Who should do my blepharoplasty, a plastic surgeon or an oculoplastic surgeon? This question answers itself: the more specialized the surgeon, the better the results! The best choice for a blepharoplasty is a specialist in oculoplastic surgery. There are many reasons; visit the “10 Reasons” section to see them in detail.
An oculoplastic surgeon is an ophthalmologist who, after finishing his ophthalmology training, acompleted a fellowship in oculoplastic surgery. Not all ophthalmologists who perform eyelid surgeries can attest to this training. If you want the best results and maximum safety, look for a surgeon who can certify his training and who is a member of the main oculoplastic surgery societies. It is the best guarantee that you can get.

A friend told me that there is “non-surgical blepharoplasty” and I would like to know if it is applicable in my case. A blepharoplasty is by definition a surgical procedure, so there is no such thing as “non-surgical blepharoplasty.” This term is most often used in business strategies trying to make the procedure more appealing by minimizing its significance.
This term is also sometimes used to refer to lower eyelid peels conducted with acid or a laser. This is a technique that Dr. Nieto also performs and it is designed to improve the texture and fine lines of the lower eyelids, and can be used alone or in conjunction with a blepharoplasty. This procedure has also been given the name of “chemical blepharoplasty.”

How old do I need to be in order to have a blepharoplasty done? Excess skin on the upper eyelids can appear beginning at 35 years of age, although some patients who have not reached that age already have eyelids that look “full” due to their individual anatomical characteristics.
Lower eyelid bags also become more common with age but sometimes appear at early ages, even before 25 years old.

I have eye problems that I am currently treating and I am afraid to have a blepharoplasty done. Only in exceptional cases do we contraindicate blepharoplasty in a patient with an eye condition. Those cases are normally severe cases of dry eye. In these patients, any procedure on the eyes or eyelids can worsen the problem. Most cases of patients with dry eye are of low to moderate severity and are not a reason to contraindicate a blepharoplasty, but they do require a more conservative surgery.
Retina or glaucoma problems are not a reason for contraindication and are not worsened during a blepharoplasty. Having had cataract surgery or LASIK surgery to correct myopia or hyperopia are not reasons for contraindication, either.

I have bags under my lower eyelids but I also have grooves, and I am worried that removing the pockets will make the bags under my eyes worse. What should I do? In patients that have pronounced grooves under the eyes in addition to bags, we do not remove the fat since it can, worsen the grooves, giving the eyelids a sunken look. In these cases, we redistribute (or transpose) the fat transconjunctivally, using the fat from to eliminate the grooves under the eyes.
In patients who have pronounced grooves or dark circles without fat pockets, we use hyaluronic acid gel injections, since these patients are not good candidates for a blepharoplasty.

I have been told that a blepharoplasty is a very simple operation that lasts about 20 minutes, and that I will have completely recovered after a few days. Is this true? Minimizing or reducing the significance of this kind of procedure is a mistake. It is true that it is a minimally invasive surgery with a fairly quick recovery, but the patient must be aware of its significance and not believe it to be something trivial. A doctor studies for more than 10 years to be able to begin his professional career and then invests many more in perfecting his or her specialty. This gives us an idea of the degree of complexity involved in any surgery.

I am going to have an upper blepharoplasty done and I want to take advantage of thiswould like to have my crow’s feet removed in the same procedure. Is this possible? A blepharoplasty is not a procedure that can remove crow’s feet, nor is there any surgery that can completely eliminate them. They are folds that appear in the skin because of the contraction of the orbicularis oculi muscle, and can be treated with botox and other techniques, but not surgically.

I want to have a blepharoplasty done using the most modern technique available, and I have heard that there is a laser blepharoplasty. Does Dr. Nieto perform this procedure?»]We have a CO2 surgical laser, but we do not routinely use it on all of our patients. The word “laser” is very catchy, but it does not imply greater modernity or better results. The most critical steps that will determine the success of a blepharoplasty are the proper planning of the surgery. Whichever instrument is used to make the incision (laser, cold scalpel or electric scalpel) does not affect the final result AT ALL. The laser creates a devitalization of approximately 0.5 mm in the tissue when the cut is made, which means that the sutures must be left in for more time when making the incision with a laser. In a survey conducted among the members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, more than 70% used the conventional (cold) scalpel for blepharoplasties.

I have health insurance and want to know if a blepharoplasty is covered by my policy.»]Cosmetic surgery is never covered by health insurance. That being said, it is true that for many patients who want an upper blepharoplasty, we can show a degree of reduction of the visual field due to the “visor effect” created by the excess skin above the eyelids. In these cases, your health insurance may cover part or all of the surgery.

