Blepharoplasty
Cosmetic Eyelid Surgery | Eyelid Lift | Eye Bag Removal Surgery | Eye Bag Reduction Surgery
Before and After Upper and Lower Lid Blepharoplasty
- Blepharoplasty (pronounced BLE- FA- RO- PLA- STEE ) surgery, commonly known by various synonyms such as eyelid lift surgery, eye plastic surgery, cosmetic eye surgery literally means ‘refashioning of the eyelid’ and is an operation commonly performed to improve the appearance of the skin around the eye.
- Although a small proportion of patients under go blepharoplasty surgery for functional improvement or rehabilitative purposes, the majority of patients have this surgery to improve their appearance.
- Most patients have cosmetic eyelid surgery to reverse the signs of ageing i.e. to help them look fresher and less tired. However many young patients have cosmetic eyelid surgery too.
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Young patients are increasingly seeking cosmetic surgery nowadays. This lady in her 20s complained that she her lower lid bags made her look tired.
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Transconjunctival lower lid blepharoplasty allows reduction of the bulging fat pockets through a small incision in the back of the eyelid - hence this is sometimes called scarless blepharoplasty surgery. This photo taken only 1 week following surgery shows how minimal the bruising can be.
How Eyelids Age: Baggy Eyelids | Drooping Eyelids | Eyelid Bags | Heavy Eyelids | Eyelid Hooding
As we all get older, changes in the structural of the tissues of the face begin to occur.
Normal age related changes with the eyelids. Notice the bulging fat pads. These are commonly referred to as eyelid bags and patients commonly complain of baggy eyelids or heavy eyelids
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- The skin starts to lose its elasticity and the upper lid skin can become excessive leading to redundant droopy skin. . Patients remark that people comment on them looking angry, tired or frowning. Women often complain that they no longer have an eyelid on to which they can apply eye makeup
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- Weakening of one of the middle layers of the eyelid allows for outward bulging of the fat of the eye socket leading to eyelid ‘bags’ known as steatoblepharon.
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- Age related stretching of the main tendon responsible for lifting the upper eyelid occurs which can lead to a drooping upper eyelid itself (ptosis) or further descent of the skin.
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- The tendons which normally keep the eyebrow elevated may weaken leading to descent of the eyebrow itself, usually starting with the tail of the eyebrow (outer end).
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In the lower eyelid:
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- The tendons, which in youth keep the eyelid tight against the globe, may start to slacken leading to the eyelid contour becoming more concave and round.
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- Weakening of the middle layer of the eyelid (orbital septum) results outward bulging of orbital fat (herniation) and the appearance of eyelid bags
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- The skin loses its elasticity and the muscles weaken leading to excess skin and wrinkles.
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- Loss of fat around the the orbitomalar ligament leads to hollowing of the area leading to the so called tear trough deformity.
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Why Have Blepharoplasty Surgery?
- In some patients the hooding of their eyelids is so severe that it compromises their superior field of vision.
- Similarly patients sometimes undergo lower eyelid blepharoplasty surgery to try to reverse the changes caused by a disease process e.g. thyroid eye disease i.e. for rehabilitative purposes.
- In such functional/ rehabilitative cases, blepharoplasty surgery may be funded by the NHS or patient's private medical insurance.
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This patient complained of difficulty seeing due to his hooded and droopy eyelids.
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Notice the low eyelid position (eyelid ptosis) even after the excess hooded skin (dermatochalasis) has been lifted out of the way. This patient needs both excess skin removal (blepharoplasty/ eyelid lift) and strengthening of the main tendon involved in lifting the eyelid itself (levator aponeurosis advancement)
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3 weeks following combined blepharoplasty surgery (excess skin excision) and ptosis correction (strengthening the eyelid tendon). This patient had both procedures performed on the NHS.
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This lady developed marked bilateral lower lid bulging brought on by thyroid eye disease. The NHS are happy to fund this cosmetic surgery for rehabilitative purposes.
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1 week following lower lid blepharoplasty surgery. Surgical steps included skin incision just under the eyelashes, reducing and repositioning the fatty bulges, lower lid tightening (lateral canthal tendon tigntening), muscle tightening and skin tightening to correct al the multiple issues.
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2 months following surgery: the patient was very very happy.
- The appearance of one's eyes are central to facial expression. How one's eyes look therefore are important in how that person is perceived which then is reflected in their own self confidence.
