 

Do other types of doctors perform eyelid surgery?

• Many other types of doctors perform eyelid plastic surgery. Not all of them are even surgeons!
• There are three main types of plastic surgeons: general plastic surgeons, facial plastic surgeons and oculoplastic surgeons.
• General plastic surgeons have the most training in body surgery and typically specialize in tummy tucks and breast surgery.
• Facial plastic surgeons are initially trained in Ear, Nose, and Throat surgery. These surgeons usually specialize in rhinoplasty (nose surgery) and facelifts. 
• Oculoplastic surgeons are initially trained as eye surgeons and have the most specialized training in eyelid plastic surgery.
• Remember – Most plastic surgeons perform eyelid surgery but only a small subset have the specialization to be an ASOPRS-certified oculoplastic surgeon.
• “Cosmetic surgeon” is not a specialty recognized by the American Board of Medical Specialties (ABMS). Be wary of this specialty as there is much less quality control and the standards of training can vary considerably.

Remember – many surgeons perform eyelid surgery, but only a small subset are ASOPRS-certified oculoplastic surgeons.

Questions to Ask Your Potential Eyelid Plastic Surgeon

Your initial consultation is your opportunity to interview your potential surgeon and ensure they are the right fit for you. We encourage you to be thorough and ask probing questions.

• What is your specific training in eyelid surgery? Ask about their fellowship training, particularly if they are an oculoplastic surgeon. This demonstrates their specialized focus.
• Are you board-certified in ophthalmology? This confirms their foundational medical training and ensures they can deal with most eye specific issues after surgery.
• How many cosmetic eyelid surgeries do you perform each year? Experience is paramount. A surgeon who performs hundreds of eyelid procedures annually will have a deeper understanding of nuances and potential complications than one who does only a few.
• Can I see before-and-after photos of patients similar to me? This is crucial. Look for natural results, not just dramatic changes. Pay attention to eye shape, symmetry, and scar visibility. There should be patients your age.
• What is your philosophy on achieving a natural look? A top eyelid plastic surgeon should prioritize results that make you look like a refreshed version of yourself, not someone entirely different. Our philosophy at Boston Eyelids, for example, centers on natural results and avoiding “over-doing” surgery.
• Where will the surgery be performed? Ensure the facility is accredited and meets safety standards.
• What type of anesthesia do you typically use for eyelid surgery?  If a surgeon performs all their surgeries with patients awake, this may not be the best option for you.
• What are the common potential risks and complications after surgery, and how do you treat them? The surgeon should have tools such as lasers to treat common post surgery problems such as prolonged redness, thick scars, etc.
• How often do you need to refer patients to another surgeon for issues that arise after eyelid surgery.  A surgeon should be able to handle most issues that can arise after surgery.
• Does the surgeon perform revision eyelid surgery. This shows particular expertise in eyelid surgery. You want to go where other doctors send their complicated patients, even if you are not a complicated case.
• How do I communicate with the office? Is there always a doctor available if there are issues after surgery? How do I get in touch?

Conclusion

Choosing an ASOPRS certified eyelid plastic surgeon is a decision that profoundly impacts both your appearance and your well-being. By prioritizing a board-certified specialist, you are investing in safety, expertise, and the highest likelihood of achieving a beautiful, natural outcome that doesn’t look “overdone.” A surgeon with a philosophy of personalized care will work with you to improve your unique features, leaving you looking like the best version of yourself.

At Boston Eyelids, we are dedicated to our philosophy of natural results and personalized patient care. We believe in enhancing your inherent beauty, ensuring you look like yourself, only more rested and refreshed. We understand the delicate balance between aesthetic improvement and functional preservation, especially in the sensitive eye area.

Ready to explore how we can help you achieve a refreshed, natural look? Schedule your consultation to discuss your goals.

The post Boston’s Best Eyelid Surgeons: Your Guide to Choosing a Doctor for Eyelid Plastic Surgery. appeared first on Boston Eyelid Surgery.

Puffiness under the eyes, also known as eye bags, can give patients a tired look even when they are well rested. Almost all patients with under-eye bags look much better when excess fat is removed under the eyes, but the lower eyelids can sometimes have a hollow appearance after surgery, also known as a tear trough deformity. This problem can be present in some very young patients even without surgery. I hate the term tear trough deformity since there is no real “deformity” and I will just refer to this problem as lower eyelid hollowing in the rest of this article.