Dr. Nieto accepts practically all health insurance providers in the country.

I have seen online offers for blepharoplasty and they are very cheap. Can I trust these offers?»]We would like to think that every professional who performs blepharoplasties is qualified to do so. However, we also believe that the decision to undergo a blepharoplasty is important enough that it should be well thought out and not the product of impulsively buying a coupon online. The process should be, first and foremost, a matter of getting informed and choosing the surgeon, and then checking prices – not the other way around.
It is also common for these offers to mark up their original prices so they can then announce discounts of 50% or even more, but in reality the discount is not so great.

Can an upper blepharoplasty be done using only local anesthesia?»]Yes. We often do this procedure with only local anesthesia, depending on the patient’spreferences. When doing so, the patient must tolerate the muild burning sensation of the local anesthetic infiltration. After that, the patient will not feel any pain, since the area will be numb. Since they are short procedures, they are well tolerated by patients.
We always perform lower blepharoplasties with local anesthesia and sedation, which we also do for brow lifts.

«I want to have a blepharoplasty done but I am very scared. Can the procedure be done using general anesthesia? «]Only in exceptional cases do we operate using general anesthesia. The IV sedations used nowadays make this unnecessary. Even patients who describe being “very nervous” are completely calm and relaxed with sedation.

«I want to have surgery on the bags under my lower eyelids and my surgeon recommends that I have the operation with an incision in the skin. Is this the best option?»]Younger patients or those who have little laxity in the skin do not normally need any incision in the skin, since the bags can be eliminated transconjunctivally. Patients who have greater laxity may require an additional incision in the skin to tighten it. But in any event, the treatment of the bags must be performed transconjunctivally, since this minimizes the risk of retraction.

My cosmetic surgeon gives me botox injections and hyaluronic acid treatments in the face twice a year. Can I still have a blepharoplasty done? «]In the case of fillers, it is best to wait a few months if they have been placed in the grooves under the eyes and you want to have a lower blepharoplasty done. In all other cases, there is no problem.
Botox is not a problem, either.

[toggle_item title=»I had a micropigmentation done on my eyelids years ago and I want to know if I can still have the surgery. «]This is not a problem if you’re going to have blepharoplasty done. The micropigmentation will be not altered by the procedure.

[toggle_item title=»My ophthalmologist has told me that I have eyelid ptosis (drooping eyelids). Can I have surgery for the ptosis and an upper blepharoplasty done at the same time?»]Yes; the surgeries for the upper blepharoplasty surgery and the ptosis correction can be performed in the same procedure and do not require any additional incisions. A lower blepharoplasty can also be done at the same time.

[toggle_item title=»My doctor prescribed children’s aspirin once daily for a vascular condition. He says it is to improve blood flow. Is there any problem with having surgery? «]Many patients who take blood thinners (Aspirin, ASAs, Plavix, Tromalyt, Warfarin and others) must stop taking them prior to having a blepharoplasty done, since they interfere with blood clotting and can cause post-operative bleeding. We will discuss the possibility of stopping this medication with your doctor.
In some patients who have suffered a heart attack or stroke, stopping this medication is not advisable. In these cases, we will assess the possibility of performing the procedure depending on the medication and the particular case.


[toggle_item title=»I had very bad scarring after I had appendicitis and was told that I tend to scar badly. I am afraid that the same thing could happen to me with my eyelids.»]Hypertrophic scarring in the eyelids is extremely rare, even in patients with a history of this. That is because the skin of the eyelid is the thinnest in the body, and so the scarring process is gentler. The skin on the abdomen, back or other parts cannot be compared to the skin of the eyelids.

[toggle_item title=»My surgeon has recommended that I have breast implants and liposuction done in the same surgery as the blepharoplasty. Is this advisable? «]Dr. Nieto is not sure that performing multiple different procedures in the same session is “reasonable.” This entails long-lasting general anesthesia and long recovery periods. It is a significant shock to the body. A decision of this magnitude should not be based on saving money by having everything done “all at once.”

[toggle_item title=»Will my eyes be covered after the surgery? «]No, Dr. Nieto never covers the eyes following the procedure, since he likes you to apply cold to the area in the first few hours.

[toggle_item title=»When can I put makeup on again following a blepharoplasty?»]It depends. In cases of a lower transconjunctival blepharoplasty, in the first week, since there are no incisions in the skin. In cases of an upper or lower blepharoplasty where there are incisions in the skin and sutures, it is best to wait two weeks to apply makeup around the incision.