- Cosmetic eyelid surgery to improve one's appearance is one of the oldest and most common operations performed worldwide. As with a good cosmetic surgery, cosmetic blepharoplasty can lead to improvements not only in a patient's appearance but also their own self confidence.
- Although for most patients this will be to reverse the signs of ageing but for many it may be to alter the appearance of one's eyelids for some sort of characteristic that runs in the family.
- The proportion of men undergoing blepharoplasty surgery is increasing year on year.
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Prior to upper eyelid blepharoplasty (eyelid lift surgery). This lady complained of problems with eyelid make up. She was also fed up of being told she looked stern.
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2 months following upper eyelid blepharoplasty One can see why blepharoplasty surgery is sometimes referred to as eyelid reduction surgery.
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Before Surgery: This lady complained of both overhanging upper eyelid skin (i.e. very heavy eyelids), lower eyelid bags (baggy eyelids) with wrinkling of her eyelids
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6 weeks following cosmetic eyelid surgery to all 4 eyelids: This lady was delighted with the improvement.
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This lady complained of lower eyelid bags. These were due to age related weakening of the middle layer of the eyelid (orbital septum) allowing the orbital fat behind it to bulge forwards. Her quality and muscle quality were good meaning that the if we could shrink the fat bulging and strengthen the orbital septum, she would likely be happy with the cosmetic result.
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Four weeks following lower eyelid transconjunctival blepharoplasty. A small amount of fat was removed from both lower lids through an incision in the back of the eyelid. This delicate minimally invasive surgical approach means that the recovery is usually very quick avoiding the need for an incision and potential scar of the skin. Notice the eye bags have now disappeared.
How is blepharoplasty/ cosmetic eyelid surgery performed?
- default_titlePrior to any surgery, the surgeon should discuss with you what you wish to achieve, what is safely achievable and the risks and benefits of surgery. At the end of the consultation, the surgeon should be able to develop a surgical plan for that particular patient. Each patient is an individual, and the surgical plan reflects this.
- default_titlePrior to any eyelid operation, it is highly recommended that every patient should ideally undergo a formal eye examination either by the surgeon who is going to be performing the procedure or an impartial ophthalmologist.
- default_titleBlepharoplasty/ eyelid cosmetic surgery is performed commonly as a day case procedure.
- default_titleMuch like the word ‘haircut’, the term blepharoplasty describes refashioning of the eyelid in general. The procedure itself will have slight variations depending on the patient. Because oculoplastic surgeons perform more eyelid operations than any other type of surgeon, they are more equipped to offer the full repertoire of techniques to address different variations in patient anatomy.
- default_titleLike all types of eyelid surgery, blepharoplasty surgery, either for cosmetic or functional reasons, can be performed under local anaesthesia, local anaesthesia with mild sedation, or general anaesthesia.
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Upper Eyelids
- default_titleFor upper eyelid blepharoplasty, the surgeons will draw some lines on the upper eyelid.
- default_title Surgery can be performed using either general anaesthetic or local anaesthetic. The vast majority of patients opt for local anaesthesia since its is quicker and very acceptable. Sometimes the anaesthetist may administer some sedation through a vein in the back of the hand to make the patient relax further.
- default_title Removal of the excess skin is then performed using either a scalpel, carbon dioxide laser, or radiofrequency cutting device. The incisions are situated within the normal skin crease of the eyelid so that afterwards, the incision scar is hidden and becomes invisible.
- default_titleFor those patients with bulging fat in the upper eyelid, the fat is then either sculpted away or repositioned.
- default_titleAn oculoplastic surgeon can then perform any additional procedures as necessary , for example, correcting a droopy eyelid with eyelid ptosis surgery, repositioning a prolapsed tear gland, debulking of any prolapsing orbital fat or lifting/ stabilising the eyebrow position.
- default_titleThe wound is then closed with sutures. Although their removal is required, non-dissolvable sutures are sometimes used, because of their more predictable cosmetic result.
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Before Surgery: This lady complained of upper eyelid hooding, lower lid lid wrinkiing and smudgy eye make up.
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After Upper and Lower Blepharoplasty: The patient remarked how her friends were amazed with the subtle natural improvement
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Before Surgery: This 55 year old man was fed up of looking older than he felt. He complained that his eyelids looked hooded and heavy.
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1 week following upper lid blepharoplasty surgery. Patients often are surprised that their swelling can so mild.