This article goes through different methods for optimizing the results of lower blepharoplasty surgery by minimizing lower eyelid hollowing after surgery. Different eyelid surgeons will have different opinions on what they think works best. My goal is not to disparage anyone else’s technique or opinion – I’m just presenting my point of view, which other surgeons I hold in high regard will completely disagree with. There are a lot of surgeons who do things differently and have great results.

The goal of lower blepharoplasty surgery is to improve the appearance of the lower eyelids by treating the skin and underlying fat. The goal is a smoother contour from the eyelid to the cheek creating a younger, less tired appearance.

The Modern Approach to Lower Blepharoplasty

Traditionally, lower eyelid surgery involved the removal of excess fat under the eyes through an incision on the outside of the eyelid, under the eyelash line. A more modern approach to this surgery involves an incision on the inside of the eyelid so there is no visible scar. This can be done in conjunction with CO2 laser resurfacing of the lower eyelid skin to improve skin texture without a visible incision. In my experience, this is the best approach for the vast majority of patients in their 20s-60s. Older patients may sometimes require skin removal and eyelid tightening.

In some patients, removing the excess fat under the eyes can create a hollow appearance. In most cases, this is because the bone under the eyes (inferior orbital rim), which was previously covered with fat, becomes more visible.

A variety of different techniques have been developed to treat this issue. Patients often ask why you can’t just remove less fat, which sounds great in theory but doesn’t work in actual practice. The problem is that any excess fat will sit on top of the bone and still cause an under eye bag. There is too much volume above the bone and not enough volume along and below the bone. Also, if a patient is still a little puffy right after surgery, this problem is likely to get a lot worse over the next few years leading to poor longer term results.

Hollowing after lower blepharoplasty surgery can be prevented or treated using different methods. All of them have advantages and disadvantages and none are perfect. I’ll explain the pluses and minuses of each of these techniques and why I do what I do. Currently, the most technique used by the most eyelid surgery specialists is fat repositioning. While I do think this is a good technique in some patients, my preferred technique is to remove the fat and add postoperative fillers when needed. Let me explain why.

Lower Blepharoplasty with Fat Repositioning

In lower eyelid surgery with fat repositioning, the excess fat in the lower eyelids is moved (repositioned) instead of removed. After the fat pads are exposed, additional dissection is performed across and below the bone and the excess fat from the lower eyelid is pulled down into this cavity.

The Drawbacks of Fat Repositioning

Theoretically, this approach makes the most sense. In my personal experience, it doesn’t work as well in practice. What are the main issues with fat repositioning?

• There is sometimes a limited amount of fat to reposition. If there is not enough fat to efface the contour of the bone completely, then there is still residual hollowing after surgery.
• Fat repositioning works better on the inner 1/3 of the eyelid than the outer 2/3. The lateral fat pad can sometimes be repositioned but is too friable in many patients and falls apart before it can provide enough integrity to efface the bone.
• The fat that’s pulled down over the bone can sometimes pull back and lead to recurrent under eye bags.
• If the fat really survives in its new position, what will this look like 20-30 years from now? I treat a lot of really young patients and worry about this issue a lot. I don’t want to do anything now that will cause a problem later. No surgery lasts forever – when I remove fat and it comes back 10-20 years later I know I can easily go back and remove some more. When it’s in a different spot it’s harder to get to if it looks too puffy.
• There is more dissection and manipulation of the tissue leading to more swelling and a longer recovery time.
• The surgery takes longer so I have to charge considerably more for the extra time.
• I am a perfectionist. Even when I reposition fat there is often some hollowing that I want to treat with fillers and I ask myself why I did all this extra work (with additional cost to the patient) when I still want to add fillers later.

Lower Blepharoplasty with Fat Transfer

In lower blepharoplasty with fat transfer, the excess fat in the lower eyelids is either removed or repositioned and liposuction from the belly or thighs is used to harvest fat that is used as a natural filler to treat hollowing.

I love the idea of this. In theory, it sounds so much better to use a natural substance like your own fat instead of an artificially manufactured filler and I get that point. I try to eat healthy foods and avoid processed products too, but here are the issues with fat transfer.

