Blepharoplasty in Miami: upper and lower eyelid surgery, explained properly

With age the upper eyelid skin stretches and the brow descends slightly; the skin folds over the natural crease, and in advanced cases hangs past the lash line into the field of vision. The medical term for the excess skin is dermatochalasis.

Upper blepharoplasty removes a measured ellipse of that skin, sometimes with a conservative amount of fat, and closes within the natural crease so the scar hides in the fold. It is the more predictable of the two operations, and the improvement shows up early. Two things it is not: not a brow lift (if your brow has dropped, removing lid skin can pull it down further) and not ptosis repair, which needs a different operation.

Ptosis is a drooping lid margin from a stretched or weak levator muscle: a muscle problem, not a skin problem, needing an operation that shortens or reattaches the levator. Skin removal on a ptotic lid leaves the eye still looking half closed. Get it measured before anything is scheduled.

Under eye bags are not usually excess skin. They are orbital fat pushing forward through a weakening orbital septum, with a hollow just below where the tear trough ligament tethers the skin down. Bulge and hollow together create the shadow that reads as exhaustion in photographs.

Older practice removed the bulging fat; modern practice frequently repositions it, releasing the fat and draping it over the orbital rim to fill the tear trough. Removing fat alone flattens the bag but deepens the hollow.

Transconjunctival means the fat is reached through the inside surface of the lid: no external scar, the orbicularis muscle left intact, and lower rates of lid retraction than an external skin incision. When loose skin also needs treatment, a conservative skin pinch or a resurfacing plan can be added.

Canthopexy tightens and supports the outer corner. It is indicated when the lower lid is lax, the canthal tilt is negative, or there is any scleral show, because operating on an unsupported lid is how corners round out and lids retract.

Reasonable candidates are in good general health, have realistic expectations, and have a complaint that maps onto what the surgery actually corrects. Where the answer gets more careful: dry eye disease, previous LASIK, thyroid eye disease, uncontrolled glaucoma, significant lower lid laxity, bleeding disorders, uncontrolled hypertension and active smoking. None of these is automatically disqualifying, but each changes the plan, and dry eye should be evaluated before, not discovered after.

You consult with your surgeon, who measures lid margin position, levator function, brow position, lower lid laxity, tear film status and fat pocket distribution. That exam decides upper, lower, both, ptosis repair, canthopexy, or none of the above. Aliestetic coordinates the pre operative workup, our affiliated surgeon performs the surgery as an outpatient with local anesthesia and sedation or general when combined with other procedures, and then you come back to us for facial recovery care.

1. 01

   Day of surgery

   You go home the same day with someone else driving: cold compresses, head elevated, ointment on the incisions that makes everything blurry.

2. 02

   Days 1 to 3

   Swelling peaks. Bruising darkens and spreads downward with gravity, so lower lid bruising can travel toward the cheek. Expect grittiness and dryness, and use the lubricating drops you were given.

3. 03

   Days 4 to 7

   Bruising turns yellow, and upper lid sutures typically come out around day five to seven.

4. 04

   Week 2

   Most people are back at work and covering residual bruising with makeup once the surgeon clears it. Strenuous exercise and bending still restricted.

5. 05

   Weeks 3 to 6

   Incision lines go through a pink phase before fading; real sunglasses and sunscreen at the lid margin matter, because fresh scars pigment easily.

6. 06

   Months 2 to 3

   The lower lid contour finishes refining as residual edema resolves. Morning puffiness that lingers for weeks is normal.

Every surgery carries risk: dry eye, often temporary but sometimes prolonged; lower lid malposition, from retraction to ectropion in significant cases; over resection of skin causing incomplete closure; over resection of fat causing a hollow look; asymmetry; visible scarring; bleeding, hematoma, infection; temporary blurred or double vision; persistent swelling. Rarely, retrobulbar hemorrhage, a surgical emergency that threatens vision: severe pain with sudden vision change is an immediate call, not a next morning question.

Revision is possible in either direction, and correcting an over resected lower lid is harder than doing the original operation conservatively.

Verify the license through the Florida Department of Health’s free public lookup, and confirm board certification with the American Board of Plastic Surgery; board certified plastic surgeon and the self applied label cosmetic surgeon are not the same credential. Then ask: did you measure my levator function and lid laxity, and what did you find? Are you removing fat or repositioning it? Do I need a canthopexy, and if not, why not? Can I see twelve week photos of patients with lid laxity like mine?

Aliestetic coordinates, our affiliated surgeon operates, and the recovery happens with us in Miami. For eyelids that recovery is deliberately facial in scope: swelling and bruising monitoring, incision checks, lubrication and sun protection coaching, and a scheduled visit cadence through the weeks when the lower lid contour is still moving.

The value of that structure is boring and real: you look at your own face every morning and see nothing change, but someone examining the same eyelids on a schedule notices asymmetry or an early sign of dryness while there is still time to act on it.