Eyelid surgery (blepharoplasty) may be considered even in younger patients when structural or hereditary factors are present, or later in life when aging and lifestyle-related changes affect the eyelids and surrounding tissues. These changes may include excess or lax skin of the upper and lower eyelids, under-eye bags, protruding fat pads, increased fine lines, downward changes around the outer eye area, and dark circles or shadowing. Together, these features can contribute to a tired or aged appearance.
In some patients, significant upper eyelid skin excess may also reduce the superior visual field. Marked lower eyelid laxity can contribute to eyelid malposition, including ectropion, in which the lower eyelid turns outward. This may affect both appearance and ocular comfort, potentially causing irritation, redness, or exposure-related symptoms.
The surgical approach depends on the patient’s anatomy and the underlying problem. Upper eyelid surgery may involve carefully removing or repositioning excess skin and, when appropriate, adjusting fat. Lower eyelid surgery may be performed through an incision inside the eyelid or, when skin treatment or additional support is required, through an external incision close to the lash line. The objective is not simply to remove tissue, but to preserve eyelid function while creating a more balanced and rested appearance.
The goal of eyelid and brow surgery is not simply to remove excess skin.
Upper eyelid skin excess, fat distribution, brow position, lower eyelid bags and laxity, the tear trough, and the support of the surrounding tissues may all need to be evaluated together.
In some patients, the main concern is located within the upper eyelid itself. In others, descent of the brow may create the appearance of excess upper eyelid skin.
The goal is to reduce heaviness and a tired appearance around the eyes while preserving the patient’s natural eye anatomy and expression.
Patients with noticeable upper eyelid skin excess, a sensation of heaviness around the eyes, a tired appearance, lower eyelid bags, or descent of the brow and temporal region may be evaluated for surgery.
Suitability is not determined by age alone.
Genetic characteristics may cause eyelid changes to appear at a younger age in some individuals, while others may experience relatively limited changes until later in life.
General health, eye health, the underlying anatomical concern, and the patient’s expectations are all considered together.
Not every tired-looking eye requires blepharoplasty.
If the appearance is primarily related to brow descent, volume loss, pigmentation, skin quality, or anatomical hollows beneath the eyes, eyelid surgery alone may not provide the desired result.
Dry eye, certain ophthalmological conditions, uncontrolled systemic diseases, or conditions that may interfere with wound healing require additional consideration during surgical planning.
Expectations of completely changing the natural shape of the eyes or creating perfect symmetry may also fall outside the realistic limitations of surgery.
During an eyelid consultation, I do not evaluate the eyes in isolation.
Upper eyelid skin, brow height and shape, the relationship between the eyelid and eyelashes, lower eyelid support, fat compartments, the tear trough, cheekbones, and midface support are evaluated together.
Natural asymmetries between the right and left eyes are also identified before surgery.
Previous eyelid or facial surgery, botulinum toxin and filler treatments, as well as a history of dry eye or other eye-related problems, are also important.
The goal is to determine whether the concern originates from the eyelid itself or from the surrounding structures.
Removing a standard amount of skin or fat from every patient is not an appropriate approach.
In upper eyelid surgery, excess skin and, when necessary, fat may be adjusted according to the patient’s individual anatomy. Avoiding excessive tissue removal and preserving the natural function of the eyelid are important considerations.
In suitable patients, lower eyelid surgery may be performed using a transconjunctival approach, with the incision placed on the inner surface of the eyelid. This may avoid the need for an external skin incision.
In other patients, excess skin or concerns involving lower eyelid support may require a different or additional surgical approach.
When volume deficiency is present beneath the eyes, fat repositioning or fat transfer may be considered.
If descent of the brow or temporal region contributes to the appearance around the eyes, procedures such as a brow lift or temporal lift may also be included in the treatment plan.
My fundamental approach is not to remove as much tissue as possible, but to identify the correct anatomical problem and treat it appropriately.
Depending on the extent of the procedure, local anesthesia, sedation, or general anesthesia may be considered.
A limited upper eyelid procedure and a combined operation involving the upper and lower eyelids, brow, or temporal region may require different anesthesia and surgical plans.
Procedures are performed in an appropriate clinical or operating-room setting, and the type of anesthesia is determined according to the patient and the characteristics of the planned surgery.
Swelling and bruising around the eyes can be expected during the first few days after surgery.
The degree of swelling and bruising varies according to the procedure performed and individual healing characteristics and generally decreases over time.
Many patients can return to social activities after the initial recovery period; however, complete resolution of swelling and the return of the tissues to a more natural appearance may take longer.