Challenges and Risks of Fat Transfer

• Survival of Fat Cells: Fat is not an inert substance and needs nutrients from blood to survive. When you inject fat into an area it needs to “take”. This means it needs to develop a blood supply so that the injected cells receive enough nutrition to survive.
• Variable Results: How much of the injected fat will take? There is no way to know for sure before surgery. Most surgeons realize that 40-60% of the injected volume will persist so injecting fat requires a lot of purposeful overcorrection. Most surgeons inject fat assuming 60% will take so most patients will be undercorrected if they reach the average of 50%. That’s not the main issue – what about if 70% takes and your whole face looks really puffy? I don’t like things I can’t control, and I can’t control how much injected fat will take.
• Difficult to Remove: Injected fat is extremely difficult to remove. When too much fat is injected or too much takes, it’s very difficult to remove it. There are tiny globules of fat all over the place which are almost impossible to find if you go in surgically to try to remove them. Large lumps that you can feel can usually be removed with additional surgery but this can leave dents. The tiny globules are almost impossible to remove.
• Weight Sensitivity: The injected fat can be very weight sensitive. If you ever gain or lose weight that fat can grow and shrink a lot more than your normal facial fat, especially eyelid fat. Remember that this fat was taken from your belly or your thighs. This fat is much more weight sensitive than the fat in your face. When I gain five pounds I see it in my belly before anywhere else and notice that my pants and belt are tighter than usual. Body fat tends to be a lot more weight sensitive than face fat. With fat transfer you are taking belly fat and putting it into your face. What will your face look like if you gain 20 pounds later in life? If you have fat transfer it’s really important that you maintain your weight for the rest of your life. Unfortunately, many women find that they gain weight during pregnancies or menopause that’s really hard to lose. When patients gain weight after fat transfer they look really puffy and there is not much that can be done. Their initial surgeon has often retired or moved to another state and I don’t have much to offer them to help besides telling them to lose the weight. It’s not a good situation. As I explained above, it’s really hard to remove injected fat.

Adding Under Eye Fillers

Why would you want to inject an artificially manufactured substance instead of using your own fat? The reason is that in practice (at least in my hands) it works a lot better and more predictably than the other options.

I’m the last person to tell you that my way of doing things is perfect. I am a perfectionist and this technique is not perfect – I definitely wish it was. I’ll tell you about not only the pluses of doing things my way, but the negatives as well. As I already mentioned, it’s not perfect.

The Advantages of Hyaluronic Acid (HA) Fillers

Hylaluronic acid (HA) based fillers have been around in the United States since the early 2000s and were used in Europe for years prior to US approval by the FDA. Hyaluronic acid is a natural substance in your body and skin. The problem is that when you inject straight hyaluronic acid it looks great but gets degraded within a few days. Your body has enzymes which break down hyaluronic acid and build it back up constantly. Hyaluronic acid fillers use a process called cross-linking to make them last longer. Are they completely natural – definitely not. Are they close to what’s naturally in your body? Definitely.

When adding volume using HA fillers you can use as much or little as you want. After the initial swelling subsides, the filler tends to hold 80-90% of its initial volume so the final result looks a lot closer to what it looks like as you put it in compared to injected fat. The final outcome is more predictable.

The single biggest advantage to using HA fillers is that they are reversible. There is an enzyme called hyaluronidase which dissolves HA based fillers. The dissolving can be done at any time, including many years later.

Why Under Eye Fillers Sometimes Get a Bad Reputation

Fillers have gotten a bad reputation because they have been overused and used incorrectly. Injectors have been putting way too much filler in people and using it in the wrong ways. There are very good injectors with lots of experience out there, but they are in the minority. A lot of injectors go to a weekend course and claim they are “certified” to do injections. That just means the injector was certified by the people who run the course. The courses are almost always given on a for profit basis, so basically everyone who takes the course is certified. There is no way to learn how to inject fillers well in a few hours. It takes years of training and experience to be good at injecting fillers and there is always more to learn.

Under eye fillers have specifically gotten a bad rep, but this is mainly because of patient selection. Under eye fillers are a great tool in the right situation, but the vast majority of patients who are seeking this treatment are not a candidate based on their anatomy. You know the saying that “when you have a hammer everything looks like a nail”? For many people who make their living injecting fillers, they push fillers as a solution to every problem on the face, and this is where poor results come from.

The most common scenario I see is that a patient has real under eye bags, which an injector tried to camouflage with fillers. In my experience, this rarely works for the long-term. It may look good for a few weeks or a few months, but the amount of filler needed to camouflage an under eye bag almost never looks natural as it settles out.

What Are Fillers Actually Good For?

Fillers are great at treating hollowing. If patients look a little hollow after lower blepharoplasty surgery, under eye fillers are a great way to treat this problem.

In lower blepharoplasty surgery, excess fat under the eyes is removed, but this sometimes makes the underlying bone more prominent, leading to a slightly hollow appearance. Adding a small amount of filler along the bone helps smooth out the eyelid-cheek junction and optimize surgical results.

