Blepharoplasty, eyelid surgery, tightens and/or removes the tissue of the upper and lower eyelid. This procedure is perfect for patients who have excess skin or bags around the eyes. Springs Aesthetics and Dr. John Burroughs offers blepharoplasty for men and women in Colorado Springs, South Denver, Castle Rock and other areas of Colorado. Patients have come to Dr. Burroughs from coast to coast.
What is Blepharoplasty?
As we age, a complex series of changes takes place in the tissue around the eye. Skin becomes thinner and less elastic, fat may protrude or atrophy, and even the bone can resorb and change lending less support for the soft tissues. Many of these changes can be improved or corrected surgically.
In Colorado Springs, blepharoplasty (or eyelid surgery) is intended to tighten the tissues of the upper and/or lower eyelids. It is useful for improving the appearance of aging around the eyes. In the upper lids, the procedure removes excess skin in virtually all cases. Depending on the individual anatomy, fat and muscle may also be addressed. The lower lids may be full and/or there may be skin laxity, both of which would be corrected surgically.
Blepharoplasties and related eyelid surgeries are among the most commonly performed cosmetic surgical procedures and may involve removing, reshaping, restoring, and repositioning of the eyelid skin and underlying tissue. Blepharoplasty is generally considered a top facial cosmetic procedure because the eyes, though not anatomically central on the face, are the central point of focus and attention for those looking at you.
Dr. John Burroughs has taught blepharoplasty surgical techniques to other surgeons and is published in surgical textbooks and journals on proper evaluation, technique, and care of blepharoplasty patients. Prior to his extensive subspecialty training in eyelid, orbital, and facial plastic surgery, he was an eye surgeon. Therefore, he has extensive concern, appreciation, skill, and experience to minimize risks and provide safe surgical treatments around the eyes. Oculoplastic surgeons, compared to other plastic surgeons, with their microsurgical skills and precision often say follow the axiom that millimeters matter.
Before and After Pictures
Who Performs Blepharoplasty Surgery?
Trained ophthalmologists and any plastic surgeon may perform blepharoplasty. Only oculofacial plastic surgeons have undergone extensive subspecialty training to do eyelid surgery more than these other disciplines. Though these other surgeons may be trained and capable to perform eyelid surgery they may not appreciate fine anatomical details needed to optimize the aesthetic outcomes. They also may not know or be skilled in the most advanced blepharoplasty techniques. Many general plastic surgeons receive the bulk of their eyelid surgery training from oculoplastic surgeons. General plastic surgeons typically perform a much lower number of eyelid surgical procedures in and after training as compared to oculoplastic surgeons.
General ophthalmologists were often but not always trained in residency to perform eyelid surgery. After residency they typically don’t learn to evolve their technique or perform a significant enough volume to obtain the safest, most cosmetic, most reproducible, or best results. General ophthalmologist typically only perform insurance-based eyelid surgery and only obtain a functional result missing the nuances or lacking the surgical know how to optimize their results aesthetically.
Oculofacial plastic surgery has its genesis over 50 years ago because of the need for specialists in eyelid surgery and particularly for ptosis (drooping of the eyelid margin), which is one of the most difficult to perform of all eyelid surgeries. Ptosis surgery requires very extensive knowledge of eyelid anatomy and precision technique to have high reproducibility in regards to achieving optimal lid height and contour correction, which is elusive to most plastic surgeons. Experienced oculoplastic surgeons generally have an over 90% success rate in obtaining contour and lid height symmetry within a millimeter. Those with less experience have reoperation rates as high as 25% or more.
Oculofacial plastic surgeons are often consulted to address the most difficult primary or revision cases because of our extensive experience and proven results. A significant portion of Dr. Burroughs’ practice is to repair or provide revisions from other surgeons. Dr. Burroughs has done revision surgeries from all over Colorado and the surrounding states. On the rare occasion of suboptimal eyelid healing , oculoplastic surgeons know the best way to improve the results and outcomes. Oculoplastic surgeons are also able to perform important ocular exams to ensure surgery is optimized for patients with underlying ocular pathology such as dry eye or thyroid related eye disease and orbitopathy.
Blepharoplasty by Burroughs
Beauty By Burroughs
- Experience matters: Dr. Burroughs is amongst the most well known and experienced eyelid surgeons in Colorado
- Highly (fellowship) trained by an oculofacial plastic surgery pioneer
- Member of the prestigious American Society of Ophthalmic Plastic Surgeons and board-certified ophthalmic surgeon
- Master surgeon chosen by other surgeons with 20+ years experience
- Local Reputation: Consistent Peer-Selected Top Doc in Colorado Springs
- National Reputation: Multi-Year Peer-Selected to Best Doctors
- Innovator & Invited speaker at national and international symposia
- Thought leader for advancing surgical techniques and outcomes
- Author of over a 100 publications and textbook chapters for cosmetic eyelid and facial surgery and rejuvenative techniques
- Collaborator and friend of other nationally respected surgeons including the cosmetic epicenters of Beverly Hills and New York
- Unique adjunctive treatments provided, many complimentarily, at his in-office medical spa not available at most other plastic surgeons
- 1st in Colorado to speed healing, reduce bruising with LidLift goggles
- 1st to bring TXA for eyelid surgery in Colorado to decrease surgical bleeding, decrease postop bleeding, and faster healing
- Compassionate, Results-Focused, & Experience-Based Practice
- Emphasis on listening to patients to give natural appearing results
- Revision and Reconstructive Eyelid Expert
- Ethical surgeon with recommendation integrity for safety first
- Patient-focused with a servant-mindedness calling as a surgeon
How Much Does Blepharoplasty Cost?
