Blepharoplasty

Eyelid Rejuvenation (Blepharoplasty) in San Antonio at the Texas Center for Facial Plastic and Laser Surgery

What are your tired eyes trying to tell you? If you haven’t caught enough ZZZs lately, an exhausted appearance may be a sign that you need more sleep. However, if you are sleeping and breathing well, yet still look tired, you may be a good candidate for a specialized type of eyelid surgery called blepharoplasty. Refresh your tired-looking eyes with Dr. Jose Barrera, a board-certified facial plastic and reconstructive surgeon.

Dr. Barrera is one of the top surgeons in blepharoplasty in the San Antonio area. He has published more than 70 articles relating to his medical specialties of plastic surgery, sleep medicine, and head and neck surgery.

Management of the lower lid is a particular specialty of Dr. Barrera. He has published his work on rejuvenation of the lower eyelid blepharoplasty in men in Facial Plastic Surgery Clinics of North America. 

A thorough evaluation of the lower eyelid and tear trough is critical in the workup of the eyelid patient. An expert in eyelid procedures, Dr. Barrera can evaluate and treat patients with transconjunctival skin muscle flap and eyelid skin abnormalities and address displaced orbital fat and excessive skin of the upper and lower eyelids.

Your eyes are unique and you probably and have specific questions about your aesthetic goals. Get your questions answered when you call us at 210-468-5426.  A consultation at the Texas Center for Facial Plastic and Laser Surgery gives Dr. Barrera the best chance to evaluate your eyes and make the most personalized recommendations.

Understanding Blepharoplasty

Blepharoplasty, also called an eyelid lift, is a cosmetic surgery that improves the appearance of the upper or lower eyelids. It can remove excess skin, fat bags under the eyes, pouches, drooping eyelids, and wrinkles around the eyes. Loose and sagging skin around the eye can leave a patient appearing tired or angry. An eyelid lift restores a rested and relaxed facial appearance.

In 2018, more than 200,000 men and women in the U.S. underwent this procedure. Blepharoplasty can enhance the upper eyelid, the lower eyelid, or most commonly, both eyelids together. Eyelid surgery offers long-lasting results.

Transconjunctival blepharoplasty avoids a skin incision by hiding the scar in the conjunctiva of the lower eyelid. Transconjunctival blepharoplasty may be a benefit for patient’s with excessive eyelid bags.

Dr. Barrera often pairs an eyelid lift with facelift or brow lift. An expert at brow lift surgery, Dr. Barrera offers hairline browlift, endoscopic browlift, lateral browlift, and male browlifts for heavy brows.

Many patients experience vision obstruction due to loosening skin that hangs over the eye. An eyelid lift removes this drooping skin, restoring a full field of vision. A browlift may be necessary to complement blepharoplasty surgery.

If you’re considering this procedure, we encourage you to call our office and schedule a consultation to learn more about your options for facial rejuvenation.

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Your Eyelid Lift Consultation

Like all our plastic surgery procedures, eyelid surgery begins with a consultation. Schedule yours by calling Texas Center for Facial Plastic and Laser Surgery at 210-468-5426 or filling out our online form.

Our consultations are a collaborative experience. Patients partner with Dr. Barrera to create a plan for facial rejuvenation. Come ready to learn, and if you are compiling questions, write them down and bring the list. We look forward to meeting with you and helping you discover the path to a younger, revitalized eye appearance.

  • Safety is our priority. We’ll review your medical history to ensure you’re a good candidate for this procedure. If you have glaucoma or dry eyes, Dr. Barrera may need further information from your ophthalmologist before clearing you for surgery.
  • Some patients benefit from additional procedures. Dr. Barrera may recommend other facial cosmetic treatments, like brow lift surgery or laser rejuvenation, to enhance your results. Depending on your needs, Dr. Barrera may recommend laser eyelid surgery, a minimally invasive treatment that offers quicker healing. CO2 laser resurfacing complements an eyelid lift by removing stubborn eyelid wrinkles and creasing.
  • We know cost is important to you. You’ll sit down with one of our patient care coordinators to discuss cost, payment, and financing options. Our estimates are clear and comprehensive, ensuring no unexpected costs when it comes time to pay for surgery.
  • Preparation sets the stage for a successful procedure. You’ll get the information you need to schedule time off from work and arrange for help during the recovery process.
  • Meet the team. Dr. Barrera believes in a team-focused approach to treatment. In addition to receiving expert care from our board-certified and dual fellowship trained facial plastic surgeon, you’ll also work with our dedicated physician assistants and associate surgeons. Using a team gives our patients better access to the care they need when they need it. You’ll meet key members of our team during your consultation with us.
  • Information is power. We don’t sugarcoat the surgical or recovery process. Learn about the risks and benefits of eyelid surgery so you can make an informed choice about your care.