Can’t you just remove less fat to reduce hollowing? In practice, this doesn’t really work. The main issue is that the excess fat is above the bone so leaving some excess fat in place just looks like the surgery was done half way and patients still have under eye bags.

Why I Prefer Fillers After Under Eye Surgery

Why do I prefer using fillers in lower eyelid surgery patients instead of fat repositioning or fat transfer?

• Fillers are reversible: There is an enzyme called hyaluronidase which dissolves fillers. If we ever don’t like the way fillers look we can always remove them with a few simple injections in the office.
• Fillers are done after we see the surgical results: During surgery, I remove excess fat and we let it heal. If it looks a little hollow later, we add back filler at the 3-4 month mark once most of the swelling is gone. Even though I have been doing this for 20 years, I can’t always predict who will need fillers after surgery. Some people who I think will need fillers look great with fat removal alone and we don’t need fillers. Other times, I look at a patient and don’t think they will need fillers but 3-4 months after surgery I decide a little filler would help. If I had to make the decision whether or not to inject fat (which is usually done at the same time as surgery) I’m not sure I would always make the right decision.
• Volume predictability: When I am injecting under eye filler, it’s an artistic process and I can visualize how the filler is working while I am injecting. In my experience, the final result is almost always about 90% of the volume I see while injecting. This is a lot more predictable than injecting fat, which can vary from about 40-60% take.
• Shorter surgery time and quicker healing: Fat removal takes less time than fat repositioning or injection. Less time means less anesthesia and usually less cost to the patient. Fat removal also causes a lot less swelling and, in my experience, patients are back to work more quickly.

What Are the Disadvantages to Using Post-Surgery Fillers?

As I’ve mentioned before, there is no perfect solution to volume issues after surgery. Fillers have their downsides as well, but in my experience are still the best option for most patients. I offer post-surgery filler injections to about 25-30% of lower blepharoplasty patients. Many of these patients are so happy with the results they don’t feel the need to have filler placed and we don’t bother.

The main downside to using fillers is chronic swelling. Fillers are made from a material that’s very similar to what’s naturally in your body, but a small subset of patients’ bodies don’t tolerate under eye fillers. When used after lower eyelid surgery, this type of chronic swelling is really uncommon, probably somewhere around 2-3% of patients where I inject fillers after surgery. Since less than 30% of patients even need fillers, this issue only arises in about 1 in 100 patients having lower blepharoplasty surgery. The good thing is that we can always dissolve the filler and the swelling goes away.

What happens if you end up in this 1% of patients? Almost everyone still looks much better than before surgery and doesn’t want to do anything else after we dissolve the filler. Hollowing after surgery is usually mild and still looks a lot better than puffiness for almost everyone. If someone doesn’t tolerate fillers and feels they really want the extra volume, they can always have fat injections but these aren’t perfect either as I’ve explained above.

Summary

Lower eyelid hollowing can sometimes be an issue post lower blepharoplasty surgery. It’s important to discuss lower eyelid hollowing with your surgeon as well as what he/she does to minimize this issue. The main ways to treat lower eyelid hollowing are fat transposition, fat transfer and filler injections. None of these techniques are perfect, but for the reasons outlined above, injecting fillers when needed after surgery is my preferred technique. I have lots of happy patients who have allowed me to show their photos in my photos gallery – feel free to look through these photos as a guide for what types of results can be accomplished with this technique.

The post The Truth About Lower Eyelid Surgery: Fat Transfer, Repositioning, and Fillers Explained appeared first on Boston Eyelid Surgery.

Our office takes care of many patients who choose to travel for surgery from across the US and overseas. I want to start by saying that traveling for surgery is not ideal, as it is hard to pop back into the office if any issues arise. With that being said, many patients are not able to find someone locally who they feel confident with and decide to travel. I always recommend patients obtain at least one consultation locally before deciding to travel for treatment. Feel free to email us to see if we know anyone local to you or at least within driving distance. If you end up really liking that person and feel comfortable with them, you should go for it. If you decide you still want to travel, keep reading.

The process starts when Dr. Kapadia examines photos that are sent by email to mitesh@bostoneyelids.com. Please also send a description of what bothers you and where you are located. If the photos aren’t adequate, he will ask you to send additional photos. It’s much better to ask someone else to take photos instead of taking selfies, which often have weird angles. For evaluating the upper eyelids, the lighting is less crucial, but it’s important to be looking straight ahead and not up or down to determine how much hooding is present. To evaluate the lower eyelids, it’s important to take photos without a camera flash using overhead lighting. Photos should be taken looking straight ahead as well as looking upward with your head straight. If Dr. Kapadia thinks you are a candidate for surgery, he will ask you to schedule a video consult so I can discuss your specific case with you and answer questions. The cost for a video consultation is $500 and is applied to the cost of any treatments performed within one year of the consultation. If additional questions come up, we can always communicate by email or with a second call.