Costs are determined on a patient-by-patient basis depending on the type of approach needed and whether insurance will cover a portion of the cost. Very restrictive criteria has to be met for insurance coverage of medically indicated eyelid surgery. Most patients don’t want to wait for their eyelids to droop so significantly that it impairs vision. Springs Aesthetics offers multiple payment options, including financing through CareCredit® and Alphaeon®. Dr. Burroughs’ team will discuss your payment options during your consultation.
Blepharoplasty for Men
When evaluating a patient’s aesthetic needs, many factors are critical in achieving the best results that are customized for that individual’s goals and situation. For men, it is important to ensure that a blepharoplasty does not compromise a masculine appearance.
Male upper eyelids are generally fuller and heavier, with greater skin redundancy than female eyelids. Male eyelids also have a lower eyelid crease and must not be over-sculpted to avoid creating a feminine look.
Dr. Burroughs is very precise about incision placement to avoid feminizing the male eyelid and to minimize scar visibility.
Blepharoplasty for Women
Female eyelids can undergo somewhat greater fat sculpting and thinning. They also should have higher, more arched eyebrows and a higher eyelid crease. In women, the ideal eyebrow is arched and peaks at the outer third junction and positioned approximately a centimeter above the orbital rim, whereas in men, the brows are generally flatter and rest at the orbital rim. Many surgeons place their incisions too high making scars more visible and creating a less youthful upper tarsal platform and lid crease position.
Brow and forehead lifting can restore the eyebrow back to these positions, but caution must be exercised to restore ideal gender-specific contours and to avoid over elevating the eyebrows, which can lead to a more feminine look in male patients and a startled or frozen look in females.
Dr. Burroughs performs, when indicated, a number of brow and forehead lift techniques. Sometimes a patient may have extreme asymmetry between the two eyebrows necessitating different techniques to improve the brow symmetry.
Ethnic lineage and racial appearance is very important in surgical decision-making, as most patients wish to maintain their family lineage characteristics of eyelid contour, thickness, and upper eyelid crease position.
Asian patients, in particular, require special attention to their variations in crease position and upper eyelid fullness. Most Asians do not want to be “westernized” or “Americanized,” but to simply rejuvenate unwanted age-related changes. Rarely, when considerable change is desired, Dr. Burroughs will follow an individual patient’s wishes regarding their own specific racial ideals of beauty and handsomeness unless this would cause an unnatural appearance. A “one size fits all” approach does not yield optimal results.
Dr. Burroughs is often referred patients of diverse racial backgrounds from other plastic and eyelid surgeons because of his expertise and expansive experience with both non-occidental (western) and occidental (eastern) eyelids.
How is Blepharoplasty Performed?
Upper eyelid blepharoplasty surgery is performed through a cosmetic lid crease incision, allowing the surgeon to reshape the contours of the upper eyelid. Removal of redundant skin allows makeup to be used more effectively and brings out the natural beauty of the human eye. This can also help make a person more approachable, less tired, and refreshed appearing.
Whenever possible, it is essential to optimize the eyelid and periocular skin health before proceeding with surgery. To achieve optimal, customized surgical results, it is critical to assess for asymmetry of the eyes and face. These asymmetries can include:
- Relative eye size (e.g., how “open” the eyes appear)
- Eyelid contours and positions
- Eyebrow positions
- Eye projection/retraction from the orbital socket
- Underlying orbito-facial asymmetries (e.g., one side is usually smaller/flatter than the other)
- Cheek and frontal bone projection or flatness
- Uneven skin quality and aging differences
Dr. Burroughs is asked by referring physicians (even other plastic surgeons) and knowledgeable patients about the specifics of how he does eyelid surgery. Blepharoplasty procedures can differ from one patient to the next, depending on their needs and goals. Each patient is unique and requires a customized approach for optimal success. See below for an overview of some of the most common blepharoplasty approaches.
Lower Eyelid Blepharoplasty
Lower eyelid blepharoplasty is performed for lower eyelid wrinkles, sagging, fat bags, deep hollows, and under eye circles. Lower eyelid surgery can be performed with a hidden incision (no scar) on the inside of the eyelid. From this inside approach, the lower eyelid fat bags can be sculpted out and/or repositioned to fill in the deep depressions and hollows under the eyes. The midface can be elevated when combined with this approach with a short crows feet area incision or through the upper eyelid incision if done with upper blepharoplasty. Sometimes an outside incision is done to remove some of the wrinkled skin with a well concealed incision under the eyelashes.
Lower eyelid blepharoplasty in many ways is a more complex decision with the various different approaches. Oftentimes the lower eyelid fat that is towards the outside corners is often more easily and efficiently removed from the lateral upper eyelid incision. Dr. Burroughs teaches approaches to get to the lower eyelid fat even in younger patients with more taut eyelid tissue, which can make getting to the fat much more difficult. The lower eyelid-upper cheek junction should usually be effaced and gently raised to get the best cosmetic result. The angles of the outside corners of the eyes can be adjusted to change the shape of the eyes to a slight more youthful upturn or cat-eye look. A key issue when selecting an eyelid surgeon is that they don’t approach every eyelid the same way. This is akin to a contractor treating every issue as a nail when your only tool in the tool chest is a hammer. Dr. Burroughs has developed many customized approaches to tailor each surgery to a patient’s unique needs. Oftentimes the lower eyelid skin needs to be smoothed, and doesn’t need skin removal.