[toggle_item title=»When can I sunbathe again following a blepharoplasty?»]You must not sunbathe while there is bruising. Afterward, in cases of transconjunctival lower blepharoplasty, you can be exposed to the sun. For upper and lower blepharoplasties where there is an incision in the skin, you can sunbathe using sunscreen one month after the procedure.

[toggle_item title=»Can I shower normally after a blepharoplasty?»]You can shower normally the day after the procedure unless the doctor has instructed otherwise.

[toggle_item title=»When will I be able to wear contact lenses again following the surgery?»]After an upper blepharoplasty, you will probably be able to wear them at the end of the first week. After a lower blepharoplasty, you may have to wait two weeks.

[toggle_item title=»Will I be able to read after a blepharoplasty?»]Most patients have no problem reading beginning the day after the procedure. Your eyes may feel dry during the first days, which can be treated using artificial tears.

[toggle_item title=»When can I return to work after the surgery?»]It mainly depends on your profession. If your job requires significant physical effort, you must rest for one week, whereas if you work from home with a computer, you will probably be able to resume two days after the procedure. The time off from work also depends on whether you interact with the public; if this is not the case, you may return to work during the first week whenever you feel recovered enough. We will always try to make your time of inactivity as short as possible.

[toggle_item title=»Is it true that it is better to have surgery in cold months? Can I have surgery during the summer so that I can recover while I am on vacation?»]As long as the patient is willing to take adequate care of the wounds and to not sunbathe too early, there is no problem.
The incisions from an upper blepharoplasty are hidden and are therefore not directly exposed to the sun, but it is still best to use sunscreen.
For a transconjunctival lower blepharoplasty, since there is no incision in the skin, you must simply avoid sunlight while you have any bruises. For lower blepharoplasties where there is an incision in the skin, they must be protected from the sunlight with high-SPF sunscreen if the surgery is done during the summer months.
Brow lifts are not a problem in this sense, since the incisions are hidden in the scalp.


[toggle_item title=»Can a blepharoplasty induce changes in my visual acuity?»]During a blepharoplasty, the eyeball is protected and is never touched, so no change in visual acuity should appear. It is normal to have slightly blurry vision during the first few days, and this is due to temporary alterations in the tear film.

[toggle_item title=»I had an upper blepharoplasty done years ago and immediately noticed that they hadn’t removed enough skin from the most external part. «]What you probably have is a drooping lateral brow (the brow tail). The “quantity” of skin is not the only factor that determines the look of the upper eyelid. There are other factors, and one of them is the position of the brow. When the brow has sagged, it causes an excess of tissue in the upper eyelid (in addition to the excess skin). When the brow is drooping, an upper blepharoplasty will probably not eliminate 100% of that eyelid “fullness”; there are limits to what can be corrected with this a blepharoplasty.
It is important to conduct a proper examination before the procedure in order to detect this. Many patients who have moderate brow drooping will be completely satisfied with just a blepharoplasty. For others, we will propose an additional brow lift technique.


[toggle_item title=»I had a lower blepharoplasty done and my lower eyelid is lower than before, with a sad look. Is there a solution?»]This is called eyelid retraction. It occurs when, due to the surgery, the tissues scar “abnormally” and that scarring pulls the eyelid down. The risk of retraction increases when the surgery is not performed carefully (greater surgical trauma) and when the blepharoplasty is performed externally rather than transconjunctivally. The risk of retraction from a transconjunctival surgery is very low.
It can also occur with a lower blepharoplasty when too much skin is removed.
In most cases, eyelid retraction can be corrected with revision surgery.


[toggle_item title=»I had a lower blepharoplasty and my eyelid was left looking very sunken; perhaps too much fat was removed. Is there a solution?»]When too much fat is removed from the lower eyelid, the result is a sunken or hollow eyelid that gives the patient a sad and old look.Many patients do not require fat pocket removal but instead a redistribution of that fat, which eliminates the groove under the eyes without the risk of removing too much volume from the eyelid. These techniques are only available to an experienced oculoplastic surgeon.
Most of these types of cases can be improved with revision surgery, or fat or hyaluronic acid infiltration.


[toggle_item title=»I had an upper blepharoplasty done, and ever since then my eyes stay partially open at night and become very irritated. What can I do?»]This is called upper eyelid retraction and is probably due to the removal of too much skin and muscle from the upper eyelid. It is an important problem and the best treatment is prevention by carefully planning the procedure.
The solution to these cases is not easy. If the surgery is recent, it is necessary to wait a few months, since it will improve during the first months. Meanwhile, we must ensure good eye lubrication and massege the eyelid downward to soften the scarring process.
The worst cases may require corrective surgery using a skin graft.


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