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After Upper Lid Blepharoplasty: His scars have gently faded away
Lower Eyelids
- default_titleFor patients with excess skin causing wrinkles, a skin incision can be made just below the eyelash line allowing removal of the excess skin. The incision is so close to the eyelash line that it becomes invisible within a few weeks of surgery. If there are eye bags ( which is usually caused by the normal orbital fat prolapsing forwards) this can be addressed at the same time through the same incision.
- default_titleIn those patients where skin redundancy is not an issue and the only problem is eyelid bags due to bulging orbital fat, the incision can be made along the inside of the lower eyelid (transconjunctival approach) and the fat prolapse can be addressed resulting in sutureless scarless surgery. This results in a much quicker recovery time following surgery.
- default_titleThere are various ways of addressing prolapsing fat in the lower eyelid and a good cosmetic surgeon should be able to discuss with you the most appropriate options. These include simple fat removal (debulking) to repositioning. In patients with a tear trough deformity, a popular technique which has gained popularity recently is to drape this fat over the edge of the socket and use it to replace the fat which has started to disappear on the rim of the orbit itself. Therefore, instead of simply disposing of the orbital fat, the surgeon is utilising it as a filler.
- default_titleLower eyelid blepharoplasty is technically more challenging than upper eyelid blepharoplasty due to its slimmer margin for error and riskier potential complications. For this reason, many surgeons choose only concentrate on upper eyelid blepharoplasty.
- default_titleThe surgery performed will be individual to that patient. For example, eyelid tendons may need to be tightened, the bulging fat may be excised or redistributed, the midface/cheek may be lifted, some of the wrinkles may be removed, the hollows underneath the eyelids may be softened and filled. A good cosmetic surgeon should be able to discuss with the patient a personalised surgical plan: customised to the patient's anatomy, the patient's wishes and expectations.
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This 33 year old lady complained of lower lid bags which had started to develop in her 20s. Her skin and muscle quality are good.
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1 week following lower lid transconjunctival blepharoplasty: The fatty bulges have been reduced by removing and repositioning them through a tiny incision on the back of eyelid. Thus there are no skin incisions. This sort of surgery is sometimes termed 'scarless blepharoplasty'.
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Lower lid blepharoplasty. This 34 year lady complained of lower eyelid bags. Note the extremely thin skin leading to fine skin wrinkling, weakness of the middle layers of the eyelid leading to bulging of the orbital fat pad pockets.
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1 week following lower lid blepharoplasty. The incision is hidden under the eyelashes. Surgery steps included draping of the fat pad to fill up the tear trough deformity, tightening up of the middle muscle layers, tightening of the outer ligaments of the lower eyelids and removing a small strip of skin to tighten up the skin.
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2 months following surgery: The incision has become invisible, the skin is smoother, the fat bags have disappeared. The patient was very happy.
Frequently Asked Questions
It is often advisable to have someone accompany you on the day of surgery, particularly if the surgery is performed as a day case procedure. Rarely, the eyes may be covered with pressure dressings for an hour, to help reduce the build up of any postoperative swelling. As the anaesthetic wears off, your eyelids may feel tight and sore, but this wears off quickly and is usually easily treated with simple painkillers. If the postoperative pain is severe, this may indicate a serious problem and patients should get in touch with their surgeon immediately.
You will advised to sleep upright and apply regular cold compresses to the eyelids to reduce the postoperative swelling. It is especially important to keep your wounds clean and dry. Eye drops are commonly provided to help soothe the eyes which can feel slightly dry due to temporary impairment of the normal blink reflex following surgery.
-Swelling and minor bruising is normal and peaks about 24-48 hours after the procedure.
-However 90% of the swelling usually disappears by 10 days but minor swelling may still persist for 10-12 weeks depending on the complexity of the procedure. For example, most of Mr Cheung's patients who return to work after 10-14 days often comment that their work colleagues remark that they look fresher but often do not realise that any surgery has been performed.
-Most patients return back to work about 10-14 days after blepharoplasty surgery.
- The first clinic visit following surgery is usually scheduled for 1 - 2 weeks following surgery. Mr Cheung often personally removes any skin sutures with the aid of an examination microscope to ensure there is no retention of the fine skin stitches.
-Make up can be safely used usually from the 10th postoperative day.
- Most patients are usually discharged at 3-6 months following surgery.