Dr. Burroughs uses chemical peels, laser resurfacing, and radiofrequency resurfacing to improve the lower eyelid skin. Non-surgical “blepharoplasty” can be done with radiofrequency Accutite as well as dermal fillers. Dr. Burroughs teaches his published techniques for a “filler blepharoplasty” both nationally and internationally. The filler blepharoplasty typically has no downtime or bruising and is a great way to have up to a 2 year improvement until surgery can be done or preferred by a patient. AccuTite is performed through a small needle incision that uses radiofrequency to tighten skin and reduce unwanted fat. Dr. Burroughs has been using these Inmode “Tite” technologies for four years and is one of the most experienced and first to perform in Colorado.
Blepharoplasty if Orbital Brow Ridge or Forehead Variances
A protruding bony eyebrow ridge or forehead can cause the eyes to appear small, set back, and shadowed. This can be improved by adding to or repositioning upper eyelid fat, raising the eyelid crease, and raising the eyelid margin height, making the eye more open so it appears larger and more forward. If the eyes are extremely set back, they can be brought forward through implants placed under and behind the eye; and rarely, by adjustments to the orbital rim and eyelid attachment points.
Alternatively, a flat bony ridge above the eyes may need varying the above approaches. Similarly, the eye position to the cheek prominences is paramount when surgically addressing the lower eyelid for cosmetic or reconstructive surgery. An ideal youthful lower eyelid blends with the cheek convexity nearly as a continuum. As we age the lower eyelid appearance elongated vertically and fat bags herniate and hollows develop under the bags.
If the brows are descended and too low, they can be raised and the contours changed through an eyelid incision approach. This minimizes the external incisions and potential for more visible scars. As we age the brow fat pads descend, so during a blepharoplasty Dr. Burroughs advocates in most patients to have their fat pads raised upward with internal fixation or secondary dermal filler placement following surgery if the fat has become too atrophic (deflated) by age. If a blepharoplasty is done without addressing the brow tissues, in most patients this leads to a lowering of the brows because of the in between skin removal. The brows can also descend because the unconscious lifting (frontalis) forehead muscle is no longer as needed.
Descent of the forehead with age also worsens brow descent and hooding of the eyes. This causes compensatory over action of the frontalis muscle that lifts the brows leading to deep forehead rhytids (folds). Therefore it is imperative in most patients to not only optimize the lid-brow junction and positions that the brows be raised or stabilized during an upper eyelid lift blepharoplasty surgery. Oftentimes this is done through the transblepharoplasty incision. For greater brow ptosis (descent) the best and longest lasting results may come from a combined upper blepharoplasty and forehead lift.
Blepharoplasty to Balance Cheeks
On the side profile, the cheeks should extend slightly anterior to the eyes. If the cheeks do not protrude forward sufficiently, then guarded surgery must be done on the lower eyelids to avoid causing them to drop (slide down the face), which can lead to lower eyelid retraction, chronic dry eye, and potentially vision problems. Noting this negative cheek vector is especially important in lower eyelid surgery.
If the eye to cheek position is not ideal, then surgical options include: fat transfer, cheek implants, and suspension of the mid-face (cheek) fat pads and soft tissues superiorly. Ideally, the lower eyelid is a convex continuum with the cheek and lower face and not the age-related sagging and indentations that are commonly seen in older patients.
Additionally, like other soft-tissue facial structures, the cheeks can descend and deflate with age. Along the bony rim, the eyelid muscles attach firmly, causing an age-related indentation that is accentuated by the superior fat bags protruding and inferiorly by the midface fat pads flattening and descending.
These multiple causes must be identified and, if desired, optionally addressed specifically during eyelid blepharoplasty. Otherwise, incomplete addressing of these issues will lead to incomplete improvement or discomfort for the eyes. Fortunately, Dr. Burroughs evaluates for these anatomic issues and utilizes techniques that can be performed through small and adjoining incisions, thereby gaining maximal improvement with minimal external skin incisions.
Blepharoplasty if Low Eyebrows
Oftentimes, when the eyebrows are low, there is apparent excess upper eyelid skin. If both issues are not addressed simultaneously, suboptimal results arise. Some surgeons erroneously try to do an upper eyelid lift, when actually a brow lift was needed or done as well. Later, when the brows are lifted, there may be insufficient skin to allow the eyes to close properly if too much skin was removed with a prior upper blepharoplasty leading to dry eye problems.
The large lacrimal tear gland is located at the outside edge of the upper eyelid. The lacrimal gland is important particularly for reflex tearing if something irritates the eye. As we age, the support attachments of the main lacrimal gland loosen, and the gland drops and extends forward into the eyelid. Novice surgeons have mistakenly removed it, thinking it was eyelid fat, which can create postoperative dry eye problems. If it is not addressed during upper eyelid surgery, its appearance is unmasked and cause an unwanted bulge contour in an otherwise smooth eyelid.
Dr. Burroughs frequently repositions the gland back to its proper position during upper eyelid surgery to avoid a lateral bulge in the upper eyelid. Furthermore, infectious, inflammatory, and even serious cancers can affect the lacrimal gland, so these concerns need to be addressed if suspected prior to undergoing cosmetic or reconstructive eyelid surgery or procedures.
Blepharoplasty for Eye Placement & Appearance
The perception of moving an eye forward or backward can be achieved by raising or lower the eyelid heights. However, the removal of skin will not safely adjust the eyelid height (where the eyelid margin rests on the pupil) as ptosis repair is needed to address this issue.