Give us a call and schedule your visit Texas Center for Facial Plastic and Laser Surgery.

What Happens During an Eyelid Rejuvenation Surgery?

Eyelid surgery can be performed on the upper eyelids, the lower eyelids, or both eyelids together. The specifics of your procedure will depend on your needs. We can provide more detailed and personalized information about your surgery during your consultation.

Eyelid surgery incisions are well-hidden. Upper eyelid incisions are typically placed in the natural crease of the eyelid. When your eyes are open, the incision isn’t visible at all. Lower blepharoplasty incisions are placed along the lash line where they are easily hidden by the eyelashes.

Dr. Barrera will use the incisions to tighten tissues, remove skin, and reposition fat deposits, as needed. The incisions are closed with sutures

Eyelid surgery is often paired with laser treatments, to improve skin quality and discoloration, and brow surgery, to enhance the appearance of the eyebrow area. If these complementary procedures are happening on the same day, we’ll perform additional procedures before you move into recovery.

After surgery, patients spend some time in our recovery suite. You’ll be carefully monitored by an experienced surgical nurse and your every need attended to until you’re ready to return home, usually a couple of hours after surgery.

Recovery After Cosmetic Eyelid Surgery

Plan on experiencing some bruising, swelling, and tenderness after eyelid surgery. Elevating the head and using cold compresses can reduce the amount of swelling and bruising experienced. We provide a prescription for pain medication to reduce discomfort.

Get back on your feet faster! Adding Arnica with Bromelain can enhance recovery and minimize bruising. Arnica and Bromelain is a natural biotanical combination that is well suited for minimally invasive cosmetic procedures such as eyelift surgery and browlift. Arnica Montana reduces bruising, swelling, and pain associated with soft tissue haling. Sublingual tablets dissolve rapidly without leaving a chalky taste. Make sure to pick up Arnica and bromelain at Rejuve MD MedSpa, our personalized Surgical MedSpa.

During recovery, we ask patients to rest as much as possible. Rest helps the body to heal. Do not use contact lenses or eye makeup until you’re cleared by Dr. Barrera.

Dry eye symptoms are a common issue for patients after eyelid surgery. Make sure to use over the counter eye lubricants to keep moisture in the eye. In addition, Dr. Barrera may prescribe additional ointment for your eyes and eyelid skin incisions.

Most of our patients take about a week off from work. Avoid strenuous exercise for at least three weeks.

If you have questions or concerns, let us know. Our team is ready to support you throughout the blepharoplasty recovery process. You’ll meet with us several times during recovery, so we can check in on your progress, and see your beautiful new look as you heal.

Barrera-Blepharoplasty-Before-After-San-Antonio
Barrera-Blepharoplasty-Before-After2-San-Antonio

Laser Eyelid Surgery: An Alternate Option

During your consultation Dr. Barrera will perform a detailed assessment and review your aesthetic goals for eyelid rejuvenation. Based on his evaluation, Dr. Barrera may recommend laser eyelid surgery. During laser eyelid surgery, the incision is made with a CO2 fractional laser rather than a scalpel, facilitating a faster and more comfortable recovery. Dr. Barrera is experienced with using the Lumenis Laser system which includes the AcuPulse™ and UltraPulse™ as well as the Syneron Candela CO2RE laser. Laser eyelid resurfacing is often performed during laser blepharoplasty to complement the results.

Eyelid Surgery FAQ

Eyelid surgery addresses concerns with the eyelid crease. The Non-Asian eyelid crease is formed by the levator muscle attachment to the skin. The Asian eyelid has a septum of orbital fat that fuses with the levator muscle, preventing an attachment to the skin. Orbital fat then occupies the space, which appears as a fuller eyelid.

In addition, eyelid surgery can treat excess fat in the upper eyelid medial compartment and the lower eyelid fat compartments, which are medial, central, and lateral. Over time in the lower eyelid, Lockwood’s suspensory ligament weakens, allowing pseudoherniation of fat and baggy eyes.

Aging effects on the eyelid and cheek occur as the orbicularis retaining ligament weakens, allowing the SOOF fat to droop. This is a common cause of tear trough deformity.

Upper eyelid incisions are made 8–10 mm above the lid margin. Ethnic eyelid creases are often 6 mm from the lid margin.