As with any cosmetic procedure, the patient's part in expecting a realistic outcome and understanding the potential complications is probably more important than the skill of the surgeon. Any good surgeon will take the time to chat with the patient so that they have a good understanding of what to expect and what is realistically achievable. Patients with unrealistic expectations are likely to be disappointed no matter how skilled the surgeon or good the postoperative result.
Complications are extremely rare and the vast majority of patients are extremely satisfied following surgery. The complications of blepharoplasty surgery include:
- default_titleEyelid Asymmetry: where one side does not match the other
- default_titleUndercorrection where insufficient skin/ orbital fat has been removed. It is important to be realistic about how much skin can safely be removed.
- default_titleOvercorrection-If too much skin is removed during upper eyelid blepharoplasty, the eyelid may not be able to close properly (termed lagophthalmos), which can be sight threatening. Lagophthalmos can be temporary from eyelid swelling, or permanent if too much skin from the upper eyelid was removed. The cornea (clear window on the front of the eye) may start to dry out due to the incomplete closure of the eyelid. This may be sight threatening since the cornea may ulcerate as a result. For severe cases of lagophthalmos, a skin graft or flap to replace the upper eyelid skin shortage may be necessary to allow the eyelid to function normally again.
- default_titleTemporary dry eye commonly occurs following upper eyelid blepharoplasty surgery and is commonly due to temporary impairment of the muscles involved in eyelid closure. Ocular lubricant drops are commonly prescribed for a few weeks following surgery for symptomatic relief. Less commonly though, permanent dry eye may result particularly particularly following excessive skin removal (both in upper and lower eyelid blepharoplasty) and in patients who have pre-existing problems with dry eye, tear film problems, previous refractive surgery and ocular surface problems. It is for this reason that the Dept of Health recommends that all patients undergoing any type of blepharoplasty surgery undergo a formal assessment by an ophthalmologist including testing ocular motility, tear film production and quality assessment.
- default_titleIf too much lower eyelid skin is removed, the eyelid may look hollowed out, too concave or may cause the eyelid to turn outwards leading to ectropion formation. All oculoplastic surgeons are trained to avoid this by performing additional procedures if necessary e.g. eyelid tendon tightening such as lateral canthopexy.
- default_titleScarring can also occur post-operatively, leading to a poor cosmetic outcome. Scarring following lower eyelid blepharoplasty can result in the lower eyelid being pulled out and downwards, leading to an unnatural appearance and ectropion. Corrective surgery may be necessary to address this. It can usually be avoided by meticulous dissection in the correct surgical planes and is rare in the hands of oculoplastic surgeons.
- default_titleAcute glaucoma is an rare but potentially blinding complication that can occur with any type of eyelid surgery and occurs when the internal pressure of the eye starts to rise as a result of some of the side effects of some of the drugs and injections utilised during eyelid surgery. Oculoplastic surgeons are trained to recognise and manage this complication through their general ophthalmology training. It is recommended in the US, that a formal ophthalmological assessment be performed prior to eyelid surgery to look for the potential risk factors for this complication.
- default_titleBleeding into the skin, known as a skin haematoma, after the procedure is an uncommon complication and excessive bruising leading to a collection of blood within the tissue. It is critical to stop all tablets which may increase the risk of bleeding and your surgeon should advise you about this prior to surgery. In the first few days following surgery, you should avoid any vigourous activity such as lifting, bending, since this can worsen any bruising or swelling of the eyelids.
- default_titleCorneal abrasion is when the corneal surface is damaged either due to the inadvertent trauma. This complication is extremely rare in the hands of oculoplastic surgeons.
- default_titleEyelid ptosis- Uncommonly the main tendon (levator aponeurosis) within the eyelid may be damaged during cosmetic eyelid surgery causing the actual eyelid itself to descend and stay permanently low. This complication is extremely rare for oculoplastic surgeons since they routinely operate on this structure anyway and the most experienced in recognising the complex anatomy. Indeed, oculoplastic surgeons routinely perform ptosis surgery anyway and may recommend simultaneous ptosis correction/ repair in patients who already have a compromised eyelid tendon.
- default_titleSunken eye (enophthalmos) and hollow eyelids- The fat within the socket (orbital fat) normally starts to shrink with age leading the the eyeball looking sunken over time. However, an artificially sunken eye can occur following excessive orbital fat removal. Similarly if excessive fat is removed the eyelids can look artificially hollow (sometimes known as skeletonisation). This complication occurs less commonly now surgeons have learnt to avoid it by being very conservative with orbital fat removal and performing safer techniques e.g. orbital fat repositioning.