Raising the upper eyelid height (ptosis repair) is accomplished by carefully identifying the major tendon or muscle responsible for eyelid elevation and tightening it.
Lowering the upper eyelid is possible by weakening the tendon of the muscle, which can help the eyes close better and lessen an unwanted startled appearance. Upper eyelid height and contour adjustments may be performed on one or both eyes to improve eyelid position asymmetries, function, and cosmesis.
Dr. Burroughs also routinely corrects lower eyelid malpositions, but these require advanced techniques and understanding of the anatomy. The shape and appearance of our eyes are largely based upon the inner and outer corners where the eyelid meet together. These corners are called the “canthi” and the height position of these are relative to one another and the surrounding facial tissue and structures.
The canthal positions of one to the other, as well as the eye to surrounding tissues, is very important, not only for the shape of the eyes but also the function of the eyelids. Patients with loose or down-turning eyelids can have dry, irritated eyes and sometimes watery eyes due to the eyelid laxity impairing the tear drainage pump. Canthi repositioning is a critical component of either upper or lower blepharoplasty surgery as the appearance (e.g., roundness, “cat eye,” “almond eye,” etc.) and function are determined by where they are positioned.
Blepharoplasty to Optimize Contours
Youthful faces and eyes have certain contours. The upper eyelids should have a generally low upper eyelid crease especially in men more so than in women. The upper eyelids should be smoothly convex, but not overly sunken before joining the eyelid-brow junction. Herniated upper eyelid fat or the main lacrimal gland should be addressed during surgery for an optimal cosmetic outcome. Descended brow fat should be raised upward to enhance the youthful and aesthetic appearance over the lateral orbital rim. Herniated upper eyelid fat is usually present close to the nose. This fat can be removed or repositioned laterally to enhance smooth the contour and youthful fullness that has been lost with age.
The lower eyelids should be vertically short in appearance and generally be without contour irregularities from fat herniation or infraorbital hollows from mid-face descent and deflation, which can expose the orbital rim. The ideal contour for the lower eyelid is a smooth convex continuum with the cheek. Some patients don’t have hollows under their eyes and can undergo conservative fat sculpting and removal. If hollows are present then the fat should be repositioned (transposed) into the hollows removing it where its appearance is bad to making the transition with cheek smoother by improving the hollowness. Some patients only achieve this ideal lower eyelid appearance from a combinational approach with homologous fat transfer from elsewhere in their body or dermal filler placement.
For patients that have large lower eyelid bags from significant fat herniation should not be oversculpted, which can cause the lower eyelid to look flat and aged. Rarely, oversculpting can also worsen the eyelid position, drop the globe (eyeball) itself, cause a sunken upper eyelid sulcus below the brow. Careful removal of fat is also important as there is an important muscle that runs between the medial and central lower eyelid fat pads that can cause double vision if it is injured. Transposed fat that is not carefully released from surrounding fibrous attachments during repositioning can also cause irregular eye and eyelid movements.
Dr. Burroughs with his prior ophthalmology background and extensive eyelid surgery experience, to include ocular muscle surgery, has provided him an advanced understanding of the pertinent anatomy to not only improve these appearance concerns but do so in the safest manner possible by minimizing risks.
Blepharoplasty If Dry Eyes
The Colorado climate is very dry, and many patients have “dry eyes” due to any number of tear film deficiencies (qualitative or quantitative). These patients with a poor tear film either require special planning, tear film optimization preoperatively, more conservative surgery, eyelid malposition repair, and optimized postop care. There are numerous conditions that can cause chronic dry eye. One example is ocular rosacea or posterior blepharitis, which is often only recognized by examination with microscopic slit lamp equipment that other plastic surgeons don’t have or even know how to perform. Dr. Burroughs performs an ocular surface assessment for all his eyelid surgery patients. He also has equipment (e.g., BlephEx) to treat anterior blepharitis, which can reduce the the postoperative infection risks for eyelid surgery.
Furthermore, patients that have undergone laser refractive surgery (e.g., Lasik, PRK) can have a worsened response to dry eyes. Some reconstructive eyelid procedures can address and improve these issues. If a patient has preoperative dry eyes, then they need to remain vigilant with the use of ocular lubricants (tear supplements, ointments) in the postoperative period. Patients who have had prior eye surgery (e.g., glaucoma) also sometime require customized surgeries to protect their ocular health and vision. Dr. Burroughs is a dry eye expert, and has advanced dry eye treatment experience. He is the first and only provider of new dry eye treatments with intense pulsed light in Southern Colorado.
Can I improve my eyes without surgery?
The short answer is yes. Dr. Burroughs has many patients that want improvement of the appearance of their eyes without surgery as they don’t have the downtime or are not surgical candidates (medical or for personal reasons). Dr. Burroughs performs “Filler Blepharoplasties” by using dermal fillers through a cannula, which can mask lower eyelid fat bags and reduce under eye hollows and circles. Some lazier or less proficient injectors don’t use cannulas as the techniques are more difficult, but injection through an appropriately sized cannula is much safer, usually less uncomfortable, and causes less bruising or swelling. Midface augmentation with fillers also improve the appearance of the lower eyelids by supporting the lower eyelids by bolstering the midface tissues. Dr. Burroughs, with 15 years experience, is one of the most experienced and safest eyelid filling providers in the U.S., and has published his techniques and taught them at national and even national symposia. The lateral brows can be improved by re-filling them, which provides contour improvements and a gentle lift to the brows. Rarely, patients have deep upper sulcus issues that can be improved with fillers to reduce the hollow aged appearance.