If you decide to schedule surgery, a non-refundable deposit is required to hold your spot. We have never had this happen thus far but there is always a chance that something is found during you in person examination which would require cancelling your surgery. If this happens, your deposit will be refunded, but we are not responsible for any of your travel expenses.

Surgery is not guaranteed until you are examined in person. We usually set up an in-person consultation the day prior to surgery so Dr. Kapadia can examine you. If we are scheduling upper eyelid surgery only, the surgery can usually be performed as an office procedure under local anesthesia (if you want to be fully awake for the surgery) or with intravenous sedation. Lower eyelid surgery is usually performed under general anesthesia, but this can be discussed at the time of your video consultation.

The Wellesley office is about 15 miles (a $40-$50 Uber ride) from Boston each way. Please check with us on times available for consultations, surgery, and post-op appointments prior to booking your flights.

There are several hotels within driving distance of the Wellesley office. We recommend the Westin hotel in Waltham or the Mariott Courtyard in Natick. You will really need a car if you are staying in the suburbs. There are lots of hotels in Boston where you can uber back and forth when needed if you want to avoid renting a car.

If you are having surgery with intravenous sedation or with general anesthesia, someone will need to take you to your hotel after surgery and stay with you for 6-8 hours to recover from anesthesia. There are several visiting nurse services in the area which can help with this requirement if you are travelling alone. If you are having upper eyelid surgery only under local anesthesia (without sedation), you can take an Uber or taxi back to your hotel and do not need anyone with you.

Patients having upper eyelid surgery only can fly home 8 days after surgery. The advantages and disadvantages of each can be discussed at the time of your consultation. Patients having lower eyelid surgery can fly home 10 days after surgery.

For upper eyelid surgery, the remaining post-op checks can usually be done by email or video call and it’s not always necessary to return to Boston. Filler injections are sometimes needed to optimize the results of lower eyelid surgery. If needed, we would discuss an optimal time to return to Boston by email, but this would be at least 3 months after surgery. One vial of under eye filler is included in the cost of lower eyelid surgery if needed.

Of course, if there are any surgery related issues, additional trips to Boston may be required. This is not usually the case, but it’s important to keep this in mind before traveling for surgery. Sometimes there are things can be done to optimize surgical results, such as 5-FU injections for hypertrophic scarring or tightness or lasers to treat redness or thickened scars that need to be done in person. These are not always practical if you need to take a flight to get to the office.

Surgery takes time to heal. Here are my general guidelines – everyone heals at their own pace and one side often heals faster than the other. I recommend at least two full weeks off work due to bruising and swelling if you need to go into an office or meet with other people. If you can work from home, you should be fine to work within a few days after surgery. Most patients look acceptable to go to work two weeks after surgery or earlier. Makeup may be needed to cover residual bruising. It takes 6 months to see the full results of surgery and about 24 months to mature the scar at any incision.

Patients having upper eyelid surgery will usually have an incision across the entire eyelid crease. The crease is hidden when your eyes are open but will look bumpy when your eyes are closed. By 24 months, the incision fades to a faint line in most patients. Most patients having lower eyelid surgery will only have an incision on the back of their eyelid, so there is no visible scar to heal. If skin removal is required, an incision under the eyelash line may also be required, which will also take time to heal.

If you are having surgery prior to a big event such as a wedding, I recommend having surgery at least three months prior, but the longer the better to give your eyes time to heal.

There is always a chance a revision (usually minor) will be needed to optimize the results. If needed, revisions are usually performed at no cost to you but may require additional trips to Boston.

Eyelid surgery is usually easy to cover with large sunglasses. Patients often feel comfortable seeing sights around Boston and going to restaurants with sunglasses on within a few days after surgery. Boston is a beautiful city, and you should explore New England while you are in town. Feel free to contact us with any questions.

The post Traveling For Eyelid Surgery appeared first on Boston Eyelid Surgery.

Upper blepharoplasty surgery can sometimes be covered by medical insurance. This article will discuss the similarities and differences between medical upper eyelid surgery and cosmetic upper eyelid surgery.