Recovery may also differ when multiple procedures are combined.
The timing of returning to contact lenses, makeup, exercise, and strenuous physical activity should be determined according to the procedure performed and the progress of healing.
In upper eyelid surgery, the incision is placed as closely as possible within the natural eyelid crease.
When a transconjunctival approach is used for the lower eyelid, the incision is located on the inner surface of the eyelid. In some patients who also require treatment of excess skin, an external incision close to the lash line may be necessary.
In brow or temporal surgery, incision locations vary depending on the technique used.
Temporary numbness, tightness, altered sensations around the eyes, or temporary dryness may occur after surgery.
Scar maturation and the resolution of sensory changes may take time.
Like other surgical procedures, eyelid and brow surgery carries risks.
Possible complications include bleeding, infection, swelling, wound-healing problems, noticeable scarring, dry eye symptoms, asymmetry, unwanted changes in eyelid position, or the need for additional surgery.
Lower eyelid malposition, including retraction or outward turning of the eyelid, may also occur.
Serious vision-related complications are very rare, but they are possible and are among the important risks associated with surgery around the eyes.
Patient-specific risks are discussed in detail during the preoperative examination and consultation.
The right and left sides of the human face are naturally not identical. Differences in eye size, brow height, and eyelid opening may already be present before surgery.
The goal of surgery is not to eliminate every millimetric difference or create mathematically perfect symmetry.
Eyelid surgery also does not stop the natural aging process.
The objective is to reduce significant concerns and improve the overall balance of the eyes within the face.
During postoperative follow-up appointments, the incision sites, swelling, eyelid position, and overall healing process are evaluated.
The timing of suture removal may vary depending on the surgical technique used.
Early swelling and asymmetry should not be considered the final result. As the tissues settle, the outcome gradually becomes clearer.
Long-term follow-up can be particularly useful for accurately evaluating the result after combined eyelid and brow procedures.
Will blepharoplasty change the shape of my eyes?
The primary goal is not to change the natural shape of the eyes, but to address excess skin, under-eye bags, or other age-related and anatomical concerns while preserving the patient’s natural anatomy. However, as with any surgical procedure, the appearance of the eyelids will change, and the result depends on individual anatomy and healing.
Do I need upper eyelid surgery or a brow lift?
Distinguishing between these two concerns is one of the most important parts of the examination. If brow descent contributes to upper eyelid heaviness, removing eyelid skin alone may not be sufficient. Some patients may benefit from blepharoplasty, others from brow surgery, and in selected cases a combination may be considered.
Can lower eyelid surgery be performed without a visible external scar?
In suitable patients, a transconjunctival approach allows the incision to be made on the inner surface of the lower eyelid. However, this technique is not appropriate for every patient.
Are under-eye bags completely removed during surgery?
Complete removal of fat is not the goal in every patient. In some cases, reducing the fat may be appropriate, while in others repositioning it may provide a more balanced transition. The objective is to avoid creating a hollow or excessively depleted appearance beneath the eyes.
Can under-eye hollows be treated during the same surgery?
In suitable patients, techniques such as fat repositioning or fat transfer may be considered. The appropriate approach depends on the anatomy of the lower eyelid and midface.
Can Botox replace a brow lift or blepharoplasty?
Botulinum toxin may create a limited change in brow position in selected patients, but it does not correct significant skin excess or anatomical descent in the same way as surgery. The two approaches serve different purposes.
Will my eyes look overly pulled or surprised after surgery?
Surgical planning aims to preserve the patient’s natural eye shape and expression. During the early recovery period, swelling may temporarily make the eye area appear different.
Are the results permanent?
The tissues corrected during surgery may show long-term improvement, but surgery does not stop aging. The brows, eyelids, and surrounding tissues continue to change naturally over the years.
A consultation with Dr. Atilla Fesli can be arranged in Antalya or Doha for evaluation of eyelid and brow surgery.
The purpose of the consultation is not simply to decide “how much skin should be removed.”
The upper and lower eyelids, brow position, temporal region, tear trough, and, when appropriate, the midface are evaluated together to identify the underlying cause of the concern and discuss individualized treatment options.
Around the eyes, even a few millimeters can influence facial expression.
For this reason, the goal is not to remove more skin or fat, but to make the appropriate change in the appropriate tissue while creating a more rested appearance and preserving the patient’s natural gaze and facial identity.
Dr. Atilla Fesli
Natural. Balanced. Still You.
Op. Dr. Atilla Fesli
Doha, Qatar
Plastic and Aesthetic Surgery in Doha, Qatar
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