Dr. Burroughs also manages complications of fillers placed into the lower eyelids from other providers if too much or inappropriate fillers were placed. He has described this as “filler sculpting” using an enzyme to reverse hyaluronic acid fillers or to reduce them to a better contour without complete removal. Lasers, chemical peels, and radiofrequency resurfacing can tighten and smooth eyelid wrinkles. Laser resurfacing along the upper eyelids just above the lashes can tighten and smooth upper eyelid skin and raise downward facing eyelashes more upward. PRP can be injected by itself or mixed with fillers to “turbo” boost the filler results and further improve the eyelid skin appearance. Skin care is essential to healthy and youthful eyelid skin. Hyaluronic acid boosters and topicals such as SkinCeuticals AOX eye serum and A.G.E. can thicken the lower eyelid skin and repair oxidative-actinic damage to improve lower eyelid dark circles that are partly caused by skin thinning over the darker underlying eyelid muscles. Botulinum toxins neuromodulators can allow one eye to open more, reduce wrinkles, reduce frown lines, and gently lift the brows. Dr. Burroughs is among the first nationwide to offer Accutite, which is a unique radiofrequency technology that tightens skin and can reduce unwanted fat. Dr. Burroughs was also amongst the first to use this technology for under eye fluid festoons (malar edema) with good success. Intense pulse light treatments can improve skin discoloration issues and even help some patients with dry eyes.
Summary of Blepharoplasty Procedures
Each of these factors makes undertaking cosmetic eyelid surgery a serious and sometimes complicated decision. However, it is generally considered one of the most satisfying of all plastic surgical procedures. It is generally quick, painless, and an affordable means toward improving the facial appearance.
Dr. Burroughs often reminds patients that if they can only do one facial procedure, start with the eyelids, since they are the center of attention on our face when we meet and talk to others. An ancient, both biblical and secular, truth is that the eyes are the windows to the soul (Matthew 6:22). Our eyes and eyelids convey our inner emotional state, and can make us appear refreshed or tired, angry or happy, and unfriendly or friendly and approachable.
Fortunately, most patients may safely undergo cosmetic eyelid surgery, but each patient is unique, necessitating individualized assessment and planning. When it comes to successful eyelid surgery the old adage that “experience matters” is very critical in a patient’s decision. During consultation, Dr. Burroughs may or may not directly speak about all the underlying anatomic issues and previously outlined factors during the evaluation, but each of them is considered by him in your individualized surgical planning. Dr. Burroughs loves to teach, and this takes place during consultation in a manner to make critical medical and anatomic factors understandable for the lay person. Dr. Burroughs is often told by patients that he should do whatever he thinks is best, but he still takes time to explain and teach about the plan. His team and patient care coordinator are also great references to understanding the surgical plan and optimal preoperative and postoperative factors to follow.
FAQ: Cosmetic Blepharoplasty and Cosmetic Eyelid Surgery
Does Insurance Ever Cover Eyelid Surgery?
Insurance will sometimes pay for eyelid surgery that is performed to improve vision. For instance, if your upper eyelids are drooping over the pupil and is blocking your vision, your insurance company may pay for upper eyelid surgery. If the upper eyelids are blocking vision, insurance companies require often require a visual field test to demonstrate that the eyelids block the peripheral vision and that the vision is improved by elevation of the eyelids. More recently, they evaluate standardized photos that must demonstrate either the eyelid margin or pseudo margin (excess skin) is covering at least a portion of the pupil. These photos must be done with the head in neutral position without squinting of the eyes and with a camera flash. Dr. Burroughs also has to document and provide what is called the margin to pupillary reflex distance (MRD), which usually needs to be 2mm or less. These are very strict criteria that insurances and Medicare have been tightening over the years. The photographs are the primary method of determination regarding medical necessity, and a patient’s visual complaints and visual field testing are significantly secondary.
If your lower eyelids are droopy, out turned or in turned causing eye irritation or watering of the eyes, your insurance company may pay for correction of these issues. Insurance companies require the medical need, measurements, ocular findings be documented with standardized photographs. These records and photographs are then submitted for insurance company review during the preauthorization process.
Dr. Burroughs’ office can act as your advocate to help your insurance company pay for medically necessary procedures. Some problems, such as bags in the lower eyelids, that do not affect vision are never paid for by insurance companies. Many of the procedures he performs are done only to improve appearances or to preempt visual issues and these cosmetic procedures are not paid for by your insurance company. During you consultation, Dr. Burroughs will determine and discuss what procedures meet medical necessity and offer a functional (medical) and for those that choose an optimal cosmetic benefit. He will not submit insurance coverage though for cosmetic surgery. Owing to his comprehensive documentation and ethical submissions, he has successfully been audited by Medicare and passed every time. It is fraudulent to submit cosmetic surgery to insurance, and Dr. Burroughs will not do this and patients seeking this should seek care from other surgeons.
What Can I Expect During My Blepharoplasty?
In nearly all cases of upper eyelid blepharoplasty surgery, there is excess skin in the upper eyelids, so removal of extra skin is only possible with an incision. Fortunately, the skin of the upper eyelid is some of the thinnest skin in the body and typically heals with little to nearly invisible scarring.
The incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing. The incisions usually have to extend to the lateral crows feet area to avoid unwanted excess skin and “hooding” at the outside corners of the eyes where brow descent is usually worst.
Dr. Burroughs uses lasers, scalpels, or bovie (radiofrequency-electric needles). His chosen incision instrument is individualized, but most often is a very fine “bovie” needle set at a low setting to provide an optimal balance of precision, wound shaping, and healing as collateral heat damage is minimized. Under the incisions, he uses various instruments to safely provide the best results and to minimize bleeding.