- default_titleThe most serious, though thankfully rare, complication of blepharoplasty is an orbital haematoma. This occurs when there’s uncontrolled bleeding, usually from a blood vessel in the fat pockets around the eye, which puts pressure on the optic nerve and its blood supply. If left untreated, this can lead to permanent blindness. That’s why it’s crucial to catch it early, especially if you experience severe eye pain or changes in your vision. In such cases, urgent reoperation may be needed to stop the bleeding and relieve pressure on the optic nerve.
To minimise the risk of this happening, it’s important that eyelid surgery is performed by a skilled surgeon with experience in working with the delicate tissues around the eye. Oculoplastic surgeons, who specialise in surgeries involving the eyes and eyelids, perform more of these procedures than any other type of surgeon and are best trained to both avoid and manage this rare but serious complication. - Show More
It is for all these reasons that Mr Cheung tends to err on the side of caution i.e. towards conservative blepharoplasty surgery to reduce the risk of complications and also give a more harmonious balance appearance, to try and avoid a 'plastic' unnatural look. Most complications can be avoid with careful preoperative examination, surgical planning and meticulous operative technique.
Yes you can have blepharoplasty surgery for functional reasons on the NHS i.e. if your eyelid hooding is so severe that it interferes with your visual field or if is for rehabilitation purposes from some pathological process e.g. for thyroid eye disease.
However the NHS is unlikely to fund blepharoplasty surgery purely for cosmetic purposes for the sake of rejuvenation purposes e.g. severe thyroid eye disease, amyloidosis.
For quite some time now, most CCGs (clinical commissioning groups) have brought out their eligibility criteria which patients would have to meet prior their surgery being agreed to be funded by their local NHS.
Dudley Procedures of Limited Clinical Value/ Aesthetic Policy Document 2019
Sandwell and West Birmingham/ Birmingham and Solihull CCG Policy for Cosmetic Surgery - Eyelid Surgery 2019
Cosmetic Eyelid Surgery Gallery
Before and After Pictures of Cosmetic Eyelid Surgery | Eye bag Reduction Surgery | Eyelid Lift Surgery by Mr David Cheung, Eyelid Specialist Surgery, Birmingham UK
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This lady was always troubled by lower lid bags since her 20s. Note the bulging fat baggy bulges which are due to weakness of the middle layers of the eyelid allowing forward prolapse of the orbital fat pad. Note also the tear trough groove deformity.
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1 week following lower lid blepharoplasty: This consisted of fat pad debulking and draping, orbicularis muscle tightening, lateral canthal tendon ligament tightening, skin sliver removal.
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Note the minimal swelling on the ocular surface. The incision is barely visible below the eyelashes.
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3 months following surgery: Conventional anterior lower lid blepharoplasty: The fat pads have disappeared, the wrinkling has reduced, the tear trough deformity has gone.
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The incision has become imperceptible.
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Combined Upper and lower lid complex multiplanar blepharoplasty: This lady in her late 50's complained of looking tired. Unfortunately she had very thin skin with weakening of the middle layers of her eyelids.
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You can see that the upper lid skin crease on HER RIGHT upper eyelid has disinserted, leading to slippage of the skin downwards. You can also see marked bulging (herniation) of the orbital fat. She has a deep tear trough deformity. The deeper muscle layers of the lower lid are also quite loose. Bespoke surgery needs to address all of these anatomical problems.
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You can see that the upper lid skin crease on HER RIGHT upper eyelid has disinserted, leading to slippage of the skin downwards. You can also see marked bulging (herniation) of the orbital fat. She has a deep tear trough deformity. The deeper muscle layers of the lower lid are also quite loose. Bespoke surgery needs to address all of these anatomical problems.
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1 week following surgery. Upper and Lower lid blepharoplasty. As with this sort of multiple plane surgery the swelling can be very marked. This sort of intense swelling is typically maximal after 48-72 hours with gradual improvement then onwards. Most patients are back to work though at 10-14 days post surgery.
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Surgery involved addressing all anatomical problems including bilateral upper eyelid anchor blepharoplasty to reform the skin crease, bilateral lower lid anterior blepharoplasty with orbital fat debulking and redraping, tear trough deformity lysis, orbicularis muscle tightening, minimal skin excision and then lateral canthopexy.
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8 weeks following surgery. This lady was very very happy. All her scars have disappeared
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8 weeks following surgery. This lady was very very happy.
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BEFORE upper and lower blepharoplasty surgery again
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AFTER upper and lower blepharoplasty surgery again.
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This lady complained that her lower lid eyebags made her look tired. These had been present even since she was young and ran in her family. She also wanted better symmetry of upper eyelids as she felt her left upper lid looked hooded. Note the lower lid orbital fat bulging due to weakness of the orbital septum.
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1 week following left upper eyelid blepharoplasty ( an exact amount of skin was removed to match the right upper lid) and bilateral lower lid transconjunctival blepharoplasty ( fat was removed from both lower lid via an incision through the back of the eyelid). The recovery time for this surgery is very quick.
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After Upper Eyelid and Lower Lid transconjunctival blepharoplasty: This patient remarked how amazed her friends and family were following surgery.
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This lady complained of upper lid hooding on both sides but with the right worse than the left. Note the asymmetrical upper lid hooding. Her right eyebrow is lower than her left.
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This lady complained of upper lid hooding on both sides but with the right worse than the left. Note the asymmetrical upper lid hooding. Her right eyebrow is lower than her left.
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1 week following surgery: Bilateral Upper blepharoplasty with endotine brow lifting
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All incisons are hidden with the normal skin creases.
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Perfect symmetry at 6 weeks following surgery
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The incisions slowly continue to disappear completely.
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Men commonly present later than women. Often the changes seen are a bit more marked therefore. This gentleman presented in his 60s complaining that his upper eyelids looked droopy and his lower lids looked baggy.
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This gentleman has marked upper eyelid ptosis and bilateral lower lid skin redundancy in addition to lower lid bags
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1 week following ptosis correction to both upper eyelids and lower lid blepharoplasty surgery. His eyelids will remain swollen for a couple of weeks at least.
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He has very fine incisions which are hidden in the upper lid skin creases and just below the lower eyelid lash lines
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3 months after surgery. Once all the swelling has slowly settled down, one can see the improvement. His upper eyelids are now more open and back to normal height. The lower lid wrinkling has improved. He still looks like natural but more refreshed.
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All the incisional scars will continue to slowly fade away but already are almost invisible at 3 months.
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Men commonly present later than women. Often the changes seen are a bit more marked therefore. This 65 year old gentleman presented quite late with quite marked hooding causing superior visual field compromise.
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He also had quite marked drooping of the tails of his eyebrows and complained of bagginess of both lower lids. He stressed that he wanted a natural looking result.
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1 week following blepharoplasty surgery to all four eyelids combined with ptosis correction. As expected with such extensive surgery, the healing reaction can be quite marked and prolonged.
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The incisions are hidden in the upper lid skin creases and just below the lower lid lash lines. Although his eyebrows were drooping, he opted not to have a brow lift operation too.
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3 months following surgery, the swelling reaction has settled down. The scars have faded to become almost invisible already to give a natural looking fresher result which is still harmonious with his age.
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His eyelids function normally and there is almost no evidence of the operation having taken place.
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Young patients are increasingly seeking cosmetic surgery nowadays. This lady in her 20s always wanted more exposure of her upper eyelids as she felt her lids looked bulky and she desired a taller platform for wearing eyeshadow. One can see that her lid fold is so low that it rests on her eyelashes.
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3 months following upper eyelid anchor blepharoplasty: This is a very specialised operation which involves reshaping the upper eyelid internal structures, repositioning fat and changing various attachments without skin removal. The result is a natural looking, less bulky more open, looking eyelid.
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38 year old lady complaining of hooded upper eyelids and difficulty wearing eyeshadow -
This lady does NOT have excessive upper lid skin causing her upper lid hooding -
Instead she has a bulging low inserting orbital septum -
1 week following upper eyelid anchor blepharoplasty -
This is a complex type of upper eyelid blepharoplasty which involves raising the skin crease and changing the position of the upper lid orbital fat thus allowing greater exposure of the pretarsal platform -
The sutures need to be carefully placed to aim for symmetry -
3 months following surgery: This lady was very happy with the result as now she was able to wear eyeshadow and mascara without blotching. -
Her eyelid wounds healed perfectly with invisible scarring
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Before surgery again: Note the eyelashes and eyelid platform is hidden
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After surgery again: Now her eyelashes are visible and she has natural looking platform allowing mascara wear