The lower eyelid incisions can be made as a transcutaneous skin only flap, transcutaneous skin muscle flap, or transconjunctival approach. The transcutaneous incision can be pinch excised or made 3 – 4 mm below the lash line. The transconjunctival approach is preferred by Dr. Barrera because it does not leave a visible scar. There is also less risk of ectropion or everting of the lower eyelid with this method, and it’s ideal for most patients with smooth skin and moderate fat pseudoherniation. The incision is made through the conjunctiva, and the orbital fat is removed. Dr. Barrera prefers to use CO2 laser skin resurfacing, a pinch technique to remove 2 – 3 mm of truly redundant skin, or a chemical peel to treat remaining dermatochalasis and superficial wrinkles.

PATIENT INSTRUCTIONS FOLLOWING BROWLIFT OR BLEPHAROPLASTY

  • Sleep on your back or side with your head elevated on two to three pillows.
  • Pain should be mild to moderate and resolves over the next 3-4 days. Use the pain medication given and slowly wean off of them as your pain lightens.
  • You MAY have a compression dressing for 48 hours after surgery if you had a browlift. After 48 hours, all dressing around your head can be removed, and you can start to put bacitracin on your scalp incisions. The sutures/staples will be removed at your 1 week post-operative appointment.
  • Use cold compresses (crushed ice in a glove or bag of frozen peas/corn) over your eyes for 20-30 minutes per hour for the first 48 hours. This will minimize the swelling and bruising.
  • Do not take aspirin or aspirin-containing pain medications. TYLENOL, DARVOCET N- 100 or other mild pain relievers prescribed are safe, if needed.
  • Your eyes may become fatigued after prolonged reading or watching television. We recommend that you limit periods of use to one hour or less for the first 2-3 days after surgery.
  • Apply the ointment provided to the incision twice a day. Use sparingly, placing only a tiny amount on the incision lines. As the ointment warms up to body temperature, it will thin. Only use the Ophthalmic ointment that has been given to you. If you have crusting, you may need to use a small amount of hydrogen peroxide on a cotton tip applicator and gently remove the crusting. If you have been prescribed eye drops, use them as directed to keep your eyes moist. It is normal to have a small gap between the upper and lower eyelids after surgery for a short time.
  • Do not use contact lenses for at least two weeks. Pulling on the eyelids while inserting or removing lenses may interfere with precise incision healing. Glasses may be used at any time.
  • Do not use mascara, eye liner, or eye shadow until approved by us (usually 10-14 days). Minimal makeup applied to any bruising of the lower lid is acceptable at any time, but do not pull on the lids or incisions.
  • Any apparent redness of the eyeball whites is only a form of bruising and will subside during the early healing process. 

Eyelid surgery recovery may take 7 – 14 days. There are precautions that the eyelid patient should consider:

  • Do not engage in vigorous exercise or sports for at least 2-3 weeks or until approved by your doctor.
  • You may bathe or shower the day after surgery, but do not get your eyes wet.
  • If you experience oozing or bleeding along the suture line, do not rub the area. Apply gentle pressure and blot the eye with a sterile gauze, holding slight pressure in this area. Remove the compress and then apply ice. This will usually stop any leakage, but if it is excessive, please notify the doctor.
  • Stitches are removed at different times after surgery, depending upon the extent of surgery carried out, type of stitches, and the type and quality of your skin. We will advise you accordingly.
  • It is not uncommon to feel slight itching and tightness of the eyelids during the early healing period.
  • If your temperature after the operation or before each dose of pain medicine is above 101.5, notify the ENT doctor or nurse.
  • Reasons to go to the Emergency room:
    • Sharp or dull pain which persists around the eyes
    • Sudden swelling around the eyes 
    • Decrease of vision
    • Swelling or increased warmth of the forehead
  • Call the Texas Center at 210-468-5426 if you have questions during duty hours.

Relative contraindications to blepharoplasty include actinic changes, acne rosacea, keloids, herpes zoster, thyroid abnormalities, autoimmune problems, smoking, and a history of dry eyes. Dr. Barrera can work with your eye doctor to overcome some of these limitations.

Dr. Barrera works with patients to decide the best treatment plan to rejuvenate the eyes and forehead. Discussion about the forehead’s position, incision placement, and adjunctive treatment, including chemical peels and laser resurfacing, is welcomed during the consultation.

Our goal is to improve eyelid position after a blepharoplasty. Factors affecting post blepharoplasty eyelid malposition include hypotonicity, malar hypoplasia, shallow orbits, thyroid ophthalmopathy, unilateral myopia, previous eyelid surgery, and actinic changes of the eyelid have to be considered.