Oral sedation and local anesthetic is all that most patients need to undergo eyelid surgery comfortably. IV sedation, inhaled nitrous oxide (“laughing gas,” Pro-Nox) or general anesthesia can be provided by patient request.
To keep patients comfortable his operating rooms have their own separate air systems, a warming blanket, a weighted blanket, and a very comfortable operating bed. Monitoring is done to ensure surgical safety.
Eyelid surgery usually takes no more than 1-2 hours, and in most cases his office-surgery patients can eat and drink prior to surgery.
What Sutures Does Dr. Burroughs Use for Blepharoplasty Surgery?
Dr. Burroughs finds eyelid wounds heal cosmetically well with dissolvable sutures, which patients prefer over sutures that require removal. These are especially helpful for his out of town and out of state patients. Some patients with very oily skin or past suture reactions do better with non-dissolving sutures that are removed between seven to 14 days after surgery. Dissolvable sutures “dissolve” by causing local inflammation and rarely leave the incisions looking more red and “bumpy” in the initial phases of healing. Persistent redness or thick or lumpy incisional healing usually will resolve on its own, but can be sped with IPL (intense pulse light) or anti-inflammatory injections when needed. Dr. Burroughs finds “running” sutures heal as well and are easier during removal than a series of interrupted sutures that have to be individually removed.
Is Fat or Muscle Removed During Blepharoplasty Surgery?
Aesthetically, the tendency is to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give one a hollow appearance that is not desirable. Oftentimes, the fat pad in the upper eyelid adjacent to the nose is bulging forward and is reduced in size or repositioned to areas of hollowness at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow or A-frame appearance.
Most patients benefit with removal of the skin only and preserving the underlying muscle to maintain a healthy and youthful fullness to the upper eyelids. This is especially important in Colorado also because of the high altitude dry climate, and high prevalence of dry eye. Older patients or those with pre-existent muscle weakness before surgery especially need preservation of the muscle to help with eyelid closure after surgery. Sometimes some eyelid muscle (orbicularis) removal or myotomy (incisional muscle modification) can help reduce the crow’s feet appearance and provide a subtle and pleasing brow elevation. To obtain symmetric results, very careful attention to detail and surgical removal of tissue must be performed. Asymmetric eyes though need asymmetric surgery to optimize aesthetic postoperative symmetry. Unlike many surgeons, Dr. Burroughs avoids performing the same exact surgery on each side and in every patient when individualized or other asymmetrical circumstances dictate variances.
Can the Eyebrows Be Lifted with Blepharoplasty Surgery?
Yes. There are several options to lift and optimally contour the brows to include wrinkle Blocker (botulinum neuromodulators), filler, and surgery to improve these areas. Dr. Burroughs has published these techniques in the medical journals and textbooks. Preoperative planning and determination of necessity is critical to address these concerns intraoperatively during upper blepharoplasty surgery. Sometimes the brows need more aggressive lifting with separate but simultaneous forehead and brow lifting surgery. Minimally invasive suspensory sutures can also be performed when there are pronounced differences between the brows. Adjunctive treatments with radiofrequency energy either externally (needle-based Fractora or Morpheus radiofrequency subdermal energy delivery) and/or by an internal approach (FaceTite or Accutite) can also be helpful, which Dr. Burroughs was first to perform in Southern Colorado and amongst the most experienced nationally.
Can Vision Be Helped with Blepharoplasty Surgery?
Yes. It is very common for patients to have surgery done to improve visual function (especially peripherally) and more rarely night vision at the same time that cosmetic upper eyelid surgery is done. The portion(s) of eyelid surgery done to improve eyelid function and eye comfort may be covered by insurance.
Can I Have Other Surgeries or Procedures with My Blepharoplasty?
Many other procedures can be done just before, during, or after your upper eyelid surgery. This can include wrinkle blocker, chemical peels, fillers, and subdermal tightening. Additionally through an upper eyelid incision, Dr. Burroughs can gently raise the eyebrows, reduce the wrinkle lines between the eyebrow, improve frontal area headaches, raise and smooth the lower eyelid-lid cheek junction, elevate the midface, and improve the crow’s feet areas. Autologous fat and dermal fillers can also be injected around the eyes to improve tissue support, fullness, and to improve contours.
What if I Had or Am Having Eye Surgery?
If you are planning on having eye surgery, it is optimal when medically appropriate (you can see well enough to function) to have eyelid surgery first. Very rarely, eyelid surgery can change one’s vision and cause the need for glasses or an adjustment to one’s glasses prescription. Critical refractive or eye surgery (e.g., cataract) measurements can be changed after eyelid surgery.
Usually by six to eight weeks, the eyes are stable and no further refractive (eyeglass) changes occur. It is quite rare for major shifts to occur, but because both laser and cataract surgery depend upon very accurate and stable preoperative measurements, it is best if one is thinking of doing both eye surgery and eyelid surgery to do the eyelid surgery first.
If you have already had laser (e.g., Lasik) or cataract surgery performed, then generally no substantial visual changes will occur, but is a slight risk. Patients that have had prior laser surgery are at a higher risk for dry eyes, which can be exacerbated following eyelid surgery and needs to be carefully monitored during healing.
Do I Need a Blepharoplasty or Forehead Lift?
This varies from patient to patient and their desired goals. Generally, if the eyebrows are resting at or below the orbital rim, then some form of brow or forehead lifting will be required for the best result. Dr. Burroughs can discuss this during your consultation.
