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Eyelid Surgery (Blepharoplasty)

In their late 30s and into the 40s, many individuals begin to notice excess, crepey skin as well as “bags” or extra fat deposits in and/or around the eyelids. This can create a more tired or exhausted appearance in the focal point of the face. Fortunately, these aesthetic concerns can often be resolved via a common cosmetic treatment called eyelid surgery.

I recently had upper eyelids done under the artistic, surgical hands of Dr. James Boynton. My consultation was informative & all of my questions were answered prior to surgery. His office staff was amazing! I had a great experience with a quick recovery. I would highly recommend Dr. Boynton’s services to anyone looking for a great plastic surgeon

Stanisse Blackburn

January 17, 2018


Also known as blepharoplasty or eyelid lift, eyelid surgery is a popular procedure performed by our board-certified plastic surgeon, Dr. James F. Boynton. Many times, this can be the first surgical treatment a patient decides on for their face due to the dramatic effect the eyes can have on one’s entire facial aesthetic. By customizing blepharoplasty to meet the specific needs and goals of each individual, Dr. Boynton is able to help patients achieve a refreshed, more youthful appearance with exceptionally natural-looking results.

Eyelid Surgery

Upper and Lower Blephroplasty

Dr. Boynton’s Modern Approach to Blepharoplasty

Eyelid surgery has been around since the 1960s. The procedure has traditionally involved removing excess skin (crepey skin), muscle, and fat deposits from around the upper and lower eyelids. However, the traditions and techniques have changed over the years as our understanding of facial aging in general has vastly advanced. Most plastic surgeons who performed eyelid surgery in the 70s, 80s, and 90s often took out too much fat—especially in the upper lids. This can lead to a “hollowing out” (and even skeletal appearance) around the upper lids, where too much upper lid skin can be seen (sometimes called “bedroom eyes”).

As knowledge of aging in the face has advanced in the last 10–15 years, we now know that “fat is our friend.” Using careful analysis, as well as going back and looking at photographs of patients at an earlier time point, one can see how a “full” upper lid is considered “attractive” and “youthful.” Dr. Boynton is careful to remove as little fat as possible during eyelid surgery, and he even incorporates nano and micro fat transfer into the procedure when needed to achieve improved results. These advanced techniques often enable both upper and lower blepharoplasty treatments to be performed in the comfort of the office without the need for general anesthesia.

How Is the Eyelid Surgery Procedure Performed?

Dr. Boynton’s approach to eyelid surgery accounts for anatomical gender and demographic differences to achieve natural-looking results. In general, incisions are typically made in the crease of the upper eyelid and just below the lashes of the lower eyelids, leaving scars that are virtually undetectable. Sometimes the lower eyelid can be approached through the inside of the lower lid if bulging fat is to be removed. This is referred to as transconjunctival lower lid blepharoplasty. Additionally, some patients have “looseness” to the lower eyelid skin that requires tightening as well. Finally, the upper eyelid can also become ptotic or “droopy,” requiring correction. Each of Dr. Boynton’s blepharoplasty techniques is highlighted below.

Upper Eyelid Surgery

For at least the last seven to eight years, Dr. Boynton has changed the way he approaches upper lid blepharoplasty. He typically does not remove muscle unless it is still necessary in some cases, nor does he remove much, if any, fat—sometimes just a small amount will be extracted from the medial compartment (subtle bulge closest to the nose). Dr. Boynton believes this approach has really improved eyelid aesthetics, and as an added benefit, it often makes the procedure very easy and manageable to perform using just local anesthesia in the office.

Dr. Boynton also performs nano and micro fat transfer to the upper lid and supraorbital rim (bone above the eyelid) to correct the “excess upper eyelid show.” Along with enhancing the upper lids, this concept can markedly improve aesthetics in the lower lids and infraorbital region below the eyelids. This small-particle fat transfer can be done in-office and can create significant improvements and rejuvenation about the entire eye.

Lower Eyelid Surgery

Depending on the patient’s needs, there are many ways to perform lower lid surgery, which is largely considered one of the most challenging areas in plastic surgery. Some plastic surgeons approach the lower lid “from the front” and remove skin, muscle, and fat, as well as use a supporting stitch called a “canthopexy” to hold up the lower eyelid. This is necessary in certain instances, but in Dr. Boynton’s experience, this approach sometimes causes more issues and a longer recovery process. In many cases, he prefers to approach the lower lid from the inside.

When a patient has “bags” and excess eyelid fat—which is much more of an issue in the lower lids rather than the upper lids—Dr. Boynton prefers to perform lower eyelid surgery from inside the lid using a “transconjunctival” approach. He feels this is a great way to remove the extra fat without any outside incision, and he has found the healing to often be faster. In rare cases, a canthopexy suture may be needed, which can easily be done in the office under just local anesthesia.

Sometimes a small bit of skin still needs to be removed from the lower lids, which can be performed with a “pinch blepharoplasty” technique using a well concealed incision just below the lash line. Nano and micro fat transfer techniques have also markedly improved lower eyelid rejuvenation. If patients have hollow creases—called “tear troughs”—rather than “bags” under the eyes, Dr. Boynton typically starts with fillers like Restylane®, as the dark (sometimes even purple) discoloration in this area cannot usually be resolved with creams and skin care. Nano and micro fat transfer to this area are also very beneficial—the particles of fat can help “rejuvenate” the region by restoring volume without creating a “lumpy” appearance, as well as impart improvements to the skin and discoloration with a stem cell effect. Fat transfer to the lower eyelids can either be done in combination with the rest of the lower eyelid enhancements or separately in a staged fashion.

What Is Eyelid Surgery Recovery Like?

Performed as an outpatient procedure, recovery from eyelid surgery is generally quick with little pain. Patients often use drops for the first week and may experience some bruising that resolves mostly within a week or so. Stitches are removed after four days, and patients can usually return to work and other non-strenuous activities after five to seven days. Exercise should be avoided for at least two weeks to allow ample time for healing.

Schedule an Eyelid Surgery Consultation

If you would like to meet with our plastic surgeon to discuss all aspects of eyelid surgery and how this procedure may benefit you, please contact Dr. Boynton. He will be happy to answer your questions, discuss your goals, and develop a personalized treatment plan to meet your needs.