Medical upper blepharoplasty and cosmetic upper blepharoplasty are similar but not identical procedures, and there are important differences prospective patients should know about. The main goal of medical upper eyelid surgery is to remove excess skin so the eyelids open better to improve vision. The main goal of cosmetic upper blepharoplasty surgery is to make patients look younger and less tired by maximizing aesthetic improvement. Medical upper blepharoplasty patients often, but not always, look better than they did before surgery, but the overall cosmetic improvement isn’t necessarily optimized.

When is Upper Blepharoplasty Surgery Covered by Insurance?

Upper eyelid surgery is covered by some, but not all, medical insurance plans if a number of specific criteria are met. Each insurance company has different specific criteria, but these are the general guidelines:

1. A patient has significant difficulty with daily activities such as reading, driving, or working on a computer due to the eyelids drooping.
2. The upper eyelids do not open to a normal position – the distance between the middle of the pupil and the upper eyelid has to be 2.5mm or less. Your doctor can measure this during a consultation.
3. A field of vision test has to demonstrate that at least 20-30% of the upper field of vision is obstructed by your eyelids. Again, this is a test that can be done during a consultation.

If all (not some) of these criteria are met, upper eyelid surgery may be covered by your medical insurance. Note the word “may”. Your insurance can still deny coverage even if you meet all these requirements.

No medical insurance plan in the United States covers cosmetic surgery. If your doctor says you are having cosmetic surgery, and it will be covered by insurance, that is insurance fraud.

Keep reading if you want to know why you may want to pay for surgery as an out-of-pocket expense even if your surgery is “approved” by insurance.

Surgical Goals

The main goal of medical upper eyelid surgery is to remove enough skin so the eyes open fully and there is no visual obstruction. The goal of cosmetic eyelid surgery is to optimize a patient’s appearance. These are different goals and can result in different outcomes. It’s important to discuss your expectations with your surgeon prior to surgery. Patients who have medical upper eyelid surgery may look better after surgery than before, but the improvement isn’t always optimized.

Differences Between Medical & Cosmetic Upper Eyelid Surgery

When upper eyelid surgery is covered by medical insurance, it only pays the surgeon a fraction of the fees for a cosmetic procedure, typically 20% or less. In most cases, you get what you pay for. Most doctors who accept medical insurance will not take the same amount of time, effort, planning, and post-operative care for a cosmetic procedure when they are doing the surgery at an 80% discount.

Meticulous pre-surgical planning is required to optimize the outcome of upper blepharoplasty surgery. Considerations include:

• What shape to make the skin incision
• How much skin to remove in different parts of the eyelid 
• Height and shape of the eyelid crease
• Whether or not ptosis is present and whether or not it needs to be corrected
• How facial bony asymmetry affects the eyelids
• Depth of the superior sulcus and how the skin will fold afterward
• Texture of the upper eyelid skin and how it will affect the results
• Lower eyelid height and how this will affect the overall shape of the eye
• Position of the lacrimal gland and whether or not lacrimal gland prolapse needs to be repaired

Care After Surgery

The care of patients after surgery is often different between medical and cosmetic procedures.

Revision surgery

After surgery has fully healed, a subset of patients may need a “tweak”, a minor secondary procedure to optimize the results. The two sides can sometimes heal unevenly and require additional skin and/or fat removal from one or both sides. In my office, minor revisions are performed at no cost to the patient. Revision procedures are not usually covered by medical insurance if there is no residual visual obstruction.

Surgical scars

Most upper eyelid scars heal very well and fade to a faint line, which is barely visible with time. Maturing the scar is a two-year process. That being said, there can be occasional issues with scars that require additional treatment. Very thick scars in the early postop period can benefit from scar modulators such as 5-FU. If scars stay thick or thicken later, CO2 lasers can help. If a scar is still red 3-6 months after surgery, pulsed dye laser treatments can help reduce redness. Bumps along scar lines may require injections, cautery, or a wound revision. None of these types of procedures are covered by medical insurance, but are performed at no additional cost to patients in my office when needed.

Summary

Medical upper blepharoplasty and cosmetic upper blepharoplasty surgery are similar but not identical procedures and often have different goals and outcomes. My advice to potential patients is to choose an eyelid surgeon who is aligned with your goals and expectations and can provide top-notch care after your procedure. This often means paying out-of-pocket for a procedure, even if another surgeon says it may be covered by medical insurance.

The post What Are The Differences Between Medical & Cosmetic Upper Blepharoplasty Surgery? appeared first on Boston Eyelid Surgery.