Unrecognized preoperative asymmetries with eyelid and facial surgery may lead to unsatisfactory results and unmet expectations. Careful discussion on what can and cannot be achieved with soft-tissue (e.g., blepharoplasty) surgery helps maximize postoperative satisfaction.
What is Double Eyelid Surgery?
Asian patients have different anatomy than occidental patients. Some Asian patients are born with a fold in the upper eyelid and others are not. When the fold is present, it is called a double eyelid. The fold in the upper eyelid of Asian patients is much lower and nearer to the eyelid margin than in the occidental eyelids. The preaponeurotic fat is more full and lower than in occidental eyelids. It had been previously believed that Asian patients wish to have their eyelids “westernized,” but this demand has dramatically reduced and not generally recommended by Dr. Burroughs.
Generally, Asian patients want their eyelids to remain Asian appearing with a low eyelid fold, and do not wish to have their eyelids look like occidental or “western.” Non-occidental eyelid surgery requires detailed understanding of anatomic differences, and is performed by Dr. Burroughs. If you are considering this surgery, it is helpful to bring a younger photograph of yourself or a model with the appearance you hope to achieve. This should be discussed and decided upon if it may safely and reasonably achieved.
Dr. Burroughs’ stepmother is Korean, and while he was still in the Air Force, he performed many Asian blepharoplasties on Filipino and Korean patients. He has also surgically treated patients from Japanese, Chinese, Taiwanese, Cambodian, and Vietnamese descent.
Will I Have Trouble Closing My Eyes After Surgery?
Sometimes but this does not uniformly occur and is usually temporary, improving after suture removal in most cases. The upper eyelids are central to form and visual function. Removal of too much skin from the upper eyelids does not look natural and can cause problems with lid closure. Removal of orbicularis eyelid skin increases this risk. Dr. Burroughs is an expert in both ophthalmology and plastic surgery, which is why he is acutely aware of the need for the lids to both look and function normally after cosmetic eyelid surgery.
The most serious complications of facial cosmetic surgery occur with eyelid surgery. Some patients with medical issues such as weakened eyelid and facial muscles require even greater concern for properly performed eyelid surgery to enable the best and safest result.
Higher intraoperative bleeding requires more cautery, which can impair motor nerves to the eyelid muscle and directly weaken the eyelid closure muscle (orbicularis). This is why careful adherence to avoiding preoperative non-prescribed blood thinners (e.g., non-steroidals like ibuprofen, fish/omega oils, many herbal and vitamin supplements, and even alcoholic beverages) is essential. Blood pressure should be well controlled and is checked prior to surgery.
The early stages of healing the eyelids may not completely close, but over time the skin loosens up and muscle strength returns allowing full closure of the eyelids. During this time, utilization of artificial tears, gels, and ointments can improve eye comfort and vision. Some patients with pre-existent dry eye can be improved with punctal cautery closure of the eyelid tear drain holes, which Dr. Burroughs can perform.
Dr. Burroughs is one of the only blepharoplasty surgeons that provides posterior eyelid (meibomian gland dysfunction) dry eye problems with intense pulse light (IPL). Warm compresses after surgery can foster blood flow to the eyelids promoting healing and to loosen the essential eyelid oil glands to get oil into the tear film.
What is Recovery Like After Blepharoplasty Surgery?
Recovery varies by the exact procedure(s) performed and the individual patient. Generally, eyelid surgery is minimally painful but results in bruising and swelling. Patients should plan on being home on the day of surgery and for two additional days.
Dr. Burroughs’ cosmetic eyelid surgery patients are provide specially designed “Lidlift” goggles, which uniquely reduce swelling, bruising, rebleeding, and wound breakage. They have foam that provides gentle pressure over the eyes and compresses the capillaries and other superficial vessels. They are to be warn most of the day for the first three days and at night for a week. Besides reducing swelling and bruising they protect the wounds during sleep preventing inadvertent rubbing or pressure from laying prone or on the side that could push the wounds apart. Patients compliant with goggle wear heal quicker and appear several weeks better at a week postop than those that don’t or properly wear them. If displeasing bruising occurs despite Lidlift goggle wear, patients can wear sunglasses to hide bruising and swelling. Consolidated bruising also responds well to intense pulse light treatments that Dr. Burroughs complimentarily provides for his cosmetic surgery patients. Springs Aesthetics also has excellent coverup makeup and experienced aestheticians that can teach how to apply. Rare, but persistent swelling can be treated with lymphatic massage and radiofrequency tightening procedures in the Springs Aesthetics medical spa. These treatments are not available at most plastic surgery offices, and are offered in those rare circumstances at no additional cost for our cosmetic surgery patients.
Traditionally and still recommended by most plastic surgeons, cool compresses were applied to the eyelids to reduce bruising and swelling, but have been found to be far less effective than use of the lidlift compression goggles. Dr. Burroughs always looking to improve patient safety and speed healing, was the first to bring the lidlift goggles to Colorado.
After the third day, most patients can drive a car and get about fairly easily. Post-op patients should avoid heavy lifting and strenuous exercise for 10 to 14 days after their procedure. It is advisable to apply some eye ointment in the eyes at night to keep them lubricated in case of incomplete closure during early healing.
Blepharoplasty Complication Risks
All medical and surgical procedures carry risk. You should discuss the risk of complications with your doctor prior to any surgery so you can make an informed decision.