The uniqueness of the eyelid crease is discussed during our consultation with Dr. Barrera. If a skin crease is missing due to lack of the dermal attachment of the levator aponeurosis or fullness due to fat herniation, then creating the supratarsal crease and debulking the eyelid fullness is addressed to allow for a sharpened upper eyelid crease.

If a patient presents with blepharoptosis due to congenital, myogenic, or aponeurotic ptosis with levator function of 4 mm or more, then a repair of the levator muscle to the tarsus can be performed.

Eyelid surgery can correct excessive skin (dermatochalasis), hooding of the eyelids, pseudoherniation of the fat pads, and a hallowed appearance from oversculpting. The results of eyelid surgery are long-lasting. Of course, aging over time can cause further signs and weakness of the eyelids.

Eyelid Lift Surgery requires an incision in the upper eyelid along a natural crease. Upper eyelid incisions are made 8 – 10 mm above the lid margin. Ethnic eyelid creases are often 6 mm from the lid margin.

The lower eyelid incisions can be made as a through the skin, also called a transcutaneous skin only flap, or transcutaneous skin muscle flap, or transconjunctival approach. The transcutaneous incision can be pinch excised or made 3 – 4 mm below the lash line. The transconjunctival approach is preferred by Dr. Barrera because it does not leave a visible scar. There is also less risk of ectropion or everting of the lower eyelid. It’s ideal for most patients with smooth skin and moderate fat pseudoherniation. The incision is made through the conjunctiva, and the orbital fat is removed.

Eye and forehead lifting is performed by cutting across the skin above the brow, resulting in a long scar within the brow hairline, along a forehead furrow, or behind the hairline to camouflage the scar. Another effective method requires an incision site and scar across the scalp from ear to ear. Such incisions can still be useful in some situations, but we are able to offer many patients an endo-brow lift, which is far less invasive eyebrow and forehead lift. With this procedure, Dr. Jose Barrera will use a small camera and specialized instruments to make tiny incisions behind the hairline to carefully lift the brow.

For most patients, recovery time is brief, and bruising is minimal.

Other procedures may be performed with an endo-brow lift, including laser resurfacing for facial wrinkles and skin tightening, eyelid lift, facelift, facial fat transfer, and rhinoplasty.

The conventional technique utilizes skin removal using a scalpel. The laser technique employs the CO2 laser to remove the skin.

Laser resurfacing using Dr. Barrera’s advanced skin resurfacing technology offers numerous advantages over conventional techniques, including:

  • Extremely precise control and advanced capabilities
    • Lower risk of unpleasant recovery issues
    • Typical recovery time after only 4-7 days
    • Convenient facilities in our outpatient surgery center
    • Integration of multiple procedures as part of a personalized facial surgery plan

Your doctor will tailor his approach to give you the most extraordinary results for you.

Possible risks of laser surgery include crusting, pain, swelling, redness, bruising, scarring, blistering, hypopigmentation, hyperpigmentation, mottling of skin vascularity or purpura, and unforeseen complications. Eye injury is possible but unlikely. Eye protection measures will be properly used throughout laser treatment sessions. 

Pain is minimal with the laser. Postoperative skincare is essential to good healing.

Most patients have minimal pain in the recovery period. Antibiotic eye drops or cream is prescribed. Swelling is common during the first week.

Eyelid surgery takes 1-2 hours to perform. More involved transposition or fat mobilization techniques take longer.

Eyelid surgery begins with a preoperative assessment of the eyelid crease. Pseudoherniation of the fat are identified. The operation can be performed under sedation or awake. After surgery, the patient recovers in the office for 30 minutes then is allowed to go home. The entire process takes 1 – 4 hours, depending on the surgical procedure performed.

A driver is recommended after eyelid surgery.

It takes 1-2 weeks to look normal after eyelid surgery.

Swelling and bruising can occur. Dr. Barrera recommends taking arnica and bromelin preoperatively to help with swelling bruising.

Eyelid surgery can affect dry eyes. Conservative treatment of the eyelid skin is recommended. It can take 2 – 5 months for the dry eye feeling to improve. Lacrimal plugs may be considerd in patients with dry eyes.

The purpose of blepharoplasty is to improve vision and the youthful appearance of the eyelids.

Cosmetic eyelid surgery is very successful for patients seeing experienced surgeons. As a facial plastic surgeon, Dr. Barrera has performed hundreds of eyelid surgeries and brow lifts. He is a top eyelid surgeon as rated by Realself.com.

Eyelid surgery, in combination with neurotoxins like Botox or Dysport, can improve crow’s feet wrinkles. Other treatments performed in combination, like brow lifts, can elevate droopy eyebrows. Dark circles are often caused by thin skin and hypertrophic orbicularis muscles. Fat transposition and mobilization can improve the dark circles of the lower eyelids.

Fat transposition and mobilization is the latest innovation for improving the darkness circle of the lower eyelids. Filling the tear trough area with natural orbital fat is successful in rejuvenating lower eyelids.

Patients seeking eyelid surgery often have visible signs of aging before needing a facelift. As the main muscle for eyelid closure, the orbicularis determines much of these aging effects. If the retaining ligament sags, then tear troughs develop. Dr. Barrera will address the tear troughs with eyelid fillers like Restylane. Patients wanting a more permanent correction can benefit from a repositioning of the orbital fat into the hollow areas of the cheek. Fat mobilization of the lower eyelids can also be done to treat deep tear troughs or prominent nasojugular grooves.

Patients must wait 6 – 12 months after a PRK or LASIK procedure to receive eyelid surgery.

There is no age limit to undergo eyelid surgery.

Eyelid surgery may be necessary when ectropion or entropion malposition of the eyelid occurs. Eyelid retraction and canthal tendon laxity can cause these problems. In addition, peripheral field testing for patients with visual field problems is necessary to determine if a medically necessary problem exists.

Scars are hidden in the eyelid crease and the conjunctiva in most patients seeking eyelid surgery with Dr. Barrera.

Eyelid surgery is a relatively safe procedure with minimal complications.

Complications are rare with eyelid surgery but can include hematoma from retraction of a vessel after eyelid surgery. Hematomas should be treated urgently. Other complications include lagophthalmos due to over-resection of eyelid skin. Treatment with massage can improve lagophthalmos or a skin graft.

Other side effects include eyelid skin webbing, conjunctivitis, chemosis, a hallowed appearance, double vision, infections, suture granuloma, excessive tearing, lateral canthal rounding, and eyelid malposition.

Patients can return to work after sutures are removed and eyelid swelling has improved to allow good vision after eyelid surgery.

Do not engage in vigorous exercise or sports for at least 2-3 weeks or until approved by your doctor.

Normal activities can return once approved by your doctor.

You may bathe or shower the day after surgery, but do not get your eyes wet.

Do not use contact lenses for at least two weeks. Pulling on the eyelids while inserting or removing lenses may interfere with precise incision healing. Glasses may be used at any time.

A single procedure may likely fail to completely remove all my excess skin hooding or textural problems in the area treated. Individual responses will vary according to skin types, hair color, degree of tanning, follow-up care, and treated body area. Touch-ups may be necessary due to aging effects. A combination of brow and eyelid lifting and skin treatments with chemical peels and laser resurfacing may be necessary.

Book an appointment with Dr. Barrera by calling the Texas Center for Facial Plastic and Laser Surgery at 210-468-5426

Informed consent implies disclosing the necessary information provided to the patient, the patient’s ability to assess the information provided, and voluntary consent to make a decision free from coercion, manipulation, or other outside force.

There are no dietary restrictions before or after surgery. A healthy, well-balanced diet is recommended.

Antibiotic drops or ointment may be prescribed. Apply the ointment provided to the incision twice a day. Use sparingly, placing only a tiny amount on the incision lines. As the ointment warms up to body temperature, it will thin. Only use the Ophthalmic ointment that has been given to you. If you have crusting, you may need to use a small amount of hydrogen peroxide on a cotton tip applicator and gently remove the crusting. If you have been prescribed eye drops, use them as directed to keep your eyes moist. It is normal to have a small gap between the upper and lower eyelids after surgery for a short time.

Dr. Jose Barrera, Blepharoplasty Expert in San Antonio, Texas

Eyelid surgery is a delicate procedure, requiring a skilled plastic surgeon for the youthful and natural-looking results you desire. Dr. Barrera is a skilled plastic surgeon with the exacting qualifications needed for a successful eyelid lift, having performed this procedure on countless men and women in the San Antonio area. A former Chief of Facial Plastic and Reconstructive Surgery at the San Antonio Military Medical Center, Dr. Barrera has earned board certification with the American Boards of Otolaryngology and Facial Plastic and Reconstructive Surgery. As a facial plastic surgeon and an expert in cosmetic eyelid surgery, Dr. Barrera was named top doctor in eyelid surgery by RealSelf.com, the premier resource for learning about cosmetic surgery online. 

Come into Texas Center for Facial Plastic and Laser Surgery for a consultation with Dr. Barrera. You can schedule your one-on-one visit to our practice by calling us at 210-468-5426. Come explore this procedure, learn about your options, and prepare for a freshly rejuvenated face.