Many patients select Dr. Burroughs as an experienced master surgeon for their surgery because of his ophthalmic background and oculoplastic subspecialized training. Oculoplastic fellowship trained eyelid surgeons, like Dr. Burroughs, lower complication risks while optimizing cosmetic outcomes. Dr. Burroughs is a “surgeon’s surgeon,” and teaches other surgeons through publications and as an invited faculty at cosmetic surgery symposia.
A careful ophthalmic history and exam is critical before any eyelid surgery. Each year, Dr. Burroughs has been the first to diagnose eye problems prior to surgery that could cause suboptimal results following surgery or even vision loss whether surgery is performed or not. Dr. Burroughs will appropriately refer you to the correct eye specialist if he detects a problem that needs to be addressed prior to eyelid surgery.
Dr. Burroughs and his team thoroughly educate (both verbally and with provided written instructions) on important preoperative factors to minimize preoperative risks (e.g., avoiding blood thinners). Intraoperatively he performs surgery very safely and has fortunately had no patients lose any significant vision loss or eye injury over his 20 years of performs eyelid surgery.
Dr. Burroughs, for his office surgeries, routinely prescribes blood pressure lowering medication, anti nausea medication, and now in appropriate patients has novel medications that help stop bleeding. Dr. Burroughs is amongst the very first cosmetic surgeons utilizing TXA (transexamic acid) in oral, IV, injections, and topically as needed in patients to avoid excessive bleeding during or after surgery. TXA has been safely used a long time in orthopedic and trauma surgery, and Dr. Burroughs is one of the pioneers first applying its use in cosmetic surgery. TXA only has a few contraindications that Dr. Burroughs screens for prior to use. Dr. Burroughs is also one of the first eyelid cosmetic surgeons using topical Hemoblast, which can stop even severe intraoperative bleeding. Dr. Burroughs has also taught and published other sight-saving techniques at national meetings to address severe intraoperative or postoperative bleeding to avoid vision loss from compression of the optic nerve behind the eye from bleeding going posterior to the eye (retrobulbar hemorrhage).
How Can I Speed My Healing From Blepharoplasty Eyelid Surgery?
- Wear your LidLift goggles for first three days approximately 80% of the day and while sleeping for 1 week
- Dramatically Reduces Rebleeding, Swelling, Bruising Risks
- Reduces risk of wound separation while sleeping
- Most patients that wear the goggles look 2-3 weeks out at just 1 week
- Avoid coughing, sneezing, straining at the stool by taking over the counter medications to avoid as needed
- Avoid vomiting by taking prescribed nausea medication if needed and early as soon nausea occurs
- Sleep Elevated 30-40 degrees for 4-7 days after surgery
- No strenuous activity for 1 week to minimize swelling and rebleeding risks
- Bruising that does occur can be treated with Intense Pulsed Light (IPL), which speeds bruising resolution about 3-4 fold
- Topical Arnica to bruise areas can help
- Persistent swelling can be addressed each morning with cold compresses and lymphatic drainage at Springs Aesthetics
- Sports tape across the lower eyelid-cheek junction placed at night speeds swelling over the cheek bone areas
- After a week, NSAIDS (e.g., Naproxen or Ibuprofen) can be taken orally, and Dr. Burroughs can prescribe a few days of oral steroids at your 1st postop appointment on an as needed basis
- Use your eye ointment as prescribed
What Are Diseases and Situations that Can Impact Healing from Blepharoplasty?
Many conditions may alter the timing and amount of cosmetic eyelid surgery that is safe. Some of these disorders need to be recognized as they affect the surgical plan and healing process. Examples include:
- Severe dry eye syndrome
- Ongoing smoking
- Thyroid eye disease and proptosis
- Muscle wasting conditions
- Neurologic conditions
- Rheumatoid arthritis
- Other autoimmune disorders
- Chemotherapy medications
Eyelid malpositions (e.g., entropion, ectropion, retraction) are also important in the surgical planning and sometimes a staged approach is crucial for a safe outcome. Tear duct blockages, for instance, can impact surgical infection risk and should be identified and addressed before proceeding with ocular or eyelid surgery.
Floppy eyelid syndrome is a form of eyelid laxity that is closely associated with sleep apnea and eye problems including tearing, redness, and eyelid ptosis. Interestingly, many of these conditions are easily recognized by a cursory look at the eyes while others require a magnified eye exam with a slit-lamp biomicroscope.
Dr. Burroughs’ prior training and ongoing board certification in ophthalmology prepares him for assuring the safest, most successful eyelid surgery possible given the impact these other co-existing diseases and issues can cause.
How Long Will My Blepharoplasty Results Last?
The benefits of undergoing an upper and/or lower eyelid blepharoplasty will continue for many years. People continue to age as do their faces and eyelids. In general, one may usually expect an upper eyelid blepharoplasty to last up to 10 years, depending upon the brow position, heaviness, and stability. Lower eyelid blepharoplasty can last even longer depending upon the stability of the mid-face. Critical to maintaining your investment and increasing your results is medical grade skin care, and excessive sun exposure without adequate sunblock. Avoid smoking, and maintain a healthy diet and lifestyle.
For more than 20 years, Dr. John Burroughs has helped men, women, and children in Texas, Florida, Utah, and Colorado. He is referred from within Colorado Springs and areas including South Denver, Castle Rock, Pueblo, and areas outside of Colorado, and even rarely internationally, by providing exceptional care in plastic surgery and eyelid surgery. At his practice, he also offers medical spa treatments performed by aestheticians and physician extenders (nurses), which complement and can speed healing. To learn more about blepharoplasty eyelid surgery, contact us today to schedule